Outcomes of total knee replacement versus unicompartmental knee arthroplasty in an enhanced recovery after surgery protocol.

Introduction: Unicompartmental Knee Arthroplasty (UKA) has become popular due to faster recovery and improved range of motion. However, concerns have been made regarding increased risk of early failure. Furthermore, the use of Enhanced Recovery After Surgery (ERAS) protocols have shown to allow faster return to activities, improved satisfaction, and reduced complication rates.

Successful 24-hour discharge for total knee arthroplasty: importance of timing of surgery and physiotherapy in enhanced recovery after surgery protocol.

Introduction: The current literature is mixed on which patient factors, if any, predict the rate of successful discharge within 24 h of enhanced recovery after surgery (ERAS) total knee arthroplasty (TKA). This study aimed to investigate the influence of timing of surgery and physiotherapy on the rate of successful 24-h discharge.

Methods: All 342 patients who underwent ERAS day surgery TKA from August 2020 to July 2021 were followed up prospectively.

Identifying who are unlikely to benefit from total knee arthroplasty using machine learning models.

Identifying and preventing patients who are not likely to benefit long-term from total knee arthroplasty (TKA) would decrease healthcare expenditure significantly. We trained machine learning (ML) models (image-only, clinical-data only, and multimodal) among 5720 knee OA patients to predict postoperative dissatisfaction at 2 years. Dissatisfaction was defined as not achieving a minimal clinically important difference in postoperative Knee Society knee and function scores (KSS), Short Form-36 Health Survey [SF-36, divided into a physical component score (PCS) and mental component score (MCS)], and Oxford Knee Score (OKS).

Rotating Hinge Revision Total Knee Arthroplasty Provides Greater Arc of Motion Gains for Patients Who Have Severe Arthrofibrosis.

Background: Arthrofibrosis is a common postoperative total knee arthroplasty (TKA) complication that results in limited range of motion (ROM). There is limited literature on outcomes after revision TKA (rTKA) for arthrofibrosis based on preoperative ROM restriction. The aims of this study were to: (1) examine ROM trajectory after rTKA for arthrofibrosis patients who have severe versus nonsevere limitations; (2) compare ROM gains and final arc of motion (AOM) between severe and nonsevere cohorts; (2a) compare ROM gain in a severe cohort treated with a rotating hinge (RH) versus a non-RH (NRH) construct; and (3) assess the impact of arthrofibrosis severity on patient-reported outcome measures.

A unique case report of a revision extensor mechanism reconstruction using Marlex mesh in the setting of proximal tibial bone deficiency: The tantalum clamshell technique.

Extensor mechanism (EM) disruption is a rare but severe complication of total knee arthroplasty (TKA) that can greatly impair function. Treatment options for chronic patella tendon ruptures include primary repair, autograft augmentation, and reconstruction with allograft or synthetic material. Despite various techniques, failures can occur, and options for reconstruction after a failed allograft or mesh are limited, especially if the tibial component is well-fixed and cannot be easily removed, and if there is proximal tibial deficiency from a previous failed EM allograft.

Enhanced recovery after surgery day surgery for MAKO® robotic-arm assisted TKA; better outcome for patients, improved efficiency for hospitals.

Introduction: Robotic-assisted Total Knee Arthroplasty (TKA) was designed to improve implant position accuracy by providing surgeons with real-time intra-operative data to tailor the operation to the patient. Proponents of robotic-assisted TKA believe that this translates into meaningful improvements in outcomes. However, there are concerns that the longer surgical duration associated with robotic-assisted TKA leads to longer length of stay (LOS).

Postponement of total knee arthroplasties due to pandemic causes significant deterioration on patients' preoperative knee and quality of life scores.

Introduction: Elective surgeries were postponed during the COVID-19 pandemic to alleviate healthcare strains, affecting majority of elective orthopaedic surgeries such as total knee arthroplasties (TKAs). The aim of this study is to evaluate the impact on knee function and quality of life of patients who had their planned TKA postponed due to the pandemic.

Methods: This is a retrospective analysis of data collected in a tertiary hospital.

Unicompartmental knee arthroplasty in obese patients, poorer survivorship at 15 years.

Introduction: The preclusion of obese patients from unicompartmental knee arthroplasty (UKA) has increasingly been challenged. This study aimed to evaluate the impact of Body Mass Index (BMI) on UKA at 15-year follow-up.

Materials And Methods: 169 unilateral UKA patients from 2003 to 2007 were followed-up prospectively for at least 15 years.

Severe genu varus deformity does not affect enhanced recovery after surgery total knee arthroplasty outcomes.

Introduction: Enhanced recovery after surgery (ERAS) has been increasingly adopted in orthopaedic surgery. Although not an exclusion criterion, patients undergoing total knee arthroplasty (TKA) with preoperative severe varus deformity may be less likely to be enrolled for ERAS. This study aimed to compare the success of ERAS TKA between patients with severe preoperative varus deformities (≥ 15° varus) and the control group (< 15° varus to 14° valgus).

Do Diabetic Patients Have Poorer Clinical and Radiological Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion?

Background: The number of patients with diabetes mellitus (DM) seeking treatment for degenerative spondylolisthesis is expected to increase. However, there is a paucity of studies examining the patient-reported outcomes (PROs) and subjective measures in patients with DM following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). The present study aimed to compare PROs, satisfaction, and radiological fusion between DM and non-DM patients following MIS-TLIF.

Enhanced recovery after day surgery total knee arthroplasty, the new standard of care: An Asian perspective.

Background: This study describes the implementation of Enhanced Recovery After Surgery (ERAS) total knee arthroplasty (TKA) with day-surgery protocol to assess the outcome of ERAS day surgery TKA compared with traditional ERAS inpatient TKA in terms of length of stay (LOS), 30-day readmission, complications, and patient-reported outcome measures (PROMs).

Methods: Patients who underwent unilateral primary TKA from August 2020 to July 2021 were followed up. All TKAs were performed with the ERAS protocol.

Novel morphogenic knee implant delivers comparable mid-term outcomes as compared to conventional non-morphogenic implants.

Introduction: Conventional total knee arthroplasty (C-TKA) implants have well-established mid- and long-term outcomes. The novel TKA (N-TKA) implants provide morphogenic implant components with smaller size increments to facilitate anatomical replication. The aim of the study is to evaluate if these advantages provides better clinical outcomes.

Larger Medial Contact Area and More Anterior Contact Position in Medial-Pivot than Posterior-Stabilized Total Knee Arthroplasty during In-Vivo Lunge Activity.

This study aimed to compare the in-vivo kinematics and articular contact status between medial-pivot total knee arthroplasty (MP-TKA) and posterior stabilized (PS) TKA during weight-bearing single-leg lunge. 16 MP-TKA and 12 PS-TKA patients performed bilateral single-leg lunges under dual fluoroscopy surveillance to determine the in-vivo six degrees-of-freedom knee kinematics. The closest point between the surface models of the femoral condyle and the polyethylene insert was used to determine the contact position and area.

Cost-Effectiveness of Robot-Assisted Total Knee Arthroplasty: A Markov Decision Analysis.

Background: Robot-assisted total knee arthroplasty (rTKA) may improve clinical outcomes for patients who have end-stage osteoarthritis of the knee. However, the costs of rTKA are high, and there is a paucity of data evaluating the cost-effectiveness of rTKA. We aimed to analyze the cost per quality-adjusted life-year (QALY) of rTKA relative to manual TKA.

Clinical Frailty Scale is a better predictor for adverse post-operative complications and functional outcomes than Modified Frailty Index and Charlson Comorbidity Index after total knee arthroplasty.

Purpose: Studies have demonstrated correlations between frailty and comorbidity scores with adverse outcomes in total knee replacement (TKR). However, there is a lack of consensus on the most suitable pre-operative assessment tool. This study aims to compare Clinical Frailty Scale (CFS), Modified Frailty Index (MFI), and Charlson Comorbidity Index (CCI) in predicting adverse post-operative complications and functional outcomes following a unilateral TKR.

The effect of topical tranexamic acid on functional outcomes and quality of life in patients undergoing unicompartmental knee arthroplasty.

Introduction: Tranexamic acid (TXA) is being increasingly utilized to reduce blood loss after knee joint arthroplasty. However, there is a lack of studies on the effect of topical TXA on the functional outcomes and quality of life after Unicompartmental Knee Arthroplasty (UKA). The aim of this study was to determine the effect of topical TXA on functional outcomes and quality of life scores in patients undergoing UKA.

Lower socioeconomic status is associated with increased co-morbidity burden and independently associated with time to surgery, length of hospitalisation, and readmission rates of hip fracture patients.

Unlabelled: This study examines the relationship between socioeconomic status, comorbidities, and clinical outcomes of hip fracture patients. Lower socioeconomic status is not only associated with poorer comorbidities but is also independently impacting surgical access and outcomes. This can be considered a "double setback" in the management of hip fractures.

Preoperative mental distress is associated with poorer physical improvements after revision total hip arthroplasty.

Aims: Despite the increasing prevalence of mental health disorders in revision arthroplasty patients, the impact of preoperative mental distress on functional outcomes after revision total hip arthroplasty (rTHA) remains unclear. Our study aims to investigate the impact of preoperative mental distress on functional outcomes after rTHA.

Methods: Prospectively collected data of 84 rTHAs was extracted from a single institution's joint replacement registry.

Artificial intelligence in arthroplasty.

Artificial intelligence (AI) is altering the world of medicine. Given the rapid advances in technology, computers are now able to learn and improve, imitating humanoid cognitive function. AI applications currently exist in various medical specialties, some of which are already in clinical use.

Development and internal validation of machine learning algorithms to predict patient satisfaction after total hip arthroplasty.

Background: Patient satisfaction is a unique and important measure of success after total hip arthroplasty (THA). Our study aimed to evaluate the use of machine learning (ML) algorithms to predict patient satisfaction after THA.

Methods: Prospectively collected data of 1508 primary THAs performed between 2006 and 2018 were extracted from our joint replacement registry and split into training (80%) and test (20%) sets.

All-polyethylene unicompartmental knee arthroplasty is associated with increased risks of poorer knee society knee score and lower satisfaction in obese patients.

Background: Although metal-backed tibial component (MB) is biomechanically superior to all-polyethylene (AP) implants in fixed-bearing unicompartmental knee arthroplasty (UKA), recent studies have shown comparable functional outcomes between the two. However, no study has examined this comparison in obese patients (BMI ≥ 30 kg/m). We investigated whether functional outcomes between the two implants differ among obese patients, and whether the extent of obesity influences these outcomes.

Poorer Preoperative Function Leads to Delayed Return to Work After Anterior Cervical Discectomy and Fusion for Degenerative Cervical Myelopathy.

Background: The factors that affect return to work (RTW) after anterior cervical discectomy and fusion (ACDF) for degenerative cervical myelopathy (DCM) remain unclear, especially in a non-Workers' Compensation setting. We aimed to (1) identify factors that influence RTW in patients undergoing ACDF (2) determine if early RTW plays a role in functional outcomes, quality of life, and satisfaction.

Methods: Prospectively collected data of 103 working adults who underwent primary ACDF for DCM were retrospectively reviewed.

Revision total hip arthroplasty is associated with poorer clinically meaningful improvements and patient satisfaction compared to primary total hip arthroplasty.

Purpose: This study aims to compare PROM improvements and satisfaction rates between revision (rTHA) and primary total hip arthroplasty (pTHA).

Methods: 84 rTHAs were propensity-score matched to 168 pTHAs using patient demographics and preoperative PROMs. Multiple regression was used to evaluate differences in PROMs, minimal clinically important difference (MCID) attainment and patient satisfaction.