[Digital tools in primary total knee arthroplasty-Prevalence in the German-speaking region].

Background: Digital tools are being increasingly used worldwide in primary knee arthroplasty. This study aimed to analyze the utilization density of digital tools, the preferred alignment strategies, and the obstacles and benefits of implementing these technologies in German-speaking countries.

Materials And Methods: An online survey with 57 questions about digital tools in primary knee arthroplasty and their usage was conducted among members of the Arthroplasty Working Group (AE).

Literature Review to Understand the Burden and Current Non-surgical Management of Moderate-Severe Pain Associated with Knee Osteoarthritis.

Introduction: To conduct a literature review exploring the humanistic burden, costs, and guideline recommendations for non-surgical management of moderate-severe pain in knee osteoarthritis (KOA).

Methods: Published studies (2018-25 April 2023) assessing the burden of moderate-severe pain in KOA were identified by searching Medline, Embase, EconLit, and Cochrane database, supplemented with grey literature hand searches and reference list snowballing. Treatment guidelines were also identified for key countries.

Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years.

Purpose: The purpose was to report detailed patient-reported outcome measures (PROMs) and satisfaction rates for computed tomography (CT)-based custom TKA at minimum follow-up of 2 years. The hypothesis was that custom TKA combined with 'personalised alignment' would yield equivalent or better PROMs compared to values reported in systematic reviews and meta-analyses on off-the-shelf (OTS) TKA.

Methods: Of an initial cohort of 150 custom TKAs, four died (unrelated to surgery), one required a revision, and five refused participation, leaving 140 patients for analysis.

Comparison of clinical outcomes of VISIONAIRE patient-specific instrumentation with conventional instrumentation in total knee arthroplasty: a systematic literature review and meta-analysis.

Introduction: Malalignment and resulting complications are major challenges in total knee arthroplasty (TKA) which patient-specific instrumentation (PSI) is proposed to alleviate. Previous PSI meta-analyses of TKA outcomes typically do not differentiate between PSI systems and assess relatively few outcomes, so the value of their findings is limited. VISIONAIRE cutting guides (Smith + Nephew Inc.

Status and future of modern technologies in arthroplasty : Results of a survey of the German Society for Orthopedics and Trauma Surgery (DGOU).

Background: The orthopedic community is divided on the question of whether modern technologies in arthroplasty improve outcomes. Therefore, the aim of this initiative of the working group on intraoperative imaging and technology integration (Arbeitsgemeinschaft intraoperative Bildgebung und Technologieintegration, AGiTEC) is to initiate the collection of additional data for the scientific evaluation of modern technologies.

Question: To what extent are modern technologies currently used and which implementations are planned? Do the members of the German Society for Orthopedics and Trauma Surgery (DGOU) consider the acquisition of additional data for scientific assessment necessary?

Methods: Members of the DGOU were asked via an e‑mail survey about the distribution and projected introduction of modern technologies in arthroplasty.

Custom TKA combined with personalised coronal alignment yield improvements that exceed KSS substantial clinical benefits.

Purpose: The purpose of this study was to report Knee Society Scores (KSS) at 12-month follow-up in a series of 266 knees that received custom TKA. The hypothesis was that custom TKA combined with personalised alignment would yield improvements greater than substantial clinical benefits (SCB) of KSS Knee and Function.

Methods: From a consecutive series of 905 patients (918 knees) that received primary TKAs, 261 (29%) patients (266 knees) received computed tomography (CT)-based posterior-stabilised cemented custom TKA.

Bicompartmental, medial and patellofemoral knee replacement might be able to maintain unloaded knee kinematics.

Introduction: Unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) are standard procedures for treating knee joint arthritis. Neither UKA nor TKA seems to be optimally suited for patients with bicompartmental osteoarthritis that affects only the medial and patellofemoral compartments. A bicompartmental knee arthroplasty (BKA) was designed for this patient group.

[New technologies (robotics, custom-made) in unicondylar knee arthroplasty-pro].

Background: Unicondylar knee arthroplasty offers the advantage that partial degenerative changes can be addressed with partial prosthetic solutions, thus preserving as much of the native joint as possible, including the cruciate ligaments. On the other hand, the number of revisions is still higher than for total knee endoprosthetics. In the literature, the causes mentioned are insufficient fit of the components as well as surgical errors.

Custom total knee arthroplasty facilitates restoration of constitutional coronal alignment.

Purpose: To describe a strategy for coronal alignment using a computed tomography (CT) based custom total knee arthroplasty (TKA) system, and to evaluate the agreement between the planned and postoperative Hip-Knee-Ankle (HKA) angle, Femoral Mechanical Angle (FMA) and Tibial Mechanical Angle (TMA).

Methods: From a consecutive series of 918 primary TKAs, 266 (29%) knees received CT-based posterior-stabilized cemented custom TKA. In addition to a preoperative CT-scan, pre- and post-operative radiographs of weight-bearing long leg, anterior-posterior and lateral views of the knee were obtained, on which the FMA, TMA and HKA angles were measured.

Reduced joint-awareness in bicruciate-retaining total knee arthroplasty compared to cruciate-sacrificing total knee arthroplasty.

Purpose: There is rising impact of patient-reported outcome (PRO) measurement in joint arthroplasty over the past years. Bicruciate-retaining implants have shown more physiologic knee kinematics and provide superior proprioceptive capacities. The aim of this study was to evaluate if the functional properties of this new implant design lead to improved PRO results after total knee arthroplasty (TKA).

Proprioception after bicruciate-retaining total knee arthroplasty is comparable to unicompartmental knee arthroplasty.

Purpose: Rising expectations in functional performance of total knee joints are inciting further improvement of knee arthroplasty implants. From a patient-centred view, bicruciate-retaining models provide a more natural feeling knee. However, there is no evidence of functional advantage for these implants.

Articulating spacers compared to fixed spacers for the treatment of infected knee arthroplasty: A follow-up of 37 cases.

Background: The standard treatment of a periprosthetic infection after TKA involves a two-stage reimplantation with the intermittent implantation of spacers. Different designs of spacers have been described; currently articulating spacers and fixed spacers are used. The aim of the present study is to compare the advantages/disadvantages of the different spacers.

[Total knee arthroplasty with the use of patient specific instruments. The VISIONAIRE system].

Background: Accurate component positioning and correct post-operative whole-leg alignment are crucial for ensuring the optimal long-term performance of a knee replacement. Patient-specific instrumentation (PSI) was introduced in an attempt to reduce outliers in the positioning of components and in the alignment of the leg axis in comparison with conventional techniques.

Methods And Results: A review of our own investigations and studies by other groups, it has been shown that PSI could reduce the amount of outliers in the positioning of tibial and femoral components and in whole-leg alignment.

Validation of the German Forgotten Joint Score (G-FJS) according to the COSMIN checklist: does a reduction in joint awareness indicate clinical improvement after arthroplasty of the knee?

Purpose: Evaluation of further improvement in treatment of patients with osteoarthritis of the knee requires measurement tools with a high discriminatory power. In this context, joint awareness in everyday life is seen as crucial criterion. Purpose of this study was to adapt and validate a German version of the "Forgotten Joint Score" (FJS) according to the COSMIN checklist.

Measuring tibial component rotation of TKA in MRI: What is reproducible?

Purpose: Correct rotational alignment of components is crucial for the success of total knee arthroplasty (TKA). Defining landmarks on the tibia that allow for reproducible measurement of component rotation seems to be more challenging than on the femoral side. This study compares the reproducibility of three different measurement techniques.

Improved tibial component rotation in TKA using patient-specific instrumentation.

Introduction: Patient-specific instrumentation (PSI) was introduced in an attempt to reduce positional outliers of components in total knee arthroplasty (TKA). It was hypothesized that PSI could help with the positioning of tibial components in optimal rotational alignment.

Methods: A magnetic resonance imaging (MRI) analysis of 58 patients following TKA was conducted.

Positive side effects of Ca antagonists for osteoarthritic joints-results of an in vivo pilot study.

Background: We have shown previously that some calcium antagonists inhibit hyaluronan export, loss of proteoglycans, and degradation of collagen from osteoarthritic cartilage. Clinically approved calcium antagonists normally are prescribed for cardiac arrhythmia. In the present study, we compared the effect of these drugs on osteoarthritic patients which had received no medication and patients which were also diagnosed for cardiac arrhythmias and were treated with calcium antagonists.

A comparison of conventional and patient-specific instruments in total knee arthroplasty.

Purpose: Several authors have observed that standard instrumentation (SI) may be insufficient for addressing component malalignment. Patient-matched cutting blocks (PMCB) technology was introduced to improve surgeons' ability to achieve a neutral postoperative mechanical axis following total knee arthroplasty (TKA). The current retrospective study was designed to compare the ability of SI and PMCB to achieve a hip-knee-ankle angle (HKA) within ±3° of the ideal alignment of 180°.

Benefits of using customized instrumentation in total knee arthroplasty: results from an activity-based costing model.

Objective: The growing demand for total knee arthroplasty (TKA) associated with the efforts to contain healthcare expenditure by advanced economies necessitates the use of economically effective technologies in TKA. The present analysis based on activity-based costing (ABC) model was carried out to estimate the economic value of patient-matched instrumentation (PMI) compared to standard surgical instrumentation in TKA.

Methodology: The costs of the two approaches, PMI and standard instrumentation in TKA, were determined by the use of ABC which measures the cost of a particular procedure by determining the activities involved and adding the cost of each activity.

Frontal plane alignment after total knee arthroplasty using patient-specific instruments.

Purpose: Although total knee arthroplasty (TKA) is regularly associated with favorable outcomes, considerable research efforts are still underway to improve its ability to achieve a neutral postoperative mechanical axis. Patient-specific instrumentation (PSI) was introduced with this and other goals in mind. The current retrospective study was designed to determine whether PSI would lead to a hip-knee-ankle angle (HKA) within ±3° of the ideal alignment of 180°.

Improved femoral component rotation in TKA using patient-specific instrumentation.

Background: Patient-specific instrumentation (PSI) was introduced in an attempt to reduce positional outliers of components in total knee arthroplasty (TKA). It was hypothesized that PSI could help with the positioning of femoral components in optimal rotational alignment.

Methods: A magnetic resonance imaging (MRI) analysis of 94 patients following TKA was conducted.

Femoro-tibial kinematics after TKA in fixed- and mobile-bearing knees in the sagittal plane.

Purpose: Lack of the anterior cruciate ligament in total knee arthroplasty results in paradoxical movement of the femur as opposed to the tibia under deep flexion. Total knee arthroplasty with mobile-bearing inlays has been developed to provide increased physiological movement of the knee joint and to reduce polyethylene abrasion. The aim of this study was to perform an in vitro analysis of the kinematic movement in the sagittal plane in order to show differences between fixed- and mobile-bearing TKA in comparison with the natural knee joint.