Journal of orthopaedics最新文献

{"title":"The revised risk analysis index outperforms the 5-factor modified frailty index in predicting postoperative morbidity after pilon fracture fixation","authors":"Gabriel DeOliveira ,&nbsp;Amber Park ,&nbsp;Arsalaan Sayyed ,&nbsp;Aruni Areti ,&nbsp;Nithin Gupta ,&nbsp;Taylor Manes ,&nbsp;Morgan Turnow ,&nbsp;Benjamin Taylor ,&nbsp;Jack W. Weick","doi":"10.1016/j.jor.2025.08.022","DOIUrl":"10.1016/j.jor.2025.08.022","url":null,"abstract":"<div><h3>Background</h3><div>Pilon fractures often result from high energy mechanisms resulting in long-term morbidity and postoperative complications. While there is extensive literature investigating frailty scales as tools for preoperative risk stratification in orthopedic surgery, there is no literature regarding their use in fixation of pilon fractures. The objective of this study was to compare the predictive ability and discriminative accuracy of the Revised Risk Analysis Index (RAI-rev) and the 5-Item Modified Frailty (mFI-5) in 30-day postoperative outcomes following surgical fixation of pilon fractures.</div></div><div><h3>Methodology</h3><div>The ACS-NSQIP database was used to identify patients undergoing surgical fixation of pilon fractures from 2015 to 2020. Multivariate analysis was used to analyze the predictive ability of frailty status for 30-day postoperative outcomes. Discriminatory accuracy of frailty scales was assessed using receiver operating characteristic analysis. Significance was determined by p &lt; 0.05.</div></div><div><h3>Results</h3><div>This study included 2935 patients, aged 33–59, of which 53 % (1562/2935) were male. The RAI-rev categorized 44.2 % (1296/2935) as normal, 44.6 % (1309/2935) as frail, and 11.2 % (330/2935) as severely frail. The mFI-5 was a significant predictor of major complications, readmission, and CDIV complications for severely frail patients and of eLOS, and NHD in both frail and severely frail patients. The RAI-rev had superior discriminative accuracy for most outcomes with good discriminative ability for NHD compared to mFI-5 (0.79 vs 0.74).</div></div><div><h3>Conclusion</h3><div>This study demonstrated that compared to RAI-rev, mFI-5 is a significant predictor of postoperative complications after surgical fixation of pilon fractures, but RAI-rev had more accurate predictive ability when compared to mFI-5, most notable for NHD (AUC 0.79 vs 0.74). However, ROC values for both RAI (AUC 0.65–0.79) and mFI-5 (AUC 0.59–0.74) still fell below an AUC of 0.80 indicating that overall frailty is not a strong predictor of outcomes. These findings support the need for further research into preoperative risk assessment in pilon fracture patients.</div></div><div><h3>Level of evidence</h3><div>III – retrospective cohort study.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 301-306"},"PeriodicalIF":1.5,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891845","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":"A prospective clinical evaluation of meniscal repair, with or without concomitant anterior cruciate ligament reconstruction, in paediatric patients","authors":"Jay R. Ebert ,&nbsp;Elizabeth Garcia ,&nbsp;Michael Mason ,&nbsp;Peter Counsel ,&nbsp;Dror Maor ,&nbsp;Ryan Lisle ,&nbsp;Clem McCormick ,&nbsp;Peter Annear","doi":"10.1016/j.jor.2025.08.015","DOIUrl":"10.1016/j.jor.2025.08.015","url":null,"abstract":"<div><h3>Background</h3><div>Studies reporting paediatric meniscal repair outcomes are limited, often retrospective and lacking objective outcomes. This study sought to determine clinical outcomes, return to sport (RTS), meniscal healing and re-injury rates in paediatric patients undergoing meniscal repair, with or without anterior cruciate ligament reconstruction (ACLR).</div></div><div><h3>Methods</h3><div>Overall, 32 paediatric patients (mean age 13.8 years) undergoing meniscal repair were recruited, in isolation (n = 14) or with ACLR (n = 18). Outcomes to 24 months included patient-reported outcome measures (PROMs), RTS, isokinetic strength and a 5-hop battery. Limb Symmetry Indices (LSIs) were calculated. Re-injuries and re-operations were presented. Magnetic resonance imaging (MRI) was undertaken to assess healing.</div></div><div><h3>Results</h3><div>All PROMs, quadriceps strength and hop test LSIs improved (p &lt; 0.05). While those undergoing isolated meniscal repair (versus those with ACLR) demonstrated higher LSIs for the triple (p = 0.023) and triple crossover (p = 0.019) hop tests at 6 months, and the medial hop test at 6 (p = 0.042) and 12 (p = 0.019) months, no other differences existed. Mean LSIs for all strength and hop tests were ≥90 % at 12 and 24 months. Of the 96.4 % of patients participating in Noyes Level 1 or 2 pivoting sports pre-injury, 89.3 % were by 24 months. One isolated repair patient encountered a re-injury at 18 months, while one combined ACLR and meniscal repair patient suffered an ACL re-tear at 14 months. Complete or near-full healing was observed on MRI in 68 % of repairs.</div></div><div><h3>Conclusion</h3><div>Subjective and physical performance scores improved following meniscal repair, either in isolation or concomitantly with ACLR, with high levels of RTS.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 226-234"},"PeriodicalIF":1.5,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852439","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":"Perioperative outcomes of the quadriceps-sparing subvastus approach versus medial parapatellar approach for primary total knee arthroplasty","authors":"James S. MacLeod ,&nbsp;Maxwell Hershey ,&nbsp;Katherine A. Sherman ,&nbsp;Michael S. Lee ,&nbsp;Corey McKenzie ,&nbsp;Vasil V. Kukushliev ,&nbsp;Adam Wooldridge ,&nbsp;Karl Scheidt","doi":"10.1016/j.jor.2025.08.019","DOIUrl":"10.1016/j.jor.2025.08.019","url":null,"abstract":"<div><h3>Aims &amp; objectives</h3><div>The quadriceps-sparing subvastus (SV) approach for total knee arthroplasty (TKA) is theorized to prevent extensor mechanism injury, accelerate recovery and is often compared to the medial parapatellar (MPP) approach. We aimed to compare postoperative outcomes of SV and MPP approaches after TKA in the veteran population.</div></div><div><h3>Materials &amp; methods</h3><div>We conducted a retrospective cohort study of all unilateral primary TKAs performed at our institution with an MPP or SV approach between January 1st, 2017 and December 31st, 2020. Information on demographics, and comorbidities were extracted from medical records in addition to length of stay, inpatient morphine milligram equivalents (MMEs), time to ambulate, discharge VAS pain score, outpatient MMEs, emergency room presentation within 30 days, and readmissions within 30 days.</div></div><div><h3>Results</h3><div>We gathered data from 393 patients undergoing TKA, 352 (89.6 %) patients had an MPP approach and 41 (10.4 %) had an SV approach. When controlling for postoperative protocol, there were no significant differences in complications or measured outcomes between the two approaches. An early ambulation protocol significantly expedited time to ambulate <em>P</em> &lt; 0.001 and outpatient MMEs were significantly lower in patients on a tapered outpatient opioid protocol <em>P</em> &lt; 0.001. There were two extensor mechanism complications with the MPP approach (0.57 %) and none with the SV approach.</div></div><div><h3>Conclusion</h3><div>There were no significant differences and effect sizes were small for measured outcomes between veterans undergoing TKA with SV and MPP approach when controlling for postoperative protocol. However, the SV approach group was underpowered. Results indicate the success of early ambulation and opioid tapering protocols.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 208-214"},"PeriodicalIF":1.5,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144840846","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":"Length of stay, pain and opioid consumption following manual versus robotic-assisted total hip arthroplasty","authors":"Felix C. Oettl ,&nbsp;Aaron I. Weinblatt ,&nbsp;Stephen Lyman ,&nbsp;Shu-Han Wang ,&nbsp;Michael Parides ,&nbsp;Francesca Coxe ,&nbsp;Gwo-Chin Lee ,&nbsp;Amar S. Ranawat ,&nbsp;Alejandro Gonzalez Della Valle","doi":"10.1016/j.jor.2025.08.018","DOIUrl":"10.1016/j.jor.2025.08.018","url":null,"abstract":"<div><h3>Background</h3><div>Robotic assistance in total hip arthroplasty (THA) has increased, but the influence on outcomes compared to manual THA remains uncertain. With the growing emphasis on reducing opioid consumption after arthroplasty, we studied whether robotic assistance was associated with length of stay (LOS), pain, and opioid use after THA.</div></div><div><h3>Materials and methods</h3><div>We included 14,501 opioid-naïve patients who underwent THA at a single institution between 2019 and 2023 (8900 manual and 5601 robotic). In-hospital pain scores (NRS), LOS, and opioid consumption patterns were collected. Opioid dosages were converted to morphine milligram equivalents (MMEs). After preliminary bivariate analysis, multivariable linear regression analyses were performed adjusting for age, sex, race, BMI, ASA-class, smoking status, cement use, marital status, year of surgery, surgeon experience, approach and periarticular injection.</div></div><div><h3>Results</h3><div>Robotic THA was associated with significantly shorter LOS (Estimate: 6.8 h, 95 %CI: 8.0, −5.6, p &lt; 0.0001). Robotic THA patients had higher minimal and mean pain scores (Estimate: 0.03, 95 %CI: 0.02–0.05, p &lt; 0.001; Estimate: 0.08, 95 %CI: 0.03, 0.14, p = 0.0042). Robotic THA patients used less MMEs per hour of hospitalization (Estimate −0.11 MMEs, 95 %CI -0.174, −0.039, p = 0.0021), but were prescribed more MMEs at discharge (Estimate: 3.59 MMEs, 95 %CI: 0.323, 6.856, p = 0.0312). The differences in MMEs refilled after discharge and total 90-day opioid prescription patterns were not significant.</div></div><div><h3>Conclusion</h3><div>Robotic assistance in THA was independently associated with a slightly shorter LOS. The significantly higher pain scores (0.08 points of NRS) and lower in-hospital opioid consumption (0.11 MMEs/hour) suggest that while some statistically significant differences exist between robotic-assisted and manual THA, these differences may not be clinically meaningful.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 202-207"},"PeriodicalIF":1.5,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144840939","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":"Female high school soccer injuries presenting to US emergency departments: A 10-year analysis of national injury data","authors":"Jennifer Yu ,&nbsp;Avanish Yendluri ,&nbsp;Julian V. Javier ,&nbsp;Sohan S. Shah ,&nbsp;Jeffrey Yu ,&nbsp;Dennis M. Bienstock ,&nbsp;Christon Darden ,&nbsp;Salvatore Capotosto ,&nbsp;Rachel M. Frank ,&nbsp;Theodore J. Ganley ,&nbsp;Robert L. Parisien ,&nbsp;Investigation performed by the Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group","doi":"10.1016/j.jor.2025.08.017","DOIUrl":"10.1016/j.jor.2025.08.017","url":null,"abstract":"<div><h3>Background</h3><div>Female athletes are underrepresented in sports injury research, especially regarding soccer-related injury patterns in adolescent females. This study analyzes injury trends among high school-aged female soccer players to address injury risks in this population. We hypothesize that soccer-related injuries in high school-aged females most commonly involve the head or lower extremities, with incidence decreasing over time due to improved prevention measures.</div></div><div><h3>Materials and methods</h3><div>The National Electronic Injury Surveillance System (NEISS) was queried for soccer-related injuries in females aged 14–18 from 2014 to 2023. Demographics, injury sites, and diagnoses were analyzed. National estimates (NEs) were calculated using NEISS statistical weights. Linear regression evaluated trends over time.</div></div><div><h3>Results</h3><div>From 2014 to 2023, an estimated 227,217 soccer-related injuries occurred in high school-aged females (7248 NEISS cases). Strains/sprains were the most common diagnosis (NE = 96,619, 33.2 %), followed by head injuries and concussions (NE = 57,311, 19.7 %). The head was the most frequently injured body part (21.1 %), followed by the ankle (20.6 %) and knee (15.7 %). Injuries significantly declined over time (p &lt; 0.05). Notably, injuries decreased by 53.4 % from 2019 to 2020 but rose by 57.7 % from 2020 to 2021.</div></div><div><h3>Discussion</h3><div>There was a significant decline in female high school soccer injuries from 2014 to 2023, with head and lower extremity injuries being most common. The high frequency of head injuries emphasizes the importance of concussion baseline testing and treatment protocols. The decline in injuries, particularly head injuries, may reflect the effectiveness of prevention strategies implemented during the study period.</div></div><div><h3>Conclusions</h3><div>This study highlights the need for targeted prevention strategies, including baseline concussion testing, protective gear, and improved training practices. The decline in injury rates suggests the positive impact of safety measures while identifying areas for further improvement to ensure player safety.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"69 ","pages":"Pages 324-328"},"PeriodicalIF":1.5,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851764","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":"Impact of psoriasis on THA and TKA outcomes: A systematic review","authors":"Robert S. Chin ,&nbsp;Andrew K. Chow ,&nbsp;Charles R. Reiter ,&nbsp;Brady Ernst ,&nbsp;Matthew Smith ,&nbsp;Joshua Setliff ,&nbsp;John Cyrus ,&nbsp;Jibanananda Satpathy","doi":"10.1016/j.jor.2025.08.007","DOIUrl":"10.1016/j.jor.2025.08.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Psoriasis is an autoimmune inflammatory condition that often intersects with orthopaedic care due to its connection to psoriatic arthritis. However, not all psoriasis patients develop psoriatic arthritis. Psoriasis patients may undergo hip or knee arthroplasties for reasons unrelated to psoriasis. This condition, marked by inflamed, scaly skin caused by an overactive immune system, may pose challenges for orthopaedic surgeries. This systematic review evaluated outcomes for psoriasis patients after total hip arthroplasty (THA) or total knee arthroplasty (TKA), focusing on postsurgical impact to inform additional considerations for patients.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, a systematic search was conducted in Medline, Embase, Web of Science, and Cochrane (up to October 2024). Studies involving patients with psoriasis undergoing THA or TKA were analyzed for postoperative outcomes.</div></div><div><h3>Results</h3><div>359 studies were screened, 7 met inclusion criteria. Two studies focused on THA, three on TKA, and two examined both procedures. Patients with psoriasis undergoing THA showed increased risk of infections compared to non-psoriasis patients. For TKA, results were mixed in whether psoriasis led to higher infection rates. Psoriasis did not lead to increased revisions in both THA and TKA. Additionally, two studies found no significant differences in wound complications in TKA patients.</div></div><div><h3>Conclusion</h3><div>This systematic review underscores the importance of considering post-surgical complications in psoriasis patients undergoing either a THA or TKA. However, lack of research makes it difficult to generalize findings. Psoriasis is an important factor to consider for surgical outcomes, but further research is needed to clarify risks and optimize care for patients.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"69 ","pages":"Pages 317-323"},"PeriodicalIF":1.5,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829378","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":"Fibrinogen-albumin-ratio is an independent predictor of deep vein thrombosis in patients undergoing knee arthroplasty","authors":"Chen Yan ,&nbsp;Qian Wang ,&nbsp;Xin Li","doi":"10.1016/j.jor.2025.08.008","DOIUrl":"10.1016/j.jor.2025.08.008","url":null,"abstract":"<div><h3>Background</h3><div>Deep vein thrombosis (DVT) is a prevalent complication of KA following knee arthroplasty (KA), leading to the development of post-thrombotic syndrome (PTS). PTS is associated with declining quality of life (QoL) and increased treatment costs. This study aims to investigate the correlation between fibrinogen to albumin ratio (FAR) and lower extremity DVT and evaluate the predictive value of FAR in diagnosing DVT post-KA.</div></div><div><h3>Methods</h3><div>A total of 331 patients undergoing KA at the Department of Joint Surgery between August 2020 and August 2022 were included in this study. Among them,38 patients with DVT identified through post-operative routine color Doppler flow imaging (CDFI) comprised the study group, while 278 patients without DVT formed the control group. Pre-operative FAR ratios were analyzed to investigate the association between pre-operative FAR and lower extremity DVT following KA.</div></div><div><h3>Results</h3><div>No significant differences were observed in the basic characteristics between the two groups. Additionally, there were no statistically significant differences in the laboratory values, including white blood cells, neutrophils, hemoglobin, fibrinogen, albumin, and platelets before and after surgery. However, the pre-operative FAR in patients with DVT was significantly higher than that in the control group (0.077 ± 0.007 vs. 0.067 ± 0.012, P &lt; 0.001). ROC curve analysis of FAR for predicting lower extremity DVT revealed a cut-off value of 0.070 (AUC = 0.732, P &lt; 0.001), with a sensitivity of 94.7 % and specificity of 51.1 %. Multivariate logistic regression analysis showed pre-operative FAR was the only independent predictor of DVT post-KA (OR = 1.12, 95 %CI: 1.06–1.17, P &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Pre-operative FAR has a good predictive capability for lower extremity DVT post-KA.Its detection may be a simple and useful method for the prediction of DVT in patients undergoing KA.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"69 ","pages":"Pages 305-310"},"PeriodicalIF":1.5,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827616","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":"Regional variation in distal femur subchondral bone mineral density: An in vitro human cadaveric model","authors":"Kyle W. Zittel ,&nbsp;Kyle P. Zielinski ,&nbsp;Madison C. Thompson ,&nbsp;William F. Postma ,&nbsp;Ryan S. Murray ,&nbsp;Bryan W. Cunningham","doi":"10.1016/j.jor.2025.08.003","DOIUrl":"10.1016/j.jor.2025.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Osteochondral defects of the knee are a frequent cause of pain that often require surgical intervention. Restorative procedures such as osteochondral autograft transplantation (OAT) and osteochondral allograft transplantation (OCA) aim to replace cartilage lesions with healthy autologous tissue or cadaveric tissue from the distal femur, respectively. Osteochondral graft donor sites are selected to optimize donor-recipient site congruity by assessing factors such as surface topography, cartilage thickness, and contact pressures. However, few studies have evaluated subchondral bone mineral density (BMD) when selecting an osteochondral graft donor site.</div></div><div><h3>Purpose</h3><div>To examine bone morphology and characterize variation in subchondral BMD of the human distal femur.</div></div><div><h3>Study design</h3><div>Descriptive Laboratory Study.</div></div><div><h3>Methods</h3><div>18 human cadaveric distal femurs were utilized in the current study. All soft tissue and ligaments of the distal femur were removed. Dual-energy X-ray absorptiometry (DEXA) scans were performed on each femur to determine BMD of five regions of interest (ROI). ROIs included the entire distal femur, medial condyle, lateral condyle, posterior condyles, and trochlea. Subsequently, 90 osteochondral bone plugs (10 mm diameter, 10 mm depth) were harvested collectively from the medial and lateral trochlea of included specimens. DEXA scans of each osteochondral graft were then performed. Statistical analysis was performed via Welch Two-Sample <em>t</em>-test. Significance was defined as p &lt; 0.05.</div></div><div><h3>Results</h3><div>All specimens were included for analysis. There were no significant differences in the dimensional characteristics or BMDs of corresponding ROIs across distal femurs. There was no significant difference in the BMD of the medial condyle compared to the lateral condyle, and the posterior condyle compared to the trochlea. Also, there was no significant difference in BMD of grafts extracted from the medial and lateral trochlea (all p &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>No significant difference was found in BMD between the medial and lateral condyles, trochlea and posterior condyles, or osteochondral grafts harvested from the medial and lateral trochlear ridges of the distal femur.</div></div><div><h3>Clinical relevance</h3><div>Similar BMD between common osteochondral donor and recipient sites may provide surgeons with added confidence that fewer adjustments must be made to optimize congruity with respect to bone density.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"69 ","pages":"Pages 283-287"},"PeriodicalIF":1.5,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827614","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":"Similar joint line convergence angle correction with mechanical and patient-specific alignment in robotic-assisted TKA","authors":"David Figueroa Poblete ,&nbsp;Waldo Gonzalez Duque ,&nbsp;Rafael Calvo Rodriguez ,&nbsp;Jorge Isla Villanueva ,&nbsp;Francisco Figueroa Berrios","doi":"10.1016/j.jor.2025.08.006","DOIUrl":"10.1016/j.jor.2025.08.006","url":null,"abstract":"<div><h3>Introduction</h3><div>In total knee arthroplasty (TKA), positioning implants closer to the patient's constitutional alignment improves joint line obliquity (JLO), replicating normal biomechanics and gait patterns. As a result, the joint line convergence angle (JLCA) has gained recognition as a key parameter for assessing intra-articular deformity and lateral soft tissue laxity. This study aimed to evaluate JLCA changes following robotic-assisted TKA (RA-TKA) using two alignment strategies. We hypothesized that a patient-specific alignment (PSA) strategy would result in greater JLCA correction and improved outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review of 98 patients (100 knees) undergoing RA-TKA was performed. Group I (50 knees) underwent mechanical alignment (MA), while Group II (50 knees) underwent PSA. JLCA was measured preoperatively and postoperatively by two independent observers. Demographic and functional data, including KOOS JR scores were collected, and statistical analyses were performed using STATA v.18.5.</div></div><div><h3>Results</h3><div>Both groups showed significant postoperative improvement in JLCA: from 2.34° to 0.35° in the MA group, and from 2.43° to 0.29° in the PSA group. However, the degree of JLCA correction did not differ significantly between groups (p = 0.285). KOOS JR scores improved similarly in both groups, with no significant differences at 1-year follow-up.</div></div><div><h3>Conclusions</h3><div>Robotic-assisted TKA significantly improved JLCA regardless of alignment strategy. Patient-specific and mechanical alignment approaches yielded comparable radiographic and functional outcomes.</div></div><div><h3>Level of evidence</h3><div>Level IV.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"69 ","pages":"Pages 265-270"},"PeriodicalIF":1.5,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144809560","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":"Closing the flexion gap: Differences in femoral sizes, level of constraint, and joint anatomy between robotic assisted and conventional high volume orthopedic surgeons","authors":"John M. Dundon ,&nbsp;Nicholas Brown ,&nbsp;Jennifer Escobar ,&nbsp;Paul M. Lombardi","doi":"10.1016/j.jor.2025.08.009","DOIUrl":"10.1016/j.jor.2025.08.009","url":null,"abstract":"<div><h3>Background</h3><div>One of the most common reasons for revision TKA is flexion instability. Using conventional methods, it is potentially difficult to fully assess flexion instability which can lead to pain and disability following TKA. The purpose of this study was to assess femoral size differences between surgeons with different techniques to determine the difference in femoral sizing or polyethylene constraint.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed data from 1508 patients who underwent unilateral primary TKA performed by either restricted kinematic alignment (RKA) with robotic assistance, mechanical alignment (MA) with measured resection, and mechanical alignment with gap balancing (GB). Component sizes, joint alignment and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) values were compared. Statistical analysis was performed using chi-square and ANOVA tests with 95 % confidence intervals.</div></div><div><h3>Results</h3><div>A total of 1508 patients were consecutively analyzed, 789 in the robotic, kinematic technique, 371 in the manual mechanically aligned technique and 348 in the manual gap balancing technique. A significant increase in femoral size and a significant decrease in polyethylene size was observed using robotics with the RKA technique than either the gap balanced or mechanically aligned approach (p &lt; 0.0001). The gap balancing surgeon used significantly smaller tibial implant sizing compared to the other two surgeons (p &lt; 0.0001). RKA resulted in the smallest change in the medial joint line, increased posterior femoral offset, and a varus alignment consistent with native knee preservation. MA techniques showed greater changes in lateral joint line and proximal tibial angles.</div></div><div><h3>Conclusion</h3><div>Restrictive kinematic technique using robotic arm navigation led to larger femoral sizes, a significant decrease in semi-constrained polyethylene usage, and better restoration of posterior femoral offset. No significant difference in patient reported outcomes was observed. Future research should investigate long-term implications of these findings on joint function and patient satisfaction.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 220-225"},"PeriodicalIF":1.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851931","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}