Orthopedic Reviews最新文献

{"title":"A Meta-analysis of Randomized Controlled Trials of Adjunctive Biophysical Stimulation for Bone Regeneration Across Distraction Osteogenesis, Limb Reconstruction, and Delayed Union.","authors":"Mohammed M Tarabishi","doi":"10.52965/001c.165096","DOIUrl":"10.52965/001c.165096","url":null,"abstract":"<p><strong>Background: </strong>Impaired bone regeneration remains a major challenge in orthopedic reconstruction, particularly in distraction osteogenesis, limb reconstruction, and delayed union, where prolonged healing increases treatment burden and complication risk. Adjunctive biophysical stimulation, including low-intensity pulsed ultrasound and pulsed electromagnetic field stimulation, has been investigated as a noninvasive strategy to improve bone-healing outcomes, but evidence in reconstructive orthopedic settings remains limited and heterogeneous.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomized controlled trials was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Scopus, and Web of Science were searched from database inception to March 21, 2026. Eligible studies evaluated adjunctive low-intensity pulsed ultrasound or pulsed electromagnetic field stimulation in distraction osteogenesis, limb reconstruction, or delayed union using comparative control groups. Random-effects meta-analysis was performed for clinically comparable outcomes. Fixation-normalized healing outcomes were pooled as mean differences, radiographic healing outcomes as standardized mean differences, and methodological quality was assessed using RoB 2.</p><p><strong>Results: </strong>Seven randomized controlled trials met eligibility criteria for qualitative synthesis. Two studies contributed to quantitative pooling of fixation-normalized healing efficiency, demonstrating significantly shorter healing duration with adjunctive intervention compared with control (mean difference, -16.78 days/cm; 95% CI, -22.72 to -10.83; P < 0.001; I² = 0%). Three studies contributed to radiographic meta-analysis, showing a significant benefit favoring adjunctive biophysical stimulation (SMD, 0.40; 95% CI, 0.07-0.74; P = 0.02; I² = 42.1%). Secondary clinical burden and safety outcomes were not suitable for quantitative pooling because of heterogeneous reporting. Six studies were judged as having some concerns and one as high risk of bias.</p><p><strong>Conclusions: </strong>Adjunctive biophysical stimulation was associated with favorable healing-related outcomes in selected distraction osteogenesis, limb reconstruction, and delayed-union settings. However, the evidence base remains limited by small study numbers, methodological heterogeneity, and inconsistent outcome reporting, supporting the need for larger contemporary randomized trials.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"165096"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician Perceptions of Particulate Versus Non-Particulate Steroids in Epidural Steroid Injections.","authors":"Jamal Hasoon, Ovie Enaohwo, Roshan Mara, Gentry Mower, Christopher L Robinson, Omar Viswanath, Alan D Kaye, Thomas T Simopoulos, Jatinder Gill","doi":"10.52965/001c.166434","DOIUrl":"10.52965/001c.166434","url":null,"abstract":"<p><strong>Background: </strong>Epidural steroid injections (ESIs) are widely used for the treatment of chronic spinal pain, particularly in cervical and lumbar radiculopathy. Corticosteroids used in ESIs are broadly classified as particulate or non-particulate formulations, each with distinct safety and pharmacologic profiles. Comparative efficacy remains controversial. However, safety concerns regarding particulate steroid use in transforaminal injections are well established. However, physician perception of steroid effectiveness may influence clinical decision-making and practice patterns.</p><p><strong>Objective: </strong>To evaluate physician perceptions regarding the comparative efficacy of particulate versus non-particulate corticosteroids in ESIs.</p><p><strong>Methods: </strong>A survey-based study was conducted assessing physician beliefs on the duration and effectiveness of pain relief achieved with particulate and non-particulate steroids in ESIs. Responses were analyzed descriptively and compared to current literature.</p><p><strong>Results: </strong>Most physicians perceived particulate steroids to provide either equivalent or longer-lasting pain relief compared to non-particulate steroids, with a slight majority favoring particulate formulations. Very few respondents believed particulate steroids were inferior. These findings align with existing literature demonstrating largely comparable efficacy between steroid types, with inconsistent evidence suggesting minor differences in duration of pain relief.</p><p><strong>Conclusions: </strong>Despite mixed evidence regarding comparative efficacy, physician perception continues to favor particulate steroids for longer duration of analgesia. Given the known safety risks associated with particulate steroids, clinical decision-making should incorporate both efficacy data and patient-specific risk profiles. These findings highlight the importance of aligning physician perception with evolving evidence and safety guidelines.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"166434"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of depression on outcomes in revision knee replacement surgery.","authors":"Bekim Arifaj, Mohamed Habad, Mubaraq Hamzat, Abdullah Shakeel","doi":"10.52965/001c.166115","DOIUrl":"10.52965/001c.166115","url":null,"abstract":"<p><strong>Introduction: </strong>Revision total knee arthroplasty is associated with more variable functional recovery and greater postoperative burden than primary surgery. Depression may influence recovery, but its effect in revision knee replacement remains incompletely defined.</p><p><strong>Objective: </strong>To synthesise evidence on the association between depression or poor preoperative mental health and outcomes after revision total knee arthroplasty.</p><p><strong>Methods: </strong>PubMed, MEDLINE, and Embase were searched on August 12, 2025. Adult revision total knee arthroplasty studies assessing depression or mental health in relation to postoperative outcomes were eligible. Owing to heterogeneity in exposure definitions, outcomes, and follow-up, findings were narratively synthesised.</p><p><strong>Results: </strong>Of 103 records identified, 44 duplicates were removed and 59 records screened; 6 studies were included. Depression or poorer preoperative mental health was associated with worse postoperative function, persistent pain, greater narcotic analgesic use, lower satisfaction, infection, reoperation or re-revision, readmission, emergency department attendance, prolonged stay, non-home discharge, and higher costs. However, patients with poorer mental health could still achieve clinically meaningful functional improvement.</p><p><strong>Conclusion: </strong>Depression is associated with poorer outcomes after revision total knee arthroplasty but should not be considered a contraindication to surgery. Mental health recognition, expectation-setting, and multidisciplinary optimisation may improve perioperative care.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"166115"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progressive Hallux Pain Due to Subungual Exostosis: Diagnosis and Surgical Management.","authors":"Hassan Zmerly, Rebecca Rauch, Federica Dellafiore, Marco Russo, Andrea Vescio, Laura Campanacci","doi":"10.52965/001c.165501","DOIUrl":"10.52965/001c.165501","url":null,"abstract":"<p><strong>Background and aim: </strong>Subungual exostosis is a relatively uncommon benign ostecartilaginous lesion of the distal phalanx of the great toe, responsible for pain and nail deformity.</p><p><strong>Material: </strong>A case of subungual exostosis in a female patient is reported. Diagnosis was made performing clinical examination and plain foot radiographs. The treatment proposed was a complete surgical excision.</p><p><strong>Results: </strong>At the 9-month follow-up, there was no evidence of recurrence, and the patient was fully satisfied with the cosmetic and functional results.</p><p><strong>Conclusions: </strong>Subungual exostosis is a relatively rare condition which can cause pain and discomfort to the patient but, once correctly diagnosed, it can be successfully solved with a complete surgical excision.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"165501"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet-Rich Plasma Facet Joint Injections for Post-Traumatic Lumbar Facet-Mediated Pain: A Two-Patient Case Report.","authors":"Preethash Sundar, Ivan Urits, Omar Viswanath, Christopher L Robinson, Alan D Kaye, Jamal Hasoon","doi":"10.52965/001c.166432","DOIUrl":"10.52965/001c.166432","url":null,"abstract":"<p><strong>Background: </strong>Lumbar facet-mediated pain is a common contributor to axial low back pain and may occur after traumatic or mechanical injury, even when advanced imaging demonstrates only mild degenerative or nonspecific findings. Standard interventional treatment pathways often include diagnostic medial branch blocks followed by radiofrequency ablation, or intra-articular facet joint injections with corticosteroids. However, some patients wish to avoid corticosteroid exposure or neuroablative procedures. Platelet-rich plasma (PRP) is a biologic injectate that could be used for the treatment of facet-mediated low back pain, although the available clinical evidence remains very limited.</p><p><strong>Case presentation: </strong>We present two patients with post-traumatic axial low back pain clinically localized to the lumbar facet joints who elected to undergo lumbar facet joint PRP injections after declining medial branch blocks, radiofrequency ablation, and corticosteroid injections to the facet joints. The first patient was a woman in her 40s who developed low back pain after a motor vehicle collision. Lumbar MRI demonstrated minimal structural abnormalities, but examination revealed focal facet-region pain worsened with lumbar extension. She underwent PRP injections at the bilateral L3-4 and L4-5 facet joints, corresponding to the areas of maximal pain. At 6-week follow-up, she reported approximately 60% pain relief and continued participation in physical therapy and a home exercise program. The second patient was a man in his 50s who developed low back pain after falling from a ladder. Imaging demonstrated mild lumbar spondylosis and degenerative disc disease. He preferred PRP over corticosteroid injections, medial branch blocks, or radiofrequency ablation. PRP injections were performed at the L4-5 and L5-S1 facet joints, corresponding to his areas of maximal pain. At 6-week follow-up, he reported approximately 70% sustained pain relief. No complications were noted in either case.</p><p><strong>Conclusion: </strong>These cases suggest that lumbar facet joint PRP injections may provide moderate pain improvement in carefully selected patients with clinically suspected facet-mediated pain after acute injury, particularly those wishing to avoid corticosteroid injections or ablative procedures. However, diagnostic certainty may be lower when confirmatory medial branch blocks are not performed. Further controlled studies are needed to define optimal patient selection, PRP preparation, injection technique, and durability of response.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"166432"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal Shockwave Therapy in Pain Management - an In-Depth Narrative Review.","authors":"Wisdom Ufondu, Oludotun Ogunsola, Ava Williams, Kayla Valenti, Gabriella Herbert, Ezinne Ezenekwe, Justin Bufano, Toyyib Suleiman, Fredrick Esiso, David Jevotovsky, Jamal Hasoon, Vwaire Orhurhu","doi":"10.52965/001c.154361","DOIUrl":"10.52965/001c.154361","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this narrative review is to explain the cellular mechanisms behind chronic pain, the mechanisms behind extracorporeal shockwave therapy, and its efficacy for the treatment of various chronic pain conditions including tendinopathies, greater trochanteric pain, de quervain tenosynovitis, myofascial pain, plantar fasciitis, fibromyalgia, osteoarthritis, fractures, osteonecrosis, bone edema, coccydynia, low back pain, chronic pelvic pain syndrome/chronic prostatitis, ulcers, and carpal tunnel syndrome.</p><p><strong>Recent findings: </strong>Many recent clinical trials and meta-analyses from the year 2024 overall supported the efficacy of extracorporeal shockwave therapy for the treatment of chronic pain conditions with minimal adverse effects.</p><p><strong>Summary: </strong>Extracorporeal shockwave therapy is a novel technique that uses mechanotransduction to induce a cellular response that prevents central sensitization, reduces inflammation, and contributes to healing that alleviates pain. The specific mechanisms through which extracorporeal shockwave therapy are largely unknown or poorly understood. A literature search of Scopus, PubMed, Embase, and the Cochrane Database of Systematic Reviews was conducted to identify 84 studies from 2000-2024 evaluating the efficacy of extracorporeal shockwave therapy for the treatment of chronic pain conditions. The results indicate that extracorporeal shockwave therapy holds strong promise for the treatment of numerous chronic pain pathologies with minimal adverse effects and should be studied further.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"154361"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Cephalomedullary Nail Design Influence Risk of Varus Collapse in Subtrochanteric Femur Fractures?","authors":"Momin Ahmed, John Mickley, Andres Lopez, Patrick Baki, Alex Moses, Porter Young","doi":"10.52965/001c.166437","DOIUrl":"10.52965/001c.166437","url":null,"abstract":"<p><strong>Background: </strong>Cephalomedullary nails (CMNs) are frequently utilized for subtrochanteric femur fractures but a lack of cortical fit in proximal fractures may lead to varus deformity. We hypothesize that as the difference between fracture site canal width and diameter of the nail increases so will the risk of varus deformity.</p><p><strong>Methods: </strong>A retrospective study of subtrochanteric femur fractures fixed with CMNs at an academic, level one trauma center over a 6.5-year period was performed. Patients were divided into two cohorts: CMN with sliding blade/screw (TFNA) or greater trochanteric entry recon nail (GTE). The primary outcome analyzed was the correlation between nail-canal mismatch with final neck shaft angle. Secondary outcomes analyzed included rates of nonunion and malunion.</p><p><strong>Results: </strong>Seventy-one patients met the inclusion criteria (35 TFNA and 36 GTE). There was not a significant correlation between the nail-canal mismatch with final neck shaft angle for GTE nails (Pearson correlation coefficient r: -0.187, p=0.274). However, when TFNAs were subdivided into 125° and 130° cohorts, there was a stronger negative correlation for 125° (r: -0.678, p=0.001) compared to the 130° (r: -0.515, p=0.041). For 125° TFNAs, linear regression analysis demonstrated that for every 1 mm increase in nail-canal mismatch there was a decrease in final neck shaft angle by 0.757⁰. There was no difference in secondary outcomes.</p><p><strong>Conclusion: </strong>GTE nails and TFNAs have similar rates of malunion and nonunion when managing subtrochanteric femur fractures. However, 125° TFNAs may be associated with increased varus neck shaft angles as the nail-canal mismatch increases.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"166437"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of dual locking-plate fixation for bicondylar tibial plateau fractures via two mini-incisions: A prospective study.","authors":"Ngoc Quyen Le, Khac Xuan Hoang, Trong Xuan Cuong Tran","doi":"10.52965/001c.165504","DOIUrl":"10.52965/001c.165504","url":null,"abstract":"<p><strong>Background: </strong>Bicondylar tibial plateau fractures are complex injuries that frequently involve a posteromedial fragment and carry a high risk of post-traumatic osteoarthritis. However, long-term outcome data on dual locking-plate fixation are limited, particularly in Southeast Asian populations.</p><p><strong>Objective: </strong>The aim of this prospective study was to evaluate longitudinal clinical and imaging outcomes of bicondylar tibial plateau fractures managed with anterolateral and posteromedial locking plates via two mini-incisions.</p><p><strong>Methods: </strong>This prospective study included 55 patients treated with open reduction and dual locking-plate fixation via anterolateral and posteromedial mini-incisions. Outcomes included radiographic parameters, clinical function and complications.</p><p><strong>Results: </strong>The mean age was 45.4 ± 12.4 years; 60% of patients were male and motorcycle accidents accounted for 90.9% of injuries. Forty-five patients (81.8%) completed the 60-month assessment. Lateral plateau depression was reduced from 5.25 mm preoperatively to 1.00 mm postoperatively and was 2.17 mm at 5 years. KSS Knee peaked at 12 months (83.4 ± 8.2) and was 78.9 ± 8.8 at 5 years; the Rasmussen clinical score followed a similar trajectory. The overall complication rate was 23.6%, with a single deep infection (1.8%). Kellgren-Lawrence grade ≥ 2 increased from 14.5% of injured knees at 12 months to 53.3% at 60 months. Schatzker VI was associated with smaller Rasmussen clinical improvement than Schatzker V (-2.09; p = 0.023).</p><p><strong>Conclusions: </strong>Dual locking-plate fixation through two mini-incisions provides favorable clinical and functional outcomes up to 5 years for bicondylar tibial plateau fractures; however, progressive post-traumatic osteoarthritis remains a long-term concern warranting surveillance.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"165504"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous Bilateral Quadriceps Tendon Rupture After Low-Energy Trauma in a 73-Year-Old Man: A Case Report and Literature Review.","authors":"Konstantinos Makiev, Theodoros Chouliaras, Antigoni Gkoudina, Vasileios Chouliaras","doi":"10.52965/001c.166122","DOIUrl":"10.52965/001c.166122","url":null,"abstract":"<p><p>Simultaneous bilateral quadriceps tendon rupture is an exceptionally rare injury of the knee extensor mechanism and may present a diagnostic challenge, particularly after low-energy trauma. Prompt recognition is essential to restore knee extension and ambulatory function. We report the case of a 73-year-old man who presented to the Emergency Department after falling while descending stairs and landing directly onto both knees. He developed immediate bilateral knee pain and inability to ambulate. Clinical examination revealed palpable suprapatellar defects bilaterally, inability to perform straight leg raise, and loss of active knee extension in both knees. Plain radiographs demonstrated bilateral patella baja with central calcific densities suggestive of pre-existing degenerative tendon changes. Based on the evident clinical findings, no further magnetic resonance imaging was required. The patient underwent urgent bilateral surgical repair using a transosseous patellar tunnel technique with No. 5 nonabsorbable Ethibond sutures in a locking Krackow configuration. A structured postoperative rehabilitation program with progressive mobilization and strengthening was implemented. At 18-month follow-up, the patient reported no pain, independent ambulation without assistive devices, unrestricted activities of daily living, full knee extension, and flexion to approximately 130° bilaterally. This case highlights that simultaneous bilateral quadriceps tendon rupture may occur even in the absence of major systemic comorbidity and should be considered in elderly patients presenting with acute bilateral knee pain and extensor mechanism dysfunction after minor trauma. Early surgical repair combined with structured rehabilitation can result in excellent functional recovery.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"166122"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional alignment preserves the native Coronal Plane Alignment of the Knee phenotype while improving early clinical outcomes after robotic-assisted total knee arthroplasty.","authors":"Georgii Airapetov, Alexey Prizov, Armen Daniliyants, Rasul Aliev, Ahmat Abdulaye, Varvara Iatsukova","doi":"10.52965/001c.166120","DOIUrl":"10.52965/001c.166120","url":null,"abstract":"<p><strong>Background: </strong>Functional alignment (FA) has emerged as a personalized strategy for robotic-assisted total knee arthroplasty (ra-TKA), aiming to preserve constitutional knee anatomy and native soft-tissue balance. However, evidence directly comparing robotic-assisted FA and mechanical alignment (MA) using the same robotic platform remains limited.</p><p><strong>The aim of the study: </strong>To compare the early clinical, radiographic, and constitutional phenotype outcomes of ra-TKA performed using FA and MA.</p><p><strong>Methods: </strong>In this prospective randomized single-center study, 100 patients with primary varus knee osteoarthritis underwent primary ra-TKA using the CORI Surgical System and were randomized to the FA (n=50) or MA (n=50) group. Clinical outcomes (KSS, FJS-12, VAS), radiographic alignment (HKA, LDFA, MPTA), soft-tissue release, and postoperative CPAK phenotype preservation were evaluated over 12 months.</p><p><strong>Results: </strong>Both groups demonstrated significant postoperative improvement. At 3 months, the FA group achieved significantly higher KSS Knee, KSS Function, and FJS-12 scores together with lower VAS pain scores than the MA group (all p<0.05). These differences were no longer significant at 12 months. FA required fewer soft-tissue releases while maintaining radiographic accuracy comparable to MA. Constitutional CPAK phenotype was preserved in 82% of FA patients, whereas all mechanically aligned knees were converted to CPAK phenotype V. Native joint-line orientation and constitutional varus alignment were preserved in all FA cases.</p><p><strong>Conclusion: </strong>Robotic-assisted functional alignment provides accurate and reproducible component positioning while preserving constitutional knee phenotype and reducing soft-tissue release. Although long-term clinical outcomes were comparable, FA resulted in superior early functional recovery and represents a safe personalized alignment strategy.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"166120"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}