An MRI-Derived Formula for Estimating the Native Joint Line Position in the Presence of Distal Femoral Bone Loss.

Background  In the presence of distal femoral condyle bone loss, estimation and restoration of the joint line (JL) position can be guided by extraarticular bony landmarks with the aid of mathematical formulas that rely on the innate correlations between periarticular measurements. To prevent JL elevation, the formula should incorporate the thickness of distal femoral articular cartilage. The aim of this study was to derive a formula to estimate native JL position.

Bi-cruciate stabilized total knee arthroplasty restores the native knee alignments better than conventional posterior stabilized total knee arthroplasty.

Introduction: This study aimed to compare the differences in the radiological, clinical, and functional outcomes and the estimated restoration rate of native knee alignment between total knee arthroplasty (TKA) with bi-cruciate stabilized (BCS) and posterior stabilized (PS) design.

Materials And Methods: This retrospective study included consecutive patients between 2020 and 2021 who underwent TKA. The patients were divided into two groups (group I, Journey II BCS TKA [106 knees]; group II, Persona PS TKA [106 knees]) after 1:1 propensity score matching.

Robotic-Assisted Total Knee Arthroplasty Results in Shorter Navigation Working Time With Similar Clinical Outcomes Compared to Computer-Navigated Total Knee Arthroplasty.

Background: Early clinical data are important in the appraisal of newly introduced robotic-assisted surgery (RAS) systems in total knee arthroplasty (TKA). However, there are few studies to date comparing 1-year clinical outcomes between RAS and computer-assisted navigation (CAS), the forerunner in reducing alignment outliers. The aim of this study was to determine if there was a difference between these two groups in early clinical outcomes, including functional outcome and patient-reported outcome measures (PROMs).

Prior tuberosity screw fixation of the osteotomized tubercle can lead to favorable outcomes in retro-tubercular bi-planar opening wedge high tibial osteotomy.

Background: Exact information regarding fixing the tuberosity screw during retro-tubercular opening-wedge high tibial osteotomy (RT-OWHTO) is still lacking. The purpose of this study was to determine whether prior tuberosity screw fixation before plate fixation of main osteotomy fragment can prevent complications associated with tuberosity screw.

Methods: From 2019 to 2021, patients who underwent RT-OWHTO were divided into two groups (group I, prior tuberosity screw fixation; group II, later tuberosity screw fixation).

Constitutional and postoperative joint line obliquity can predict serial alignment change after opening-wedge high tibial osteotomy: analysis using coronal plane alignment of the knee classification.

Purpose: The purposes of this study were (1) to clarify the distribution of the Coronal Plane Alignment of the Knee (CPAK) phenotype in patients who underwent medial opening-wedge high tibial osteotomy (OWHTO) and (2) to identify the predictive factors for postoperative serial alignment changes after OWHTO by analyzing constitutional phenotypes.

Methods: Patients who underwent OWHTO between March 2014 and December 2019 were retrospectively evaluated. Those who completed a minimum follow-up of 3 years were divided into three groups based on the direction of alignment changes from postoperative 3 months to the final follow-up: Group 1 (varus direction) when the weight-bearing line ratio (WBLR) change was less than - 4%, Group 2 (maintained) when the WBLR change was between - 4% and 4%, and Group 3 (valgus direction) when the WBLR change was greater than 4%.

The use of an anatomic tibial baseplate in total knee arthroplasty optimizes coverage without compromising rotation: A propensity-matched evaluation.

Background: The aims of this study were (1) to compare in vivo coverage and rotational alignment of 2 tibial component designs: anatomic and symmetrical; and (2) to determine if coronal deformity and tibial torsion were related to rotation and coverage.

Methods: Postoperative CT scans of 200 propensity score-matched patients who underwent TKA with either an anatomic (ATC) or symmetrical tibia component (STC) were analyzed. Rotation was measured using four axes: surgical transepicondylar axis (sTEA), Berger's protocol, medio-lateral (ML) axis and posterior borders of the tibial plateau, while coverage was assessed by measuring fit and surface area.

Arthroscopic Meniscal Repair and Meniscectomy for Adult Discoid Lateral Meniscus Results in Progression to Valgus Alignment and Lateral Compartment Degeneration Compared With Nonoperative Treatment and Nondiscoid Lateral Meniscus.

Purpose: To analyze the effect of the arthroscopic meniscal procedure in adult discoid lateral meniscus (DLM) according to the age and meniscal-preserving by making comparisons with the nondiscoid lateral meniscus (N-DLM).

Methods: From March 2014 to October 2020, a comparative analysis was performed in adults with DLM who underwent arthroscopic meniscal procedures (operative DLM: 134 knees), nonoperative treatment (nonoperative DLM: 56 knees), and adult N-DLM who underwent arthroscopic meniscal procedures (operative N-DLM: 64 knees). These patients were between 20 and 65 years old and completed a minimum follow-up of 2 years.

The development of machine learning algorithms that can predict patients satisfaction using baseline characteristics, and preoperative and operative factors of total knee arthroplasty.

Background: Patient satisfaction following primary total knee arthroplasty (TKA) is a crucial part to evaluate the success of the procedure. The purpose of this study was to develop to predict patient satisfaction following TKA.

Methods: Satisfaction outcome data after 435 consecutive conventional TKAs performed between August 2020 and December 2021 were retrospectively collected.

Postoperative Intravenous Iron Supplementation Increases Hemoglobin Level in Total Knee Arthroplasty.

Iron supplementation provides iron storage and facilitates effective production of hemoglobin. The purpose of this study was to investigate the effect of early postoperative intravenous (IV) iron supplementation in different types of total knee arthroplasty (TKA) surgery. We retrospectively analyzed 863 patients who underwent TKA between September 2017 and September 2021.

Retro-tubercular Biplanar Medial Opening-Wedge High Tibial Osteotomy Results in Superior Patellofemoral Alignment Versus Supra-tubercular Osteotomy.

Purpose: To compare the changes in patellofemoral (PF) joint alignment, focusing on multiple planes, between two different types of biplanar medial opening-wedge high tibial osteotomy (OWHTO).

Methods: Patients who underwent biplanar OWHTO between July 2017 and May 2021 were retrospectively evaluated. They were allocated to either the supra-tubercular (ST)- or retro-tubercular (RT)-OWHTO group.

Outcomes of Geriatric Hip Fractures in a Tertiary Referral Center in Malaysia During the COVID-19 Pandemic.

Introduction With the advancing age of the population, there are an increasing number of patients with geriatric hip fractures. Despite the advancement of surgical knowledge and improvement of implant designs to treat geriatric hip fractures, mortality and morbidity remain high among these frail patients. In conjunction with the COVID-19 pandemic, the collateral damage dealt to these patients remains unknown as scarce resources are funneled to deal with the pandemic.

Association Between Tunnel Position, Tunnel Angle, Graft Signal Intensity, and Graft Thickness in the Reconstructed Posterior Cruciate Ligament.

Background: An appropriate tunnel position, tunnel angle, and tunnel-graft angle are important factors for maintaining the stability and mechanical properties of a posterior cruciate ligament (PCL) graft.

Purpose: To evaluate the association between tunnel position, tunnel angle, graft signal intensity ratio (SIR), and graft thickness after remnant-preserving PCL reconstruction.

Study Design: Cross-sectional study; Level of evidence, 3.

Preoperative education on realistic expectations improves the satisfaction of patients with central sensitization after total knee arthroplasty: a randomized-controlled trial.

Purpose: The aim of this study was to investigate whether an additional module on realistic expectations following total knee arthroplasty (TKA) would lead to a higher proportion of satisfied patients compared to existing preoperative education.

Methods: This was a single-center, randomized-controlled trial. A total of 172 patients who were scheduled for TKA between September 2020 and October 2021 were enrolled.

Graft impingement increases anterior cruciate ligament graft signal more than acute graft bending angle: magnetic resonance imaging-based study in outside-in anterior cruciate ligament reconstruction.

Purpose: In this study, the relationship between patient-specific geometric factors and tunnel placement in graft impingement was identified by using magnetic resonance imaging (MRI) signal intensity of anterior cruciate ligament (ACL) grafts.

Methods: Ninety-two patients, who were treated between 2014 and 2020, were included retrospectively. These patients underwent primary remnant-preserving outside-in ACL reconstruction (ACLR) and were followed up with postoperative MRI at least one year after surgery.

Mobility and Hip Function Among Geriatric Patients With Displaced Neck of Femur Fractures Treated With Arthroplasty.

Background: Neck of femur fractures result in impaired function for older people. Despite surgery, many patients experience a decrease in functional level and poorer health status after the injury. The objectives of this study were (1) to determine the short-term mobility and hip function of geriatric patients who underwent hip replacement surgery for a displaced neck of femur fracture in our local population and (2) to identify factors which affect the functional outcome of these patients.

Key-Point Detection Algorithm of Deep Learning Can Predict Lower Limb Alignment with Simple Knee Radiographs.

(1) Background: There have been many attempts to predict the weight-bearing line (WBL) ratio using simple knee radiographs. Using a convolutional neural network (CNN), we focused on predicting the WBL ratio quantitatively. (2) Methods: From March 2003 to December 2021, 2410 patients with 4790 knee AP radiographs were randomly selected using stratified random sampling.

COVID-19 Collateral Damage: Management of Periprosthetic Joint Infection in Malaysia.

Background and objective Periprosthetic joint infection (PJI) is one of the dreaded complications in patients after arthroplasty surgeries, owing to the risk of morbidity and arduous investigations and management associated with it. Nevertheless, as Malaysia is currently battling against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) pandemic head-on, the treatment for other non-life-threatening diseases including PJI has taken a backseat. In this study, we present a case series of 11 patients with PJI who were managed surgically at the largest tertiary hospital in Malaysia and we hope to shed some light on the difficulties we have encountered during this trying period.

Tibia vara in Asians: Myth or fact? Verification with three-dimensional computed tomography.

Background: There is a common perception among surgeons that Asian tibiae are significantly more varus compared to non-Asians, contributed both by an acute medial tibial proximal angle (MPTA) and diaphyseal bowing. Insight into the normative morphology of the tibia allows generation of knowledge towards disease processes and subsequently planning for corrective surgeries.

Methods: Computed tomography (CT) scans of 100 normal adult knees, aged 18 years and above, were analysed using a 3-dimensional (3D) analysis software.

The Relationship of Transepicondylar Width with the Distal and Posterior Femoral Condyles and Its Clinical Implications: A Three-Dimensional Study.

Background:  Restoration of the anatomical joint line, while important for clinical outcomes, is difficult to achieve in revision total knee arthroplasty (rTKA) due to distal femoral bone loss. The objective of this study was to determine a reliable method of restoring the anatomical joint line and posterior condylar offset in the setting of rTKA based on three-dimensional (3D) reconstruction of computed tomography (CT) images of the distal femur.

Methods:  CT scans of 50 lower limbs were analyzed.

Distal Femoral Rotation Correlates With Proximal Tibial Joint Line Obliquity: A Consideration for Kinematic Total Knee Arthroplasty.

Background: We hypothesized that there is a correlation between the distal femoral rotation and proximal tibial joint line obliquity in nonarthritic knees. This has significance for kinematic knee arthroplasty, in which the target knee alignment desired approximates the knee before disease.

Methods: Fifty computed tomography scans of nonarthritic knees were evaluated using three-dimensional image processing software.

Three-Dimensional Computed Tomography Analysis of the Posterior Tibial Slope in 100 Knees.

Background: The posterior tibial slope (PTS) is an important consideration in knee arthroplasty. However, there is still no consensus for the optimal slope. The objectives of this study were (1) to reliably determine the native PTS in this population using 3-dimensional computed tomography scans and (2) to determine the normal reference range for PTS in this population.