Journal of Joint Surgery and Research最新文献

{"title":"Early functional outcomes of a conjoined tendon-preserving posterior approach in robotic arm-assisted total hip arthroplasty: A retrospective cohort study","authors":"Ryuichi Sato ,&nbsp;Hajime Sugiyama ,&nbsp;Yohei Matsushita ,&nbsp;Tetsuya Yokoyama ,&nbsp;Eriko Okawa ,&nbsp;Hisahiro Tonotsuka ,&nbsp;Tetsuo Hayama ,&nbsp;Mitsuru Saito","doi":"10.1016/j.jjoisr.2026.01.002","DOIUrl":"10.1016/j.jjoisr.2026.01.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Minimally invasive surgery (MIS) techniques in total hip arthroplasty (THA) seek faster recovery. The conjoined tendon-preserving posterior (CPP) approach has recently been introduced as a MIS posterior technique; however, evidence regarding its clinical benefits in THA remains limited. To determine whether the CPP approach shortens the time to independent walking without limping and improves early postoperative clinical outcomes compared with the conventional posterolateral (PL) and piriformis muscle-sparing PL (P-PL) approaches in patients undergoing robotic arm-assisted THA.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 100 consecutive patients who underwent robotic arm-assisted primary THA using one of the three approaches: PL (n = 33), P-PL (n = 34), or CPP approach (n = 33). Time to independent ambulation with two canes (T1) and with or without a single cane (T2) was recorded postoperatively. Patient-reported outcomes were assessed preoperatively and up to 1 year postoperatively using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ).</div></div><div><h3>Results</h3><div>The CPP group achieved independent walking significantly earlier than the PL and P-PL groups (T1: 5.1 vs. 10.9/9.1 days; T2: 14.3 vs. 24.7/24.5 days, all <em>p &lt;</em> 0.001). CPP group showed significantly higher JHEQ movement scores from 3 months postoperatively and lower dissatisfaction scores at 6 and 12 months, with no significant differences in pain scores.</div></div><div><h3>Conclusion</h3><div>The CPP approach significantly accelerated postoperative gait recovery and improved early functional outcomes compared with conventional posterior approaches, likely due to preservation of short external rotators and the posterior capsule. Further large-scale, prospective studies are warranted to confirm these findings.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"4 1","pages":"Pages 97-103"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical alignment can still be an optimal target in total knee arthroplasty for severe varus knee","authors":"Shuichi Matsuda,&nbsp;Kohei Nisthitani,&nbsp;Shinichi Kuriyama","doi":"10.1016/j.jjoisr.2025.12.002","DOIUrl":"10.1016/j.jjoisr.2025.12.002","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this review was to investigate which alignment strategy provides the most appropriate target in total knee arthroplasty (TKA) for severe varus deformity, taking into account age-related skeletal changes, ligament balance, and implant longevity.</div></div><div><h3>Methods</h3><div>Relevant radiographic, biomechanical, intra-operative, and clinical studies were reviewed to clarify how age-related deformity, soft tissue conditions, and post-operative alignment influence outcomes in varus knees undergoing TKA.</div></div><div><h3>Result</h3><div>Radiographic analyses show that lower limb deformity progresses with aging and osteoarthritis, making it difficult to identify the constitutional alignment based on pre-operative morphology. Intra-operative findings reveal that the medial structures are not necessarily contracted, whereas lateral laxity increases with varus severity. Biomechanical simulations indicate that varus alignment exceeding 6° results in a marked increase in medial contact stress, and clinical studies report inferior outcomes and a higher risk of tibial loosening in such cases. Reconstruction in neutral mechanical alignment without excessive medial release provides stable kinematics and satisfactory clinical outcomes, even in severe varus knees.</div></div><div><h3>Conclusions</h3><div>In patients with advanced varus deformity, aiming to reproduce the native alignment is neither practical nor beneficial because of age-related skeletal changes and altered ligament balance. Mechanical alignment within 3° of neutral, achieved without excessive medial release, remains a reasonable and safe target that minimizes implant stress and ensures long-term stability. Alignment beyond 6° varus should be avoided.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"4 1","pages":"Pages 60-65"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal femoral periprosthetic fractures: A review of current concepts","authors":"Dylan Green,&nbsp;Humza Osmani,&nbsp;James Li,&nbsp;Vishal Senthilkumar,&nbsp;Andreas Fontalis,&nbsp;Fares S. Haddad","doi":"10.1016/j.jjoisr.2025.12.004","DOIUrl":"10.1016/j.jjoisr.2025.12.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Periprosthetic femoral fractures (PFFs) are a serious complication of total hip arthroplasty (THA) and are expected to become more frequent as older patients live longer with osteoporotic bone and well-fixed implants. This review summarizes recent evidence to support rational prevention and management.</div></div><div><h3>Methods</h3><div>A narrative review of contemporary clinical, registry, and biomechanical studies on proximal femoral PFFs was performed, focusing on epidemiology and risk factors, femoral stem design and biomechanics, classification, treatment of Vancouver B fractures, and peri-operative optimization.</div></div><div><h3>Results</h3><div>Registry and cohort studies show that PFFs occur mainly in frail older patients, with 1 year mortality similar to that after fragility hip fracture. Early post-operative fracture risk is consistently higher after uncemented than cemented THA, while composite beam cemented stems and collared cementless stems appear to reduce risk compared with polished taper slip and collarless designs. Short stems and hip resurfacing have theoretical advantages for proximal load transfer but have not shown consistent protection against PFF. Conventional Vancouver and Unified Classification System schemes are less reliable around polished taper slip stems; interface based concepts that focus on cement–bone integrity may better guide management. For selected Vancouver B2 and B3 fractures, especially in physiologically high-risk patients, open reduction and internal fixation can achieve outcomes comparable with revision when the cement–bone interface is intact. Early surgery in orthogeriatric pathways appears important.</div></div><div><h3>Conclusion</h3><div>A design-specific, physiology-led approach combining implant selection, interface-based classification, selective fixation, and peri-operative optimization is central to improving outcomes in PFF.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"4 1","pages":"Pages 66-74"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual-mobility constructs or large femoral head bearings in revision total hip arthroplasty?","authors":"Mohamad B. Adada,&nbsp;Stephen M. Lancia Jr,&nbsp;Jesus M. Villa,&nbsp;Carlos A. Higuera-Rueda","doi":"10.1016/j.jjoisr.2025.10.001","DOIUrl":"10.1016/j.jjoisr.2025.10.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Dislocation remains a leading cause of failure following revision total hip arthroplasty (rTHA). Dual-mobility cups (DMCs) and large femoral heads (LFHs) have been employed to mitigate this risk, yet the comparative effectiveness remains debated. This systematic literature review aimed to compare dislocation, re-revision, and complication rates between DMC and LFH constructs in rTHA.</div></div><div><h3>Methods</h3><div>This review followed PRISMA guidelines. A systematic search of Scopus, PubMed, and Embase databases yielded 2970 records. After screening using Covidence and removal of duplicates, 35 full texts were reviewed, and 9 studies met the inclusion criteria. Studies included patients undergoing rTHA with either DMC or LFH constructs and reporting on dislocation, re-revision, or related complications. Relative risk (RR), absolute risk reduction (ARR), and number needed to treat (NNT) for outcomes of interest were calculated.</div></div><div><h3>Results</h3><div>Nine comparative studies encompassing 3095 rTHAs (1204 DMCs and 1891 LFHs ≥36 ​mm) met the inclusion criteria. Post-operative dislocation occurred in 17 of 437 DMC hips (3.9%) and 54 of 711 LFH hips (7.6%), yielding a RR of 0.51 (49% reduction when DMC is used) and an ARR of 3.7% (NNT 27). Re-revision for any cause was also lower with DMCs (6.3% <em>vs.</em> 9.2%; ARR 2.9%), driven mainly by fewer re-revisions for instability (3.1% <em>vs.</em> 6.2%; ARR 3.1%).</div></div><div><h3>Conclusions</h3><div>In rTHA, DMCs offer a potential reduction in dislocation and re-revision risk compared with LFHs, particularly in high-risk patients. While cost-effectiveness and survivorship analyses support DMC use, well-powered randomized controlled trials with long-term data are warranted.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"4 1","pages":"Pages 13-18"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145748202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appreciation to reviewers in 2025","authors":"","doi":"10.1016/j.jjoisr.2026.01.001","DOIUrl":"10.1016/j.jjoisr.2026.01.001","url":null,"abstract":"","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"4 1","pages":"Page 117"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How I perform total knee arthroplasty: functional alignment in practice","authors":"Simon W. Young","doi":"10.1016/j.jjoisr.2025.11.004","DOIUrl":"10.1016/j.jjoisr.2025.11.004","url":null,"abstract":"<div><h3>Background</h3><div>Alignment has traditionally been central to total knee arthroplasty (TKA). Mechanical alignment (MA) offers reproducibility and long-term durability, whereas kinematic alignment (KA) seeks to restore native anatomy. Functional alignment (FA) has recently emerged, integrating alignment and ligament balance within defined boundaries. This review summarizes the evolution of alignment philosophy and describes the uthor's current robotic-assisted FA technique.</div></div><div><h3>Methods</h3><div>Key technical domains—alignment, balancing, and boundaries—are outlined. Evidence from a series of randomized controlled trials (RCTs) comparing MA, KA, and FA is summarized, with a detailed description of the FA technique including initial kinematic positioning, boundary definition, virtual gap assessment, algorithm-guided optimization, and robotic execution.</div></div><div><h3>Results</h3><div>RCTs comparing KA and MA demonstrate no significant differences in functional outcomes at 2, 5, or 10 years. In contrast, FA provides equivalent overall outcomes to MA, but with fewer soft tissue releases and improvements in specific patient subgroups, particularly those with greater pre-operative deformity or constitutional asymmetry. While alignment and balance influence stability and mechanical loading, their effect on patient-reported outcomes appears limited once acceptable thresholds are met. Patient selection, expectation management, pain sensitization, and surgical technique remain major determinants of satisfaction.</div></div><div><h3>Conclusions</h3><div>FA represents a pragmatic convergence of mechanical and kinematic philosophies, using technology to individualize alignment and balance targets within safe boundaries. FA provides a balanced, reproducible approach, although outcomes in TKA depend on more than alignment alone.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"4 1","pages":"Pages 49-53"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kinematic alignment in total knee arthroplasty: principles, outcomes, and evolving perspectives","authors":"Manabu Akagawa ,&nbsp;Loïc Villet ,&nbsp;Ciara Harman ,&nbsp;Charles Rivière","doi":"10.1016/j.jjoisr.2025.12.005","DOIUrl":"10.1016/j.jjoisr.2025.12.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Mechanical alignment (MA) has traditionally guided total knee arthroplasty (TKA), seeking neutral limb alignment for all patients. However, this uniform method disregards anatomical diversity and leaves up to 20% of patients dissatisfied. Kinematic alignment (KA) was introduced to address these limitations by restoring each patient's native pre-arthritic knee alignment.</div></div><div><h3>Methods</h3><div>A literature review conducted in April 2025 examined the rationale, biomechanics, clinical outcomes, implant considerations, and future directions of KA-TKA.</div></div><div><h3>Results</h3><div>KA replicates the knee's natural joint lines and ligament balance, avoiding the soft tissue and kinematic distortions inherent to MA. Biomechanical studies show that KA better reproduces native knee kinematics and more physiological gait patterns. Clinical evidence, including randomized trials and meta-analyses, demonstrates that KA provides superior joint perception, greater patient satisfaction, and comparable implant survivorship relative to MA. Long-term data extending beyond 10 years indicate that component positioning and prosthetic limb alignment have a negligible influence on implant loosening or revision rates. Implant selection also plays a key role, with medial pivot designs and posterior cruciate ligament retention further enhancing (i.e. symbiotic effect) the kinematic and clinical benefits of KA.</div></div><div><h3>Conclusions</h3><div>KA represents a validated, patient-specific alternative to the long-standing MA paradigm. By aligning prosthetic components to each patient's anatomy rather than enforcing a neutral axis, KA enhances TKA performance without compromising implant durability. Future research should focus on refining three-dimensional assessment tools and implant designs to optimize the reproducibility and longevity of KA-TKA.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"4 1","pages":"Pages 75-80"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip–spine relationship in total hip arthroplasty: Concepts, clinical relevance, and future perspectives","authors":"Hidetoshi Hamada ,&nbsp;Keisuke Uemura ,&nbsp;Nobuhiko Sugano","doi":"10.1016/j.jjoisr.2025.11.005","DOIUrl":"10.1016/j.jjoisr.2025.11.005","url":null,"abstract":"<div><h3>Purpose and Methods</h3><div>Dislocation remains a leading cause of revision in total hip arthroplasty (THA). While Lewinnek's “safe zone” for acetabular component placement has historically guided surgical orientation, dislocations still occur within this range, highlighting its limitations. Recent research has emphasized the importance of spinopelvic dynamics, particularly the relationship between pelvic tilt and spinal alignment, in influencing functional component orientation and dislocation risk.</div></div><div><h3>Result</h3><div>Patients with spinal stiffness, prior fusion, or spinopelvic imbalance are at higher risk for instability after THA. Several spinopelvic classification systems have been developed to stratify risk and guide implant positioning. However, these systems often rely on static imaging and fail to capture post-operative or age-related changes in spinopelvic mobility. Furthermore, they do not account for femoral motion or multidirectional impingement. Virtual range of motion (VROM) simulation offers a dynamic, patient-specific alternative by modeling critical movements, such as flexion, extension, and rotation, relative to the functional pelvic plane. This enables pre-operative planning of impingement-free zones tailored to individual pelvic and femoral alignment. Even in patients with altered spinopelvic dynamics, implants planned within these parameters may achieve stability without depending solely on sagittal spinopelvic classification.</div></div><div><h3>Conclusion</h3><div>Although spinopelvic classification systems contribute valuable insights, their clinical utility is limited by post-operative variability and omission of femoral alignment. Patient-specific, VROM-based planning may offer clinical relevant implant orientation, improving THA stability and outcomes through individualized functional alignment strategies.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"4 1","pages":"Pages 44-48"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transverse osteotomy in medial opening wedge high tibial osteotomy with distal tibial tubercle osteotomy gets closer to the tibial articular surface in patients with steep posterior tibial slope","authors":"Yutaka Nakamura ,&nbsp;Hiroyasu Ogawa ,&nbsp;Yusuke Ota ,&nbsp;Kaito Takagi ,&nbsp;Masaya Sengoku ,&nbsp;Kazuichiro Onishi ,&nbsp;Haruhiko Akiyama","doi":"10.1016/j.jjoisr.2026.02.002","DOIUrl":"10.1016/j.jjoisr.2026.02.002","url":null,"abstract":"<div><h3>Purpose</h3><div>In medial opening wedge high tibial osteotomy (OWHTO) with distal tibial tubercle osteotomy (DTO), the transverse osteotomy is typically made perpendicular to the tibial axis in the sagittal plane to avoid posterior gap behind the tibial tubercle. However, directing the osteotomy toward the fibular head may place the osteotomy line too close to the tibial articular surface. The purpose of this study was to investigate the relationship between fibular height on intra-operative fluoroscopy, the true fibular–articular distance, and the transverse osteotomy–articular distance.</div></div><div><h3>Methods</h3><div>Seventy-five patients (92 knees) who underwent OWHTO with DTO were evaluated retrospectively. Medial and lateral posterior tibial slopes (mPTS and lPTS) were measured on pre-operative computed tomography (CT) scans. On sagittal CT images, the anterior and posterior distances from the fibular head to the articular surface of the lateral tibial plateau (AD and PD) were measured, and their difference (AD-PD) was used as a surrogate for fibular height on fluoroscopy. On post-operative CT scans, the minimum distance from the transverse osteotomy line to the articular surface (TO-A) was measured. Correlations among these parameters were analyzed.</div></div><div><h3>Result</h3><div>The mean AD, PD, AD-PD, and TO-A was 13.1 ± 2.2 mm, 9.5 ± 2.3 mm, 3.6 ± 1.9 mm, and 15.5 ± 3.0 mm, respectively. TO-A correlated positively with PD and negatively with AD-PD. PD and TO-A correlated negatively, and AD-PD correlated positively with both mPTS and lPTS. Linear regression analysis showed that lPTS was a predictor of TO-A.</div></div><div><h3>Conclusions</h3><div>In patients with steep posterior tibial slope, the transverse osteotomy in OWHTO with DTO may be closer to the articular surface than expected, even when the fibular head appears low on fluoroscopy. Surgeons should therefore avoid placing the osteotomy too close to the articular surface in such cases.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"4 1","pages":"Pages 109-114"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147420685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronological changes in lower leg swelling up to one year after total knee arthroplasty: A prospective case series","authors":"Kohei Nishitani ,&nbsp;Shinichi Kuriyama ,&nbsp;Shinichiro Nakamura ,&nbsp;Hiromu Ito ,&nbsp;Shuichi Matsuda","doi":"10.1016/j.jjoisr.2025.10.004","DOIUrl":"10.1016/j.jjoisr.2025.10.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Lower leg swelling is a common complication following total knee arthroplasty (TKA). However, the long-term natural course of post-operative swelling remains unclear. This study aimed to evaluate chronological changes in calf circumference and to identify swelling patterns after TKA.</div></div><div><h3>Methods</h3><div>Patients with osteoarthritis who underwent unilateral TKA between 2020 and 2021 were included. Calf circumference on the operated side was measured on the day of surgery, at discharge (2–3 weeks post-operatively), and at 1.5, 3, 6, and 12 months after surgery. The minimum detectable change (MDC) of calf circumference was calculated to define a detectable change in swelling. Chronological changes were analyzed using Friedman's test, and factors associated with increased calf circumference were evaluated using multiple linear regression.</div></div><div><h3>Results</h3><div>A total of 104 patients (mean age 76.2 years) were enrolled. The MDC was calculated as 1.59 ​cm. The median calf circumference increased significantly at 1.5 months post-operatively (31.0 ​cm) compared with the pre-operative value (30.0 ​cm), then gradually decreased to baseline level. A detectable increase in swelling was observed in 31% of patients at 1.5 months. A greater increase in calf circumference at 1.5 months was associated with lower pre-operative calf circumference (β ​= ​−0.35; <em>p</em> ​&lt; ​0.001) and higher body mass index (β ​= ​0.14; <em>p</em> ​= ​0.02).</div></div><div><h3>Conclusions</h3><div>Calf circumference increased significantly at 1.5 months after TKA, and one-third of patients showed a detectable increase in swelling. These findings help clarify the time course of lower leg swelling and may guide patient education and post-operative monitoring.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"4 1","pages":"Pages 33-38"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145748198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}