JBJS Open Access最新文献

{"title":"Efficacy of Ultra-high and High Molecular Weight Cross-Linked Hyaluronic Acids Compared with Saline in Knee Osteoarthritis: A Randomized Controlled Trial.","authors":"Supakit Kanitnate, Pattaranatcha Charnwichai, Yot Tanariyakul, Nattapol Tammachote","doi":"10.2106/JBJS.OA.25.00341","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00341","url":null,"abstract":"<p><strong>Introduction: </strong>Intra-articular hyaluronic acid (HA) injections are widely used for knee osteoarthritis (OA) to reduce pain and improve function. The efficacy of cross-linked HA over placebo remains debated. This study aimed to compare the efficacy of 2 single-injection, ultra-high, and high molecular weight (HMW) cross-linked HAs against a saline placebo for symptomatic knee OA.</p><p><strong>Methods: </strong>We conducted a single-center, double-blind, randomized, placebo-controlled trial with 24-week follow-up. A total of 276 patients with primary knee OA were randomized into 3 groups: ultra-high MW HA (Hyruan ONE), HMW HA (hylan G-F 20), and saline. All participants received a single intra-articular injection. Primary outcomes were visual analog scale (VAS) pain scores at rest and during motion at weeks 1 to 24 and the change from baseline over the 24-week period. Secondary outcomes included the modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-36 (SF-36), Lequesne index, Time Up and Go (TUG) test, and active knee flexion at weeks 2, 4, 12, and 24. Patients who did not improve could receive a rescue corticosteroid injection, after which they were excluded from further analysis.</p><p><strong>Results: </strong>No significant differences in pain reduction were observed between the HA and saline groups at rest (p = 0.92) and during motion (p = 0.99). All groups showed significant improvement in VAS scores over 24 weeks (p < 0.0001). Modified WOMAC scores were also similar among the 3 groups (p > 0.05). All groups had comparable outcomes for the SF-36 (p = 0.91), Lequesne index (p = 0.93), TUG test (p = 0.48), and knee flexion (p = 0.90). The rates of rescued corticosteroid injections rates were similar across the 3 groups (17% vs. 21% vs. 25%, p = 0.98).</p><p><strong>Conclusions: </strong>Ultra-high and HMW cross-linked HA injections did not provide superior pain or functional outcomes compared with saline for knee OA. These findings provided high-level evidence challenging the clinical benefit of cross-linked HAs. Consequently, the cost-effectiveness is uncertain and warrants formal economic evaluation.</p><p><strong>Level of evidence: </strong>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843838","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 Effect of Tibial and Femoral Component Coronal Alignment on Survivorship After Total Knee Arthroplasty: A Systematic Scoping Review of the Literature.","authors":"Wayne Hoskins, Charles Gusho","doi":"10.2106/JBJS.OA.25.00350","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00350","url":null,"abstract":"<p><strong>Background: </strong>Component alignment in contemporary total knee arthroplasty (TKA) is frequently achieved through personalized alignment philosophies that aim to restore prearthritic knee anatomy. The long-term clinical efficacy and safety of these approaches remain uncertain. This comprehensive review assessed the relationship between coronal component alignment and TKA implant survivorship.</p><p><strong>Methods: </strong>A scoping review was performed of published primary TKA studies that (1) reported postoperative tibial or femoral component coronal alignment on long-leg radiography, (2) reported survivorship with a minimum 12-month follow-up, and (3) were written in English. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and its scoping review extension (PRISMA-ScR). The primary <i>a priori</i> outcome was all-cause aseptic revision. Included studies underwent qualitative synthesis.</p><p><strong>Results: </strong>Of 3,786 screened studies, 332 underwent full-text review and 51 met inclusion criteria, encompassing 7,944 patients (9,687 TKAs) (mean [SD] age 68.1 [3.2] years; mean [SD] follow-up 4.6 [3.3] years). Most studies (76.5%, n = 39/51) investigated a single alignment philosophy (most commonly mechanical alignment [MA], n = 23, 56.1% of single-philosophy studies), while 10/51 (19.6%) compared 2 philosophies. Only 5 studies (9.8%) included >500 TKAs. Long-term follow-up (>10 years) was reported in 9 MA studies (28.1% of MA reports), 5 of which noted decreased survivorship with component varus or valgus. Survivorship ranged from 74.2% to 79.3% with increased tibial varus, 90% with increased femoral varus, and 83.3% with femoral valgus. Two kinematic alignment (KA) studies with >10-year follow-up reported no survivorship concerns. Decreased short-term to mid-term survivorship was reported in 2 KA studies (10.5%). No long-term data existed for other alignment philosophies, and the largest personalized alignment series included only 338 TKAs.</p><p><strong>Conclusion: </strong>Most studies demonstrated excellent short-to-midterm (5-year) survivorship regardless of coronal component alignment. However, limited evidence suggests increased early revision risk with some personalized alignment philosophies and reduced long-term (>10 years) survivorship with nonmechanical component alignment. Until higher-quality, long-term evidence with aseptic survivorship as the primary outcome is available, mechanically aligned TKA remains the most extensively validated approach.</p><p><strong>Level of evidence: </strong>Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843862","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":"Biomechanical and Computational Modeling of Metastatic Acetabular Defects: Influence of Tumor Location on the Risk of Fracture.","authors":"Jacob Doddridge, Hongjia He, Rui Yang, E U Conrad, Nicholas Dunbar","doi":"10.2106/JBJS.OA.26.00069","DOIUrl":"https://doi.org/10.2106/JBJS.OA.26.00069","url":null,"abstract":"<p><strong>Background: </strong>Metastatic bone disease can lead to pathologic fracture of the pelvis which affects quality of life. There are limited validated approaches for biomechanical modeling, classification, or surgical treatment of metastatic acetabular defects.</p><p><strong>Methods: </strong>An artificial hemipelvis bone was used to calibrate a computed tomography-based computational model of the pelvis with varying locations and sizes of acetabular defects. Metastatic defects affecting the anterior and posterior column, medial wall, and their combinations were created. Mechanical testing was performed on each defect, and images of the lateral surface of the acetabulum were analyzed by digital image correlation to measure peak surface strains. Finite element models were calibrated to match the measured peak surface strains. Pelvic stress during acetabular loading was predicted at the (1) medial wall, (2) superior acetabular region, (3) anterior, and (4) posterior columns. Acetabular regions with the highest risk for fracture based on margin of safety were identified by the defect type.</p><p><strong>Results: </strong>The predicted surface strains were strongly correlated (<i>R</i> ² = 0.95) with the biomechanical testing results, with a mean error of 0.14 ± 0.12 mε. Combined posterior column and medial wall defects had the highest surface strain and resulted in decreased margins of safety by 66% in the superior acetabular region and 86% in the anterior column. Across all single-region defects, the posterior column defect was the most at-risk for fracture, with a margin of safety reduction of 63% in the medial wall.</p><p><strong>Conclusions: </strong>Pelvic fragility resulting from metastatic lesions was sensitive to the periacetabular defect location. Combined posterior column and medial wall defects caused the greatest compromise to pelvic structural integrity, with the superior acetabular region and medial wall identified as the most critical locations for pelvic fracture. These findings influence surgical decision-making by identifying posterior column and medial wall lesions as high-risk patterns that may require earlier prophylactic stabilization.</p><p><strong>Level of evidence: </strong>Level V. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843830","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":"Resorbable Suture Is a Suitable Surgical Repair Material in a Rat Achilles Rupture and Repair Model.","authors":"Natalie K Gilmore, Sophie V Orr, Selena K Lam, Blaine A Christiansen, Keith Baar","doi":"10.2106/JBJS.OA.26.00079","DOIUrl":"https://doi.org/10.2106/JBJS.OA.26.00079","url":null,"abstract":"<p><strong>Background: </strong>Treatments for Achilles tendon rupture (ATR) are insufficient because they often do not result in full recovery and return to activity. There is no universal standard protocol for ATR, with surgeons using different repair techniques and materials. Some surgeons prefer nonresorbable (NR) suture due to the superior tensile strength, and others use resorbable (RES) because they decrease foreign body reactions.</p><p><strong>Methods: </strong>To establish a model for future interventional studies, we performed ATRs on 3-month-old female Sprague-Dawley rats using either NR or RES suture to repair the tendon and collected tissues at 1 and 2 months.</p><p><strong>Results: </strong>No significant differences in mechanical or material properties as a function of suture type were noted. Independent of suture type, tendons were wider at 1 month and both wider and thicker at 2 months, resulting in large increases in cross-sectional area (CSA) at each time point. The repaired tendons were stronger than the uninjured contralateral tendons at 1 month, but their strength decreased from the first month to the second despite increasing in CSA during this time, indicating progressive deterioration of tissue quality.</p><p><strong>Conclusions: </strong>Our data suggest that without loads in excess of body weight, the healing process becomes maladaptive after repair regardless of suture material.</p><p><strong>Level of evidence/clinical relevance: </strong>These experiments provide Level I pre-clinical evidence showing that RES suture performs at least as well as NR in all physiological measures following repair, indicating it is the preferable repair material for ATR. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843867","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":"Biomarkers of Injury Severity in Shoulder Instability and Posttraumatic Osteoarthritis.","authors":"Patrick W Rooney, Reilly Corken, Mark D Wishman, Cory Call, Maria Bozoghlian, Carter Lane, Mitchell C Coleman, James V Nepola, Brendan M Patterson, Joseph W Galvin","doi":"10.2106/JBJS.OA.25.00351","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00351","url":null,"abstract":"<p><p>» There is a poor understanding of the significance of biomarkers in the blood, synovial fluid, and tissue in patients with shoulder instability and posttraumatic osteoarthritis (PTOA). » Identification of biomarkers associated with injury severity in shoulder instability may provide prognostic information to help guide surgical treatment algorithms. » Current evidence suggests that the biomarkers of periostin, tumor necrosis factor-alpha, IL1B, and cartilage oligomeric matrix protein are associated with injury severity in patients with recurrent anterior shoulder instability. » There is limited information on genetic, transcriptomic, and protein biomarkers which may indicate individuals who are at more risk for development of shoulder instability. » An improved understanding of the local biomolecular tissue response to first-time and recurrent anterior shoulder instability may contribute to the development of novel therapeutic strategies for gene and protein targets to halt the early cascade of PTOA.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843751","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":"Corrosion-Related Failures in Modular Total Knee Arthroplasty: A Narrative Review of Rare Published Clinical Cases.","authors":"Krithi Pachipala, Amy Z Lu, Aymen Alqazzaz, Joshua J Jacobs, Lisa Follett, H John Cooper","doi":"10.2106/JBJS.OA.26.00005","DOIUrl":"https://doi.org/10.2106/JBJS.OA.26.00005","url":null,"abstract":"<p><p>» Corrosion at modular junctions is a well-known cause of failure in primary and revision total hip arthroplasty, but it is underrecognized in modular total knee arthroplasty (TKA) despite the potential to cause clinically significant implant failure. » Although descriptions vary throughout case reports, mechanically assisted crevice corrosion (MACC) appears to be the underlying failure mechanism at these modular TKA junctions, as is seen in femoral component modularity in total hip arthroplasty (THA). » Adverse local tissue reactions (ALTR) and fatigue fractures can occur even in well-fixed TKA implants and can be difficult to detect clinically or radiographically. » The femoral component in constrained or rotating-hinge designs may be at higher risk for corrosion-related complications. » An appropriate index of suspicion, improved surveillance protocols, advanced imaging, and design innovations are needed to aid diagnosis, mitigate future failures, and guide revision strategies.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843759","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":"Get a Grip: How Hand Anthropometrics, Grip Strength, and Sex Influence Power Tool Use in Orthopaedics.","authors":"Catrin Morgan, Olivia O'Malley, Esma Lüleci, Chahak Saraogi, Peter Reilly, Angela E Kedgley","doi":"10.2106/JBJS.OA.25.00343","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00343","url":null,"abstract":"<p><strong>Introduction: </strong>Female surgeons typically have smaller hands, report negative perceptions, and experience pain and discomfort related to instrument design. The aims of this study were to determine whether orthopaedic surgeons receive teaching on power-tool handling, identify power-tool grips used, evaluate whether grip strength and hand anthropometrics influence grip choice, and examine the impact of sex on power tool perceptions.</p><p><strong>Methods: </strong>Orthopaedic surgeons (residents and attendings) were surveyed on their power tool perceptions and teaching methods. An objective assessment was carried out which included the categorization of power tool grips, measurement of grip strength, and anthropometric measurements of the hand.</p><p><strong>Results: </strong>Forty-six orthopaedic surgeons (12 female, 34 male) were recruited with a response rate of 96%. No orthopaedic surgeon reported formal teaching on power tool handling. Female surgeons reported more negative experiences using the wire driver and drill. Participants demonstrated 2 variations in power tool posture, with an equal split, determined by the index finger position on either the top or bottom trigger. The index finger bottom position was associated with reduced grip strength, female sex, and smaller hand and palm length compared with the index finger top position.</p><p><strong>Conclusion: </strong>Surgeons with smaller hands or lower grip strength, particularly females, were more likely to use an index finger supported grip, likely as a compensatory strategy. There is the need for early training in power-tool ergonomics and grip techniques, as well as grip strengthening initiatives. The current one-size-fits-all approach is inadequate; manufacturers should ensure designs accommodate a wide range of hand sizes, accounting for palm length and overall hand length, to accommodate all users.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843784","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":"Assessing Surgical Skill in Orthopaedic Trauma Surgery Training: Behavioral Metrics for Digital Performance Evaluation.","authors":"T Stauffer, T Schlegel, N Diwersi, F Tillmann, F Beeres, Q Lohmeyer, R Babst, M Meboldt","doi":"10.2106/JBJS.OA.25.00315","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00315","url":null,"abstract":"<p><strong>Background: </strong>Surgical skill assessment in orthopaedic trauma surgery still relies on subjective expert ratings, which limits consistency and scalability. While digitalization offers a path toward objective and scalable assessment, the highly manual and haptic nature of surgery makes tool use difficult to capture digitally, keeping such approaches underdeveloped. This study introduces a digital assessment framework for orthopaedic trauma training that derives digital behavioral metrics (DBM) from tracked surgical tool motion. Specifically, it investigates (1) which DBM indicate technical proficiency and (2) to what extent these DBM are capable of predicting expert-rated surgical performance.</p><p><strong>Methods: </strong>Twenty-eight participants performed 3 standardized fracture fixations on synthetic bone models of the radius, ulna, and fibula. Tool motion was captured and transformed into a digital twin from which metrics such as path length, smoothness, and task duration were derived. These metrics were statistically compared with the average Global Rating Scale (GRS) obtained from 4 experts who rated each surgical performance. (1) Correlation analysis identified skill-relevant metrics and (2) a predictive model was trained to estimate performance from DBM evaluating its accuracy against the individual expert ratings.</p><p><strong>Results: </strong>(1) Several DBM were found to be indicative of surgical performance. Measures based on tool path length and time per activity showed strong correlations with expert ratings, reaching coefficients of up to 0.6. Correlation strength varied across tools and procedures. (2) The predictive model achieved a mean absolute difference of 3.8 points from the average GRS score (scale range: 28-70), outperforming the mean interexpert difference of 4.6 points.</p><p><strong>Conclusion: </strong>DBM were identified as valid indicators of surgical skill. The study further demonstrated their predictive value, showing closer alignment with experts' average GRS score than individual expert ratings. These findings highlight the feasibility of objective, expert-independent performance assessment in orthopaedic trauma surgery training.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843799","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":"Impact of Robotic Assistance and Fixation Type on Revisions, Complications, and Survivorship Following Total Knee Arthroplasty.","authors":"Hania Shahzad, Mandeep S Chhokar, Sahej Deep Singh Randhawa, John P Meehan, Mauro Giordani, Adam J Taylor, Zachary C Lum","doi":"10.2106/JBJS.OA.26.00043","DOIUrl":"https://doi.org/10.2106/JBJS.OA.26.00043","url":null,"abstract":"<p><strong>Introduction: </strong>With the increasing adoption of both cementless fixation and robotic-assisted techniques in total knee arthroplasty (TKA), it is important to recognize that these approaches carry distinct historical concerns. Earlier generations of cementless implants were associated with higher early failure rates due to inadequate osseointegration, while early robotic systems faced criticism for increased operative times and complication risk. As a result, the current literature presents conflicting evidence regarding the impact of these technologies on early complications and revision rates. This study compares the reoperation rates across 4 TKA cohorts, cemented vs. cementless, with and without robotic assistance.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using a national administrative claims database. Primary TKA cases were identified using International Classification of Diseases, 10th Revision, and Current Procedural Terminology codes, and 4 cohorts were created: robotic-cemented (R-CEMENT), robotic-cementless (R-CEMENTLESS), conventional-cemented (C-CEMENT), and conventional-cementless (C-CEMENTLESS). Matching was performed based on age, sex, Elixhauser Comorbidity Index, obesity, tobacco use, and diabetes, resulting in 5,210 patients in each group. Outcomes assessed included 1-, 5-, and 10-year ipsilateral reoperations, 30-day emergency department utilizations, and 10-year failure-free survival. χ² tests were used for group comparisons, with p < 0.05 indicating significance.</p><p><strong>Results: </strong>In the matched cohort (n = 20,840, C-CEMENTLESS, C-CEMENT, R-CEMENTLESS, R-CEMENT; n = 5,210 each), 1-year reoperation rates were lowest in C-CEMENTLESS (0.44%) and R-CEMENTLESS (0.52%), followed by R-CEMENT (0.84%) and C-CEMENT (0.92%) (p = 0.005). At 5 and 10 years, reoperation rates remained lowest in C-CEMENTLESS (0.79%) and R-CEMENTLESS (1.02%), compared with higher rates in C-CEMENT (1.86%) and R-CEMENT (1.71%) (p < 0.001). Kaplan-Meier survival showed 99.7% 5-year survivorship in C-CEMENTLESS and R-CEMENTLESS, versus 99.5% in both cemented groups (p-value < 0.05). No significant differences were observed in 30-day ED utilization (p = 0.11) or readmissions (p = 0.75) across all 4 matched cohorts.</p><p><strong>Conclusion: </strong>Cementless fixation in TKA, whether robotic or conventional, demonstrated comparable short-term reoperation rates and equivalent long-term survivorship to cemented fixation. Robotic assistance did not significantly affect failure-free survival or healthcare utilization. All 4 cohorts showed excellent 10-year outcomes.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843902","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":"Comparable Outcomes and Implant Survivorship of Total Knee Arthroplasty After High Tibial Osteotomy and Primary Arthroplasty: A Matched Cohort Study.","authors":"Eva A Bax, Rana A Ahmad, Sean C Clark, Roel J H Custers, Michael J Taunton, Rafael J Sierra, Daniel B F Saris, Mario Hevesi","doi":"10.2106/JBJS.OA.25.00303","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00303","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is the treatment of choice for end-stage knee osteoarthritis in many patients. In younger patients with predominantly medial compartment disease, high tibial osteotomy (HTO) is performed as a joint-preserving treatment. However, concerns remain regarding potentially compromised outcomes of TKA after previous HTO given the axial deviation, osteotomy site, secondary surgery, previous hardware, and instrumentation. Therefore, this study compared long-term implant survival, revision, and infection rates, and patient-reported outcomes between patients undergoing TKA after HTO and matched TKA-only controls.</p><p><strong>Methods: </strong>Postoperative complications and revision surgeries were prospectively recorded in patients who underwent TKA from 2000 to 2023 at a single academic center. Patients with previous ipsilateral HTO formed the study group and were propensity matched 1:2 to TKA-only patients without a previous osteotomy based on age, sex, and body mass index. Knee Society Scores (KSS) were collected prospectively. Implant survivorship was analyzed using Kaplan-Meier survival curves and Cox proportional hazards models.</p><p><strong>Results: </strong>The study included 134 HTO-TKA and 268 matched TKA-only patients, with a mean follow-up of 10.5 ± 6.4 years (range: 0-24 years) after TKA. Both groups showed significant postoperative improvements in KSS (p < 0.02) with comparable clinical outcomes (HTO-TKA: 79.0 (6.0), TKA-only: 79.0 (11.8)). Revision arthroplasty rates were 5.2% for HTO-TKA and 4.5% for TKA-only (p = 0.69); the mean time to revision was 8.1 ± 8.7 years vs. 4.4 ± 3.5 years, respectively (p = 0.30). Infection rates were 2.2% and 1.1%, respectively (p = 0.74).</p><p><strong>Conclusions: </strong>Revision and infection rates were comparable between HTO-TKA and matched TKA-only patients, with no statistically significant differences. Our findings demonstrate comparable patient-reported outcomes in both groups. These findings indicate that a previous HTO does not adversely affect TKA implant longevity or clinical outcomes when compared with matched primary TKA patients within the US population.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843764","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}