Supramalleolar osteotomy: technical note.

Supramalleolar osteotomy (SMO) aims to correct extra-articular deformities of the distal lower leg. There are several indications, the most common being varus osteoarthritis of the ankle. The rationale in this indication is to modify talocrural stress and pressure distribution by reorienting the limb axis.

Plantar compartment block for hallux valgus surgery: a proof-of-concept anatomic and clinical study.

Background: Hallux valgus surgery is associated with moderate to severe postoperative pain. We hypothesized that a plantar compartment block may be a good technique for postoperative analgesia. We describe an anatomic approach to ultrasound-guided plantar compartment block and assess the clinical efficacy of the block for outpatient surgery.

Finite element analysis in the optimization of posterior-stabilized total knee arthroplasty.

Posterior-stabilized total knee arthroplasty (PS-TKA) is associated with high rates of satisfaction and functional recovery. This is notably attributed to implant optimization in terms of design, choice of materials, positioning and understanding of biomechanics. Finite elements analysis (FEA) is an assessment technique that contributed to this optimization by ensuring mechanical results based on numerical simulation.

Midfoot Tarsectomy in Cavovarus: Why PSI Makes a Difference?

The cavovarus foot is a complex deformity that can be treated using multiple surgical procedures, ranging from soft tissue surgery to triple arthrodesis. Among these options, anterior midfoot tarsectomy is a three-dimensional closed-wedge osteotomy, traditionally performed slowly and progressively in a blind fashion, and remaining a challenge for unexperimented surgeons with variable outcomes. As such, we investigated and discussed the use of patient-specific cutting guides (PSCGs) in computer-assisted anterior midfoot tarsectomy in terms of accuracy, reproducibility, and safety.

Contemporary mortality rate and outcomes in nonagenarians after aseptic revision hip and knee arthroplasty.

Aims: Nonagenarians (aged 90 to 99 years) have experienced the fastest percent decile population growth in the USA recently, with a consequent increase in the prevalence of nonagenarians living with joint arthroplasties. As such, the number of revision total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) in nonagenarians is expected to increase. We aimed to determine the mortality rate, implant survivorship, and complications of nonagenarians undergoing aseptic revision THAs and revision TKAs.

Combined structural allograft and tantalum cone to manage segmental metaphyseal tibial bone defect in revision knee arthroplasty.

Tibial bone defect remains a challenge in revision knee arthroplasty. The present innovative technique combines structural allograft and tantalum metaphyseal cone for treatment of AORI stage 2A and 2B (uncontained peripheral metaphyseal) tibial defect. The aim is to reconstitute bone stock and enhance allograft osseointegration, while limiting stress to the allograft by implanting the metaphyseal cone through the allograft and the original bone.

Extensively Porous-Coated Stems Demonstrate Excellent Long-Term Survivorship in Revision Total Hip Arthroplasty.

Background: Extensively porous-coated cylindrical stems have demonstrated excellent results in revision total hip arthroplasties (THAs). However, most studies are midterm follow-ups and of modest cohort size. This study aimed to evaluate long-term outcomes of a large series of extensively porous-coated stems.

Influence of kinematics of the lumbopelvic complex in hip arthroplasty dislocation: from assessment to recommendations.

Introduction: In total hip arthroplasty (THA), misplacement of the implant can provide instability. Adequate orientation of the acetabular cup is a challenge due to variations in inter-individual anatomy and kinematics of the pelvis in everyday life. The aim of this study was to characterize the kinematic factors influencing the risk of dislocation in order to give recommendations for optimal placement of the cup.

Knee immobilization reproduces key arthrofibrotic phenotypes in mice.

Aims: As has been shown in larger animal models, knee immobilization can lead to arthrofibrotic phenotypes. Our study included 168 C57BL/6J female mice, with 24 serving as controls, and 144 undergoing a knee procedure to induce a contracture without osteoarthritis (OA).

Methods: Experimental knees were immobilized for either four weeks (72 mice) or eight weeks (72 mice), followed by a remobilization period of zero weeks (24 mice), two weeks (24 mice), or four weeks (24 mice) after suture removal.

Validation of a novel finite-element model for evaluating patellofemoral forces and stress during squatting after posterior-stabilized total knee arthroplasty.

Introduction: Several studies have documented the relationship between patellofemoral pain and patient dissatisfaction after total knee arthroplasty (TKA). However, few computer simulations have been designed to evaluate the patellofemoral joint during flexion. The aim of this study was to validate a new computational simulation, driven by forces and moments, and to analyze patellofemoral reaction forces and stress under squat loading conditions after TKA implantation.

Three-dimensional biometrics using weight-bearing imaging shows relationship between knee and hindfoot axial alignment.

Background: Existence of a relationship between knee and hindfoot alignments is commonly accepted, but not clearly proven. While studied in the coronal plane using 2D imaging, axial alignment has not been studied yet, likely requiring 3D measurements. We aimed to investigate how knee and hindfoot rotational alignments are related using 3D biometrics and modern 3D weight-bearing technologies.

Procedural simulation training in orthopaedics and traumatology: Nationwide survey among surgeon educators and residents in France.

Background: Simulation is among the tools used in France to train residents specialising in orthopaedic and trauma surgery (OTS). However, implementing simulation-based training (SBT) is complex and poorly reported. The objective of this study was to describe the use of simulation for OTS training in France.

Are modern knee outcomes scores appropriate for evaluating anterior knee pain and symptoms after total knee arthroplasty?

Background: Up to 45% of patients who undergo primary total knee arthroplasty (TKA) with contemporary implants have residual anterior knee pain. While a specific evaluation of anterior knee symptoms is mandatory, little is known about the capability of patellofemoral scores to be used individually. This study aimed to assess the distribution of patellofemoral scores after TKA from a uniform cohort and to investigate their external validity and ability to detect anterior knee symptoms using floor and ceiling effects.

Influence of residual anterior laxity on functional outcomes after anterior cruciate ligament reconstruction.

Introduction: Residual laxity can persist after anterior cruciate ligament (ACL) reconstruction. This increased anterior translation can be measured with a knee arthrometer. Nevertheless, the measurement parameters and functional impact of this residual laxity are not well understood.

Influence of dual-mobility acetabular implants on revision and survivorship of cup and Kerboull-type reinforcement ring constructs in aseptic acetabular loosening.

Introduction: Dual-mobility (DM) acetabular implants have been used in revision total hip arthroplasty (THA) to prevent postoperative instability, with excellent mid-term survivorship. However, few comparative studies assessed the long-term outcomes of DM implants used in Kerboull-type reinforcement ring constructs for acetabular revision. The present study aimed to compare long-term survivorship, dislocation rates and clinical outcome between DM acetabular implants and conventional single-bearing (SB) implants when cemented in a reinforcement ring.

Contemporary Mortality Rate and Outcomes in Nonagenarians After Primary Total Knee Arthroplasty.

Background: Nonagenarians (90-99 years) have experienced the fastest percent growth in primary total knee arthroplasty (TKA) utilization recently. However, there are limited data on the results of the procedure in this population. The goals of this study are to determine the mortality rate, implant survivorship, clinical outcomes, and complications of primary TKAs in nonagenarians.

Renal Toxicity Associated With Resection and Spacer Insertion for Chronic Hip PJI.

Background: Two-stage exchange arthroplasty with high-dose antibiotic-loaded bone cement spacer and intravenous (IV) antibiotics is the most common method of managing infected total hip arthroplasties. However, the contemporary incidence, risk factors, and outcomes of acute kidney injuries (AKIs) in this cohort are unknown.

Methods: We identified 227 patients treated with 256 antibiotic-loaded bone cement spacers after resection of an infected primary total hip arthroplasty between 2000 and 2017.

Biomechanical, histological, and molecular characterization of a new posttraumatic model of arthrofibrosis in rats.

Experimental analyses of posttraumatic knee arthrofibrosis utilize a rabbit model as a gold standard. However, a rodent model of arthrofibrosis offers many advantages including reduced cost and comparison with other models of organ fibrosis. This study aimed to characterize the biomechanical, histological, and molecular features of a novel posttraumatic model of arthrofibrosis in rats.

Acute Kidney Injury When Treating Periprosthetic Joint Infections After Total Knee Arthroplasties with Antibiotic-Loaded Spacers: Incidence, Risks, and Outcomes.

Background: Two-stage exchange arthroplasty with a high-dose antibiotic-loaded bone cement (ALBC) spacer and intravenous or oral antibiotics is the most common method of managing a periprosthetic joint infection (PJI) after a total knee arthroplasty (TKA). However, little is known about the contemporary incidence, the risk factors, and the outcomes of acute kidney injuries (AKIs) in this cohort.

Methods: We identified 424 patients who had been treated with 455 ALBC spacers after resection of a PJI following a primary TKA from 2000 to 2017.

Bony asymmetry in patellofemoral morphology and risk factors of instability are mostly clinically negligible.

Purpose: Previous investigations suggested that femoral side-to-side differences were located in the upper femur anatomy. However, little is known about the asymmetry between distal femur and patella. The degree of bony asymmetry in the patellofemoral joint was evaluated using pairs of CT-scans with emphasis on morphometric measurements and risk factors relevant to patellofemoral disorders.

A Potential Theragnostic Regulatory Axis for Arthrofibrosis Involving Adiponectin (ADIPOQ) Receptor 1 and 2 (ADIPOR1 and ADIPOR2), TGFβ1, and Smooth Muscle α-Actin (ACTA2).

(1) Background: Arthrofibrosis is a common cause of patient debility and dissatisfaction after total knee arthroplasty (TKA). The diversity of molecular pathways involved in arthrofibrosis disease progression suggest that effective treatments for arthrofibrosis may require a multimodal approach to counter the complex cellular mechanisms that direct disease pathogenesis. In this study, we leveraged RNA-seq data to define genes that are suppressed in arthrofibrosis patients and identified adiponectin () as a potential candidate.

Contemporary Mortality Rate and Outcomes in Nonagenarians Undergoing Primary Total Hip Arthroplasty.

Background: Nonagenarians (90-99 years) have experienced the fastest percent growth in primary THA utilization recently. However, there are limited data on this population. This study aimed to determine the mortality rate, implant survivorship, clinical outcomes, and complications of primary THAs in nonagenarians.