Introduction: The purpose of this study was to investigate the long term follow-up outcomes and survivorship of total knee arthroplasty (TKA) performed using a new high-flexion design prosthesis, the LOSPA knee system.

Methods: From September 2011 to March 2013, 504 TKAs (369 patients) with a follow-up period of 9-11 years were analyzed. For radiographic analysis, positions of femoral and tibial implants as α, β, γ, and δ angles, hip knee ankle (HKA) angle, and radiolucent lines were used. The patients were assessed clinically using range of motion (ROM) of the knee, the Knee Society scoring system (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The endpoint of survival was revision of implant.

Results: The mean ROM was 116.7°±14.5° preoperatively and 128.1°±7.6° at the last follow-up (p<0.001). Both the mean KSS and WOMAC scores showed significant improvement after surgery compared to preoperatively (all p<0.001). A non-progressive radiolucent line less than 2 mm was observed in 23 cases (4.7%). A total of 9 patients underwent revision surgery on the knee during the follow-up period. Of these, 4 patients underwent surgery for deep infection and 5 patients for aseptic loosening. In addition, 2 patients had deep infection, but their symptoms improved after synovectomy and polyethylene change. The survival rate of at least 9 years was 99.0% for aseptic causes and 98.2% for any reasons.

Conclusions: A new high-flexion design total knee prosthesis, the LOSPA knee system, showed excellent long-term survivorship and improvements in clinical outcomes at 9- to 11-year follow-up.

Introduction: In the last years, we observed an increasing number of transfemoral amputations following uncontrollable periprosthetic joint infection (PJI) after total knee arthroplasty (TKA).
Aim: We analyzed patients who suffered an uncontrollable PJI after TKA. In Germany, the PJI rate 3 years after primary standard TKA is 1.0%. Current statistics of the German Arthroplasty Register EPRD shows that in 2019 in 14.5% and in 2020 in 14.9% a PJI is the 2nd most common reason for a primary revision operation! After a first revision after PJI, the probability of a second revision within 2 years is 24.8% or 24.0% (in 2019 and 2020 respectively).
Discussion: The former PCT study showed that a transfemoral amputation due to an uncontrollable PJI after implantation of a TKA is not uncommon - we found 2.3% in our patient population.
We presented first results at the EBJIS 2014 in Lisbon and at the German EPK 2018 in Berlin. In regular discussions with the EPRD wefound that it is not yet possible to make any statements about whether a transfemoral amputation has taken place or about the frequency of transfemoral amputations. The EPRD registered in 2019 that in 14.5% and in 2020 that in 14.9% a PJI of a TKA is the 2nd most common reason for revisions. In the 2019 annual report, the probability of a second revision after PJI within 2 years is 24.8%, and in the 2020 annual report it is 24.0%. TKA revision for other reasons was only necessary in 11.3% (2019) and 11.2% (2020). We compared these findings with other national registries: NARA, SKAR, NAR, NJR, AJRR and found similar numbers! Those facts are alarming!

Introduction:
Low back pain (LBP) is nowadays called a “silent epidemic” in the world. The surgical outcome of knee arthroplasty has been found to be influenced by a good sort of factors including high BMI, pre-operative psychological state, and poor pain coping mechanisms. Low back pain is one of these factors that occur in 54.6–58.1% of people with osteoarthritis of the knee. The aim of this study was to determine whether symptomatic low back pain influences the outcome of total knee arthroplasty surgery.

Material and Methods:
All adult patients undergoing total knee replacement surgery at our centers between 2020 and 2021 were included in our study. Patients were divided into Group A(those with LBP) and Group B(without a documented history of LBP). Clinical outcomes were measured by WOMAC, KOOS, and Modified ODI score preoperatively and at 6 weeks, 6 months, and 1year follow-up periods.

Results:
108 patients were included in the study. Patients had improved WOMAC and KOOS final scores in both groups and Significantly higher scores were noted in GroupB compared to GroupA, postoperative pain, stiffness, ADL, and quality of life components of the KOOS scores were statistically significant for patient satisfaction in both groups.

Conclusion:
We found that Symptomatic low back pain influences functional outcomes after total knee arthroplasty surgery, Patients with LBP show poor functional scores after TKR compared to patients without LBP. Also in GroupA, patients reported functional improvement of back pain after the TKR surgery even though no intervention was done to the back pain.

Introduction: Unicompartmental Knee Replacement (UKR) for isolated medial compartment osteoarthritis has been shown to have better patient reported outcomes and lower complication rate. Higher revision rates than Total Knee Replacement (TKR) is thought to be a key factor in explaining why more knee surgeons do not perform UKR. In this study, we aim to report our short to medium term outcome of UKR performed in our arthroplasty centre.

Methods: This was a retrospective study with prospectively collected data. Results: There were 22 (2 bilaterals) UKRs performed between 2017 and 2020 in our centre. There were 14 females and six male patients. The mean age was 65.5 (range, 51-78) years. The mean follow up was 36.5 (range, 19-54) months. The mean BMI was 28 (range, 20-33). The average improvement of knee range of movement post-operatively was 10.3 degrees. The mean pre-op OKS was 12.25 and mean post-op OKS was 42.9 (p<0.00001). The mean post-op FJS was 84.1. Two patients had a manipulation under anaesthesia (MUA) and inpatient physio with continuous passive motion machine for knee stiffness within 6 weeks of surgery. Their stiffness resolved post MUA. No patients needed revision surgery. One patient passed away due to malignancy two years post-operatively.

Conclusion: From our study we can conclude that UKR is a good surgical option for isolated end stage medial compartment osteoarthritis in the Malaysian population. Patient selection is crucial and it is best performed in an arthroplasty unit.

Introduction and purpose:The aim of this study was to evaluate whether combined IV and IA administration of Tranexemic acid reduced total blood loss compared with IV-only administration of Tranexemic acid.
Methods: In this randomized comparative study, 50 patients scheduled for total knee arthroplasty were randomized to one of two interventions.The TXA IV and IA group received combined administration of TXA consisting of 1 g administered intravenously preoperatively and 2 g diluted in 100 mL of saline solution administered intra-articularly. The TXA IV alone group received 1 g of TXA administered intravenously only .The primary outcome was the 24-hour calculated blood loss. Secondary outcomes were blood loss on postoperative day 2, thromboembolic complications, and transfusion rate. Blood loss was calculated by hemoglobin differences using the Gross formula.
Results: The mean 24-hour blood loss (and standard deviation) was 200 ± 100 mL in the TXA IV and IA group compared with 700 ± 200 mL in the TXA IV alone group; treatment effect (difference), 500 mL (95% confidence interval [CI]) (p = 0.002).Second-day blood loss was 400 ± 100 mL in the TXA IV and IA group compared with 1000 ± 500 mL in the TXA IV; treatment effect, 600 mL(95% CI) (p = 0.003). No thromboembolic complications were observed. Transfusion rates was nil in the combined group compared to average 1.5 units required in IV Group.
Conclusions: The combined administration of IV and IA TXA resulted in a clinically significant reduction in blood loss of 55% compared with IV TXA alone.

Introduction:
The aim of this meta-analysis was to compare clinical efficacy and safety of lateral parapatellar approach with standard medial parapatellar approach in total arthroplasty of valgus knees.
Methods:
This meta-analysis was performed according to the PRISMA guidelines. Three independent literature searches were performed and 2 authors independently completed study selection, data extraction, and assessment of methodological quality.
Results:
A total of 6 studies with a total of 617 total knee arthroplasties were included. Results of the meta-analysis showed that lateral approach group had significantly less residual valgus deformity postoperatively (P=0.01) compared to medial group. Only one study assessed patellar tilt postoperatively showing a significantly less lateral tilt in lateral approach group (P=0.02). We did not find any significant difference between 2 groups in terms of Knee Society Score, Visual Analogue Scale, postoperative range of movement, length of surgery, or blood loss. Although more complications were reported in lateral approach group, the difference was not statistically significant (P=0.29).

Conclusions:
Although lateral parapatellar approach was superior in terms of postoperative residual valgus deformity and patellar tracking, this did not seem to have any impact on knee outcome scores or range of movement. Majority of the studies were under powered with only 3 randomised controlled trials and this makes interpretation of results difficult. We recommend that choice of surgical approach should be influenced by experience of the surgeon, familiarity with approach, and decided on a case by case basis with an understanding of potential risks and benefits.

Introduction: Posterior-stabilized (PS) total knee arthroplasty (TKA) poses problems such as the need for intercondylar notch bone resection as well as cam and post wear and patella clunk. Owing to its heightened anterior profile, an ultracongruent polyethylene insert prevents the excessive posterior translation of tibia in the case of a deficient or scarified posterior cruciate ligament (PCL). This study aimed to determine whether an ultracongruent insert provides satisfactory clinical and functional outcomes and midterm survival benefits. Methods: A retrospective medical records of 78 patients, 91 primary TKA cases involving the use of Columbus Anterior Stabilised ultracongruent insert were reviewed for the study. Data was used to evaluate the clinical, radiological and Kaplan-Meier survival analysis. Results: The mean follow-up duration for 91 knees was 6.8 years (range 5-7.5 years). A revision was made due to infection in one patient and due to instability in other patient. The mean knee flexion improved from 91.97° ± 9.43° (range 85°-105°) to 115.75° ± 9.58° (range 100°-130°) at the final follow-up. The mean Knee Society score improved from 43.1 ± 9.76 to 88.3 ± 3.2, and the function score improved from 44.95 ± 7.26 to 90.16 ± 3.71. None of the patients showed radiographic loosening of either insert component. The Kaplan-Meier analysis showed that the five-year survival of the insert with an endpoint of revision for any reason was 98.1% (confidence interval, CI, 95.7-99.6%). Conclusion: The Columbus Anterior Stabilised insert showed a low failure rate with good clinical, functional, and midterm survival outcomes.

Introduction: Hypovitaminosis D (HypoD) is associated with adverse outcomes, including peri-prosthetic fracture and peri-prosthetic joint infection, in arthroplasty. The aim of the study is to assess the incidence of HypoD, and its risk factors in patients undergoing lower limb arthroplasty, including knee (KA) and hip arthroplasty (HA). Methods: We prospectively measured preoperative serum 25-hydroxyvitamin D (25-OHD) level by immunoassay (Roche Cobas-e601-System) in 324 patients (mean age: 67.7±11.5; Female: Male = 200:124, KA Vs HA = 231:93) in our institution from Feb 2020 to June 2021. Baseline demographics, blood parameters, and information in the questionnaire, including the history of Vitamin D supplementation, and duration of sunlight exposure, were collected as independent variables for predicting 25-OH deficiency in a multivariable logistic regression model with a cut-off at 50 nmol/L. Results : Mean 25-OHD level was 56.5±21.9 nmol/L (41.4% Deficiency (<50 nmol/L), 41.4% Insufficient(50-74nmol/L), 17.3% Sufficient (≥75 nmol/L)) in the recruited patients. Younger age, higher Body Mass Index, higher serum albumin, no history of vitamin D supplementation, lower duration of outdoor activity were associated with HypoD in the multivariable logistic regression. The final model with 50 nmol/L cut-off (p<0.05) has Akaike Information Criterion (AIC) of 417.785 and Nagelkerke R square of 0.121. Conclusion : An alarming high incidence of HypoD was found in our patients undergoing arthroplasty. The multivariable logistic regression model was able to screen patients with HypoD. The at-risk group could be just treated by vitamin D repletion without relying on serum testing, which could save significant laboratory cost.

Introduction: Significant frontal deformities, in particular the historical genu-varum, still represent one of the operative difficulties which the orthopedic surgeon is confronted with when it comes to fitting a total knee prosthesis. Materiel and methods :Prospective study from 2015 to 2020, including 37 patients and 53 operated knees, average age of 80 years, all presented a stage V knee osteoarthritis of Ahlback , deviation of the tibial site in all our subjects, with extremes ranging from 25 ° to 32 °. These patients all benefited from a first-line total sliding knee replacement without prior correction of the deformity. Our pre and postoperative evaluation took into account the functional gene, Devane and Charnley scores, functional scores (HSS, IKS, KSS knee) and radiological criteria (Angle HKA, HKS). Results: Clear improvement in scores with an IKS knee which goes to 92% of good results and an HSS score of 76% of good results postoperatively, the HKA angle goes from an average of 154 ° preoperatively to 179 ° postoperatively. Discussion: Clinically clear improvement, in patients who were dependent preoperatively, having regained autonomy. Ligament liberation gestures were necessary, nor did we notice any laxity at the greatest follow-up; we compared our results with those of the literature (A. Mulladji, Hulet, Dejour, Krackow) Conclusion: Careful planning combined with an adapted technique allows us to obtain this equation even when it comes to large axial deviations exceeding 25 ° of varus; this without having to associate an osteotomy or have to resort to a constrained prosthesis.

Introduction
The objective of this study was to assess the change in FFD in patients undergoing me-dial UKA.

Methods
This prospective cohort study included 63 patients with medial compartment arthritis undergoing robotic-arm assist-ed UKA at a single tertiary centre between 2018 and 2022. This study included 30 males and 33 females with a mean age of 62 ± 5.7 years. Patients were divided into four study groups based on the degree of preoperative FFD: < 3 de-grees, 3 – 6 degrees, 6-9 degrees, and >9 degrees. Intraoperative optical motion capture technology was used to assess pre- and postoperative FFD.


Results
This study found statistically significant increase in mean preoperative to mean postoperative FFD for each of the four treatment groups: : < 3 degrees (pre op FFD = 1.53, post op FFD = 0.61 degrees, P = 0.004), 3 - 6 degrees (pre op FFD = 4.94 degrees, post op FFD = 3.71, P = 0.015), 6 – 9 degrees (pre op FFD = 7.96 degrees, post op FFD = 3.63, P < 0.001), >9 degrees(pre op FFD = 11.63 degrees, post op FFD = 7.18, P value < 0.001).

Conclusion
This is the first study to use optical motion capture technology to quantify the change in FFD during robotic-arm assisted UKA. The FFD was reduced by approximately half in all four treatment groups with no difference in functional outcomes based on the degree of preoperative FFD. These findings may help to modify existing clinical criteria for medial UKA.

Introduction: Currently the placement of a Total Knee Prosthesis is well codified. however even if they remain rare, certain complications can occur;most often it is persistent pain after prosthesis, stiffness, mechanical problems or even sepsis. and they can be dramatic for both the surgeon and the patient. Material and Methods: Prospective single-center cohort study, 59 failures from 560 first-line total knee arthroplasties operated for knee osteoarthritis at various stages of development between 2012 and 2020. The average age is 66 years, BMI is 29.45, an average follow-up of 06 years. Results: out of the overall population of 423 patients, 36 patients were lost to follow-up. A failure rate of 10.53% or 59 patients, the results obtained were different depending on the cause of the failure. All patients were assessed according to the DEVANE Score and CHARNLEY Categories, HSS-Insall, Functional IKS and Knee Score. Discussion: The results obtained remain inferior to those obtained during a primary implantation, but are comparable to those in the literature, in particular with regard to the causes of failure found, which are almost identical. (SPLIF, Bonnin , Prosset , Pailhé , Richard ). Conclusion: The failures of total knee prostheses are mainly the result of a technical defect, a bad choice of the implant and a bad analysis of the ground. Rigorous preoperative planning makes it possible not to reproduce the same errors as well as multidisciplinary collaboration between orthopedic surgeons, radiologists and infectious diseases specialists for better, faster, more efficient and better adapted care.

Painful arthritic joints are common in Ankylosing Spondylitis, Haemophilia, Rheumatoid Arthritis and Spondyloarthropathies pose a challenge due to severe impairment in quality of life. Joint replacement surgery improves quality of life and mobility.

Forty-five patients includes 11 of Haemophilia A with bilateral knee and one hip affections (three joint replacements) with minimum follow up of 3 years. Twenty-one patients with Ankylosing Spondylitis with 4 joint replacements was done with follow up 3 years. Twelve patients operated with Rheumatoid Arthritis with all 4 joint replacement with follow-up of 1 yr. One patient with Reiter’s disease with 4 joint replacement was done with follow up of 18 months.

All patients were non ambulatory for 2 years before admission and underwent staggered joint replacements in single hospitalisation. Data was collected during the preoperative and postoperative periods through patient records and questionnaires. The SF-36 scores compared, analyzed, and tested for significance using the Wilcoxon signed rank test.

The age range was 22 – 52 yrs. Ratio of female to male was 1:4. All were ambulatory during post-operative period. The average rehabilitation period varied from 75 to 240 days. One case developed wound problems treated with antibiotics and dressing with complete healing. The average pre-operative SF-36 score was 32.4 and post-operative score 67.5. On comparison of preoperative and postoperative physical component and mental component scores, the differences were found to be significant (p-value: < 0.01).

Multiple joint replacements were helpful in improving the mobility and quality of life in patients with polyarthritis in inflammatory arthritis.