Purpose: This study aims to provide level I meta-analysis to compare the clinical, radiological and survivorship of all-polyethylene and metal-backed tibias of total knee arthroplasties.
Methods: Literature review according to PRISMA guidelines was performed. Detailed search of English literature using PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases. Randomized control trials were only included in the analysis . Analysis of different variables like range of motion, Knee Society Score, Stairs Climbing Scores, Radiostereographic analysis (RSA), survivorship and complication rate was performed.
Results: Thirteen randomized trials, with 1367 patients, were included in our analysis. Of these, 686 patients had all-polyethylene tibias of their total knee arthroplasties. while the other 681 had metal-backed tibial design . There were no statistically significant differences between both knee designs in terms of range of motion and knee society (Functional and clinical) scores. While 10 years survivorship with revision as endpoint was comparable between the two designs, 5 years survivorship was significantly lower in the metal-backed design. Likewise, the complication events were fewer, and the stairs climbing score was better in all-polyethylene tibias, however, only the later was statistically significant. Moreover, RSA documentation of maximal implant subsidence was significantly higher in metal-backed tibias.
Conclusions: We found that both all-polyethylene and metal-backed tibial trays of total knee arthroplasty incorporate similar surface design concepts with almost equivalent clinical, functional and long-term survivorship (10 years). However, short-term survivorship (5 years), stairs climbing scores and maximal implant subsidence results were significantly better in all-polyethylene tibias.

ntroduction: Management of Prosthetic joint infections (PJI) is challenging especially when associated with massive bone loss. The aim of this study was to prospectively assess results of single stage revision TKA for (PJI) employing Tantalum (TA) cones to overcome bone loss in comparison to a similar group who were revised for aseptic loosening. Methods: 15 patients with PJI and no draining sinus received single stage revision (2 in 1 technique) Total Knee Arthroplasty (TKA). The infecting organisms were identified preoperatively by aspiration and extended cultures and sensitivity test. The Bone defects were grades IIB and III according to Anderson’s classification. Tantalum cones were used to reconstruct tibial and femoral defects or both before inserting cemented revision implants. A comparable group of 14 patients who received the same procedure for aseptic loosening were evaluated and analyzed to present a control group. Results: At a mean follow up 3 years (range 2 to 7) all knees were free of infection. Significant improvement in all parameters of the knee society score KSS and WOMAC score observed from pre to latest follow up (P<0.05). No difference in outcome was observed between the study group of single stage revision for PJI and the control group of revision for aseptic loosening. Conclusion: Single stage revision can safely be performed even in presence of bone defects in specially selected group of patients when organism has been identified pre operatively

Background: Good functional outcome is the aim of every joint replacement procedure. It would be ideal to know if the functional outcome of the surgery can be predicted during the early follow-up period. Objectives: To assess early functional activity levels in patients undergoing knee arthroplasty using Time Up & Go (TUG) score and Iowa Level of Assistance Scale(ILAS) score and to estimate the correlation of TUG and ILAS scores with long-term Patients' Reported Outcome Measures (PROMs). Methods: Patients undergoing primary TKAs were evaluated preoperatively and till 6 months postoperatively for the study. TUG & ILAS scores were assessed pre-operatively and post-operatively on day 2, week 2, and week 6, while KOOS and WOMAC scores were assessed pre-operatively and post-operatively at 6 months. Results: A total of 140 patients were included in the study. There was a significant correlation between the activity scores (TUG, ILAS) and Outcome measures (KOOS and WOMAC scores) at all evaluation points ( p<0.05). The strength of the association increased as the follow-up period increased, with TUG scores at 6 weeks strongly correlating with KOOS (r=.56) and moderately with WOMAC(r=o.46). A similar pattern was seen with ILAS scores correlating with KOOS (r= .45) and WOMAC(r=0.33) Conclusion: TUG & ILAS scores could be used as early predictors of long-term functional outcomes and have significant correlation with PROMs like WOMAC and KOOS. A wider implication of the study is that low early activity scores could alert clinicians to focus more on this subset of patients to improve long-term outcomes.

Introduction: Total knee arthroplasty (TKA) is widely known for its outstanding clinical outcomes and long-term survival rates for the surgical treatment of osteoarthritis changes in the knee joint. While performing a TKA, due to its proximity to the articular space during bone cuts, the integrity of the popliteus tendon may be compromised. We conducted a meta-analysis of articles published to understand the role of the popliteus tendon in TKA.
Methods: We performed this study following both preferred reporting items for systematic reviews and meta-analysis statement (PRISMA) and the Cochrane handbook for systematic reviews and meta-analysis. Our literature search strategy included Pub Med (MEDLINE), Google Scholar, and Cochrane for peer-reviewed full-length articles on popliteus tendon in TKA and the following keywords were used: TKA, popliteus tendon, Complications following TKA, Soft tissue balancing.
Results: A total of 13 studies, with 1497 Knees, were included in this meta-analysis. After carefully reviewing these articles, we found that isolated popliteal tendon injury does contribute significantly to static knee stability following TKA, and injury causes an increase in external rotation as well as varus angulation and anterior translation. Thus, there may be a functional loss associated with intra-operative injury to the popliteus tendon.
Conclusion: We conclude that the popliteus tendon does play an important role in maintaining stability in a TKA and hence careful attention must be given to avoid injury. Also, repair in case of injury should be considered to improve functional outcomes in patients.

Introduction:
Ligament balancing is important for the functional result of a total knee arthroplasty (TKA). Mechanical alignment is one of the most commonly used surgical planning procedures.
The main objective was to compare short-term functional results between two robotic alignment techniques: a bone systematic alignment and a ligament specific alignment.

Material and Methods:
A retrospective comparative case-control series was used to compare the ligament specific alignment technique (LSA) with a bone systematic alignment technique (BSA : mechanical or adjusted alignment). There were 70 subjects in each group. Surgical procedures were performed using the MAKO® haptic robotic arm. Functional scores forgotten joint score (FJS), knee society score (KSS), Oxford knee score (OKS) were measured between at a minimum of 6 months postoperatively.

Results:
In the LSA group, the mean clinical scores were FJS: 60.0+/-26.4 [0-100], OKS: 38.7+/-8.2 [16-48] and KSS = 180.6+/-22.3 [120-200]. Concerning the BSA group, the mean clinical scores were: FJS: 52.0+/-29.8 [0-100], OKS: 36.7+/-10.0 [10-48] and KSS = 172.9+/-23.8 [102-200]. These functional results did not show any significant differences between the groups with respectively FJS p=0.097, OKS p=0.199 and KSS p=0.054.
Discussion:
Despite fewer instability and radiological alignment outliers in the ligament specific alignment group, there was no difference in short-term clinical scores. The comparison of two different techniques using the same robotic system does not show the superiority of a specific ligament alignment.
Conclusion:
In robotic TKA, the specific ligament alignment does not show any difference in short-term functional scores compared to systematic bone alignment technique.

Background: Total knee arthroplasty (TKA) is one of the most successful surgical procedures. Severe deformity may represent a significant challenge for successful outcomes. Pre-operative planning, computer navigation, and robotics have improved the outcomes of such cases. Patient-specific instrumentation (PSI) surgery is another alternative to these techniques and could present a reliable, low-cost, and safe technique in such patients.
Methods: Prospective data recording was done in the Egyptian Community Arthroplasty register, comorbidities, and degree of pre-operative deformity were recorded. Post-operative complications and length of hospital stay were recorded. Range of movement and Knee Society Score (KSS) were used to assess functional outcomes. Unicompartmental, revision, and conventional TKA were excluded.
Results: 617 TKAs were performed using the PSI technique between 2012 and 2022. Patients with varus deformity above 15 degrees were 298, while patients with valgus deformity above 15 degrees were 24. 151 patients had fixed flexion deformity above 20 degrees. Hospital stay length for all patients ranged between 4.2 to 4.4 days, KSS improved in all patients with any deformity above 15 degrees by an average of 70 points.
Discussion: In low-income countries, patients often present late for joint replacement surgery, which invariably results in severe deformity and significant bone loss. Multiple techniques and implants are utilized to correct these deformities. In our study, we present the results of TKA using PSI in patients with a high degree of deformity. Our study shows that PSI could be a reliable method for severe deformity correction in TKA.

Introduction: Current consensus advocates for routine patella resurfacing (PR) during total knee replacement (TKR) in patients with inflammatory arthritis, but the evidence remains limited in Asians. This study aims to evaluate short-term postoperative outcomes and complication rates of PR in patients with inflammatory arthritis undergoing primary TKR in Asian population. Methods: A retrospective study of our institution’s registry data was performed on all patients with inflammatory arthritis who underwent primary TKR in our institution between August 2017 to December 2021. Cases were categorized into resurfaced patella (PR, n=25) and non-resurfaced patella (PNR, n=31) groups. Demographics, operative data, patient reported outcome measures, and complications were compared. Results: Both groups had similar baseline demographics. There was no statistically significant difference in their preoperative range of motion (ROM) (PR:95.32±23.57 vs PNR:105 ±19.54, p=0.11), Oxford Knee Score (OKS) (PR:24.96±7.81 vs PNR:23.26±10.31, p=0.53), Knee Society Scoring System Knee score (KS-KS) (PR:44.63±17.40 vs PNR:49.27±17.74, p=0.33) and Knee Society Function Score (KS-FS) (PR:40.86 ± 27.30 vs PNR:47.67±26.97, p=0.33). Outcomes between PR and PNR groups at the 1 year mark in terms of ROM (PR:112.68±18.14 vs PNR:114.57±16.49, p=0.46), OKS (PR:41.54±3.91 vs PNR:41±4.65, p=0.95), KS-KS (PR:84.51±13.17 vs PNR:89.22±9.26, p=0.10) and KS-FS (PR:73.63±18.27 vs PNR:78.7±19.30, p=0.17) were similar. Postoperative complication (PR:16% vs PNR:12.9%, p=0.74) and reoperation rates (PR:16% vs PNR:6.45%, p=0.25) were also similar in both groups. There was no patella-related complication identified in either group. Conclusion: One-year postoperative functional and ROM outcomes as well as complication and reoperation rates are similar in both groups in patients with inflammatory arthritis.

Title - Measurement of external rotation of femoral component in total knee arthroplasty using a simple device ( K measure )

The external rotation of femoral component affects several aspects of the knee function including stability, range of motion and load distribution. General, studies have shown that a range of external rotation between 3 and 7 degrees from the transepicondylar axis (a line that connects two points on the knee joint) is considered to be within the optimal range for most patients
In this study, we aimed to determine the optimal external rotation of the femoral component in total knee arthroplasty for a cohort of middle eastern patients. We recruited 100 patients who underwent total knee arthroplasty using a posterior-stabilized implant with measured resection technique in varus knees. We measured the femoral component rotation relative to the posterior condylar axis using a simple device - K ( khoula )measure.
Results The results of the study showed that the optimal external rotation of the femoral component in Asian patients was 5 degrees ± 1.7 degrees. The patellar tracking was better and rectangular flexion was achieved with lesser amount of medial releases.
We concluded that 5 deg external rotation of femoral component was associated with better patellar tracking and lesser degrees of medial release in flexion to obtain a rectangular gap.

Objectives: According to the literature and national registers, the patients are unsatisfied with the results of TKA about 20% and the most of them suffer from constant pain. The main causes are PPI, malposition, pain, and early aseptic loosening. However, number of authors and registers reflect such inconclusive causes as pain, patellofemoral pain, or deficiency of the extesor mechanism. The goal: of the study was to identify the reason of pain after total knee arthroplasty (TKA) and to evaluate the results of revision knee arthroplasty in patients with painful knee. Materials: From 2017 to 2019 79 patients with painful knee after TKA were examined using a single precision algorithm. Revision knee arthroplasty was performed in 72 patients (39 two-stage). The evaluation of the results was carried out.
Results: According to our research PJI was diagnosed in 49.4% of cases, malposition in 35.4%, aseptic loosening in 16.5%, extra-articular causes and knee joint instability were in the in 8.9%, periprosthetic fracture in 2.5%. We identified 2 or more causes of pain simultaneously in 21.5% of cases. All patients noted improvement in 6 months follow-up. After 12-24 months 8.4% had various complications – 5.1% recurrence of PPI; 2.9% had the primary infections, 1.4% had periprosthetic fracture. Patient were not satisfied for other reasons in 7.8%. Conclusions. The reason of pain identification helped to perform correct revision knee and achieve the real improvement in the early stages. Revision arthroplasty associated with the risk of new complications in a later follow-up and requires further monitoring.

Purpose: Patellofemoral (PF) joint osteoarthritis (OA) is a major cause of anterior knee pain. Combined PF and medial knee compartment OA are common in adults. We evaluated the effect of arthroscopic patellar denervation (PD) in patients with combined pathology after malalignment correction. Methods: A prospective study including forty patients [females/males, 23/17; age, 30–59 years (45.5 +/- 8.50); mean body mass index, 25.15 +/- 3.04 kg/m2] were treated in our department from February 2018 to February 2019. The patients were randomized into 2 groups: group A included 19 patients who underwent open-wedge high tibial osteotomy (OWHTO) and arthroscopic PD and group B included 21 patients who underwent OWHTO without denervation. The effect of denervation was statistically and clinically evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS) and Kujala (anterior knee pain score) score. Results: After 24 months, 38 patients were available for the final follow-up. The final values of KOOS and the Kujala score were significantly different between the groups (p < 0.001). For group A, the average KOOS improved from 42.73 to 72.38 (p < 0.001) and the Kujala score improved from 42 to 74.1 (p < 0.001), whereas in group B, the average KOOS improved from 39.22 to 56.84 (p < 0.001) and the Kujala score improved from 39.7 to 56.4 (p < 0.001). Conclusion: Adding arthroscopic PD to OWHTO relieves anterior knee pain in patients with combined TF and PFOA and improves knee joint function and quality of life.

Background: Tranexamic acid (TXA) reduces bleeding and the need for transfusion after total knee replacement. Most literature has focused on its intravenous (IV) administration with less data available on the efficacy of topically administered TXA. This randomized clinical trial assessed the efficacy of topical compared with IV TXA.
Methods: A total of 140 patients who underwent primary unilateral total knee replacement were randomized to group A received an IV injection of TXA (1000mg) 15 minutes before inflation of tourniquet followed by (1000 mg) TXA 15 minutes before deflation of tourniquet and group B received Intra-articular injection of TXA (1000mg) in 20 ml saline injected into the drain at the end of the operation followed by clamping the drain for 2 hours.
Results: The study revealed that the mean drain volume 24 hours after the operation was 348.6 ml for group A and 345.7 ml for group B, with no significance difference between both groups (p=0.79). There was no statistically significant difference between studied groups regarding mean pre-operative, post-operative Haemoglobin (Hb) and Haematocrit (HCT) values. Additionally, there was a significant positive correlation between male sex, body mass index, diabetes mellitus, hypertension and postoperative bleeding.
Conclusion: There was no difference between IV and topical TXA regarding postoperative bleeding, postoperative Hb and postoperative HCT between the study groups.
Keywords: Tranexamic Acid, Total Knee Replacement.

A prospectively collected Study comparing the size of polyethylene in total knee replacement using patient specific instrumentation (PSI) versus conventional total knee arthroplasty (TKA). The comparison in polyethylene size is in 30 Conventional TKA patients and in 30 PSI patients.The study had 60 patients in total, 30 PSI and 30 conventional TKA patients. Patient specific instrumentation total knee arthroplasty by customized cutting blocks of the PSI generated from pre-operative three-dimensional model, using computed tomography (CT) or magnetic resonance imaging (MRI). 30 patients underwent conventional Total knee arthroplasty (TKA) using the total condylar prosthesis (TCP) which resurfaces all 3 compartments of the knee, the medial femoral tibial , the patellofemoral compartment the lateral femoral tibial compartment using modular cutting jigs for all patients.Records were obtained from the Egyptian Community Arthroplasty Register which is a member of the International Society of Arthroplasty Registers which conduct total knee arthroplasty using conventional instruments and patient specific instruments to conduct a record based study with data adapted from the years 2010 to 2022. The data showed a significant difference in average polyethylene size between PSI and conventional TKA with a decrease of 3.6 mm in males and 4.7mm in females respectively, this indicated that there is lesser bone resection in PSI conserving more anatomical bone stock.

The medial patellofemoral ligament (MPFL) is one of the most important structures in patella stabilization, preventing its lateral dislocation.
In MPFL reconstruction, anatomical positioning of the graft is desirable in order to restore joint biomechanics and patellofemoral stability.
The ideal method of intraoperative positioning of the femoral tunnel is controversial.
Schottle et al. was the first to use radiographic references for the positioning of the femoral tunnel from lateral radiography, and it is currently the most widely used method.
A retrospective study that included all patients who underwent MPFL reconstruction in a single center between 2009 and 2020 was conducted.
The aim was to determine the variability of femoral tunnel positioning using intraoperative fluoroscopy and to verify whether the Schottle point is a reliable method in MPFL reconstruction.
The distances in anterior-posterior and proximal-distal from the place where the femoral tunnel was positioned and Schottle point were measured.
A total of 46 patients were included, the majority of them were female (73,9%). Mean age was 20,3 years. The mean distance from the femoral tunnel to Schottle point was 5,54mm (SD 4,23) in anterior-posterior and 5,01mm (SD 3,53) in proximal-distal. Only 4 patients (8,7%) presented femoral tunnels outside the area <7mm of the Schottle point.
This study allowed to conclude that fluoroscopy control is a credible and effective method that allows the placement of femoral tunnels in a reproducible and anatomically accurate way in the reconstruction of the MPFL.