Corentin Philippe, Alexandre Leguen, Nicolas Vari, Pablo Froidefond, Gary Kolenc, Emilie Berard, Etienne Cavaignac
{"title":"Shoes size can predict implant sizes for primary total knee arthroplasty in a quick, reliable and costless manner","authors":"Corentin Philippe, Alexandre Leguen, Nicolas Vari, Pablo Froidefond, Gary Kolenc, Emilie Berard, Etienne Cavaignac","doi":"10.1002/jeo2.70363","DOIUrl":"https://doi.org/10.1002/jeo2.70363","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Knowing the component sizes needed for a specific patient before total knee arthroplasty (TKA) surgery could help to optimise the logistics of medical device availability. Previous studies have correlated component size with patient age, sex, height, weight, and shoe size, but none have validated this method using the European shoe sizing system. The primary objective of this study was to determine the correlation between a patient's European shoe size at the time of surgery and the size of the tibial and femoral components used during primary TKA. The secondary objective was to evaluate the accuracy within ±1 size between the European shoe size and the component size.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective observational, single-centre, single-surgeon study of 227 primary TKA procedures done with the Score II implant (AMPLITUDE®, Valence, France) between 1 April 2022 and 1 July 2023. Data on the patient's shoe size was determined before the surgery. This information was retrospectively correlated with the size of the components used in the TKA surgery that was recorded in the operative report.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The correlation between a patient's shoe size and the component size was very strong: Spearman rho of 0.8095 for femur, 0.8400 for tibia and 0.6393 for patella (<i>p</i> < 0.001). The correlation between a patient's shoe size and the size of the PE insert was weak: Spearman rho 0.1532 (<i>p</i> = 0.0210). After adjusting for sex, the femoral component was predicted accurately within ±1 size in 92% (210/227) of procedures and the tibial component in 94% (213/227). After adjusting for sex and BMI, the patellar implant was predicted accurately within ±1 size in 97% (220/227) of procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our model provides a cost-effective, assignable and easily implementable method for predicting tibial and femoral component sizes using European shoe size, demonstrating high accuracy (≥92%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, retrospective observational study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70363","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647458","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":"Infrapatellar fat pad fibrosis after anterior cruciate ligament reconstruction is associated with male sex, high body mass index, prolonged operation time and articular cartilage damage, with detrimental effects on one-year clinical outcomes","authors":"Ryu Yoshida, Hideyuki Koga, Tomomasa Nakamura, Nobutake Ozeki, Mai Katakura, Masaki Amemiya, Takashi Hoshino, Aritoshi Yoshihara, Toyohiro Katsumata, Yasumasa Tokumoto, Ichiro Sekiya, Yusuke Nakagawa","doi":"10.1002/jeo2.70365","DOIUrl":"https://doi.org/10.1002/jeo2.70365","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of this study was to examine the risk factors of infrapatellar fat pad (IFP) fibrosis and the associations between the degree of IFP fibrosis and clinical outcomes in patients who underwent anterior cruciate ligament reconstruction (ACLR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 97 patients who underwent primary ACLR using autologous hamstring tendons were divided into the mild fibrosis group (M group) and severe fibrosis group (S group), based on IFP fibrosis scoring (Grades 0–5) on magnetic resonance imaging at 3 months postoperatively. Clinical outcomes at 1 year postoperatively were compared between groups. Univariate logistic regression analysis was performed to determine factors associated with IFP fibrosis. Additionally, multiple linear regression analysis was performed to investigate whether IFP fibrosis affected clinical outcomes at 1 year postoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients were classified into the S group (<i>n</i> = 21) and the M group (<i>n</i> = 76). There were significantly more males (<i>p</i> = 0.036), higher body mass index (<i>p</i> = 0.004), longer operation times (<i>p</i> = 0.031), and more cartilage injuries identified during arthroscopy (<i>p</i> = 0.030) in the S than M group. International Knee Documentation Committee (IKDC) subjective scores (<i>p</i> = 0.040), and Knee Injury and Osteoarthritis Outcome Score (KOOS) symptoms (<i>p</i> = 0.009) and quality of life values (<i>p</i> = 0.026) were significantly lower in the S than M group. The range of motion was significantly worse on both extension (<i>p</i> < 0.001) and flexion (<i>p</i> = 0.002) in the S than M group. Multiple regression analysis revealed IFP fibrosis as an independent factor affecting the IKDC subjective score (<i>p</i> = 0.037), KOOS-symptom subscore (<i>p</i> = 0.037) and extension angle (<i>p</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Male sex, high BMI, prolonged surgery, and articular cartilage damage are risk factors for IFP fibrosis after ACLR. IFP fibrosis affects the range of motion and subjective patient evaluations at 1 year postoperatively. MRI-based evaluation at 3 months may help identify high-risk patients, and early interventions targeting fibrosis could improve postoperative recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, case–control study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647089","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}
Nicolas C. I. Ion, Sorin R. Fleaca, Bogdan-Axente Bocea, Cosmin-Ioan Mohor, Mihai-Dan Roman, Alexandru-Florin Diconi, Adrian N. Cristian, Doru-Florian-Cornel Moga, Mona Y. Cataniciu, Ovidiu N. Popa, Adrian G. Boicean, Victoria Birlutiu
{"title":"Key factors influencing orthopaedic operating room contamination: Impact of human activity and Staphylococcus epidermidis prevalence","authors":"Nicolas C. I. Ion, Sorin R. Fleaca, Bogdan-Axente Bocea, Cosmin-Ioan Mohor, Mihai-Dan Roman, Alexandru-Florin Diconi, Adrian N. Cristian, Doru-Florian-Cornel Moga, Mona Y. Cataniciu, Ovidiu N. Popa, Adrian G. Boicean, Victoria Birlutiu","doi":"10.1002/jeo2.70321","DOIUrl":"https://doi.org/10.1002/jeo2.70321","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The presence of pathogen microorganisms in the operating room remains a significant concern. This study aims to explore the factors influencing the presence of pathogens in the operating room.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed the presence of microorganisms in the operation theatre during total knee and hip replacement procedures for 33 patients performed in the same operation room (OR) over a period of 2 months. Three hundred and ninety-six samples were taken from several areas belonging to the sterile field. We have also analysed behavioural aspects in the OR that could influenced the potential contamination of the sterile field, such as the number of touches of the lamps, the temperature in the OR, the height of the operating table, the number of door openings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of the total of 396 samples, 74 were positive. Most contaminations were with <i>Staphylococcus epidermidis</i> (45.45%). Most pathogens were found on the instrument table at the end of the intervention (27.27%). There is a correlation regarding the fact that at lower heights, the risk of contamination higher than if the table is raised more. We also find correlations between the number of operating room doors opened and the presence of field contamination, as well as between the number of touches of the lamps and the presence of pathogens on sterile fields.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The presence of pathogens in the OR is influenced by the number of lamp touches, the frequency of door openings, and the increased number of people in the room. However, temperature and the height of the operating table do not have a significant impact on the occurrence of pathogens. The most commonly found pathogen in the OR was <i>S. epidermidis</i>. At the end of the surgery, the instrument table showed the highest percentage of pathogen presence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, case series.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647402","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}
Pier F. Indelli, Bruno Violante, Pawel Skowronek, Marko Ostojić, Nicolas Bouguennec, Giuseppe Aloisi, Christian Schaller, Giuseppe U. Longo
{"title":"The combination of a medial pivot design with kinematic alignment principles in total knee arthroplasty can ensure a closer to normal knee kinematics than combining mechanical alignment and more traditional implant designs: An umbrella review","authors":"Pier F. Indelli, Bruno Violante, Pawel Skowronek, Marko Ostojić, Nicolas Bouguennec, Giuseppe Aloisi, Christian Schaller, Giuseppe U. Longo","doi":"10.1002/jeo2.70358","DOIUrl":"https://doi.org/10.1002/jeo2.70358","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The recent introduction of personalized alignment strategies in total knee arthroplasty (TKA) has transformed adult reconstruction. Proponents advocate for these techniques due to their kinematic benefits compared to traditional methods. Current literature supports combining medial-pivot designs with kinematic alignment (KA) surgery. This review summarizes the application of gait analysis in KA medial-pivot TKA and recommends gait parameters related to patient satisfaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). One hundred twenty-one articles from the three search engines underwent a preliminary title/abstract and full-text screening. The final screening resulted in 23 systematic reviews (SR), meta-analyses (M-A) and narrative reviews (NR) as core articles of the current umbrella review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of the original 121 SR/M-A/NR articles, 23 (19%) were ultimately evaluated based on the reported results. Twelve articles fell into the first category (gait analysis following TKA as the main topic), five articles were designated for the second category (knee implant design), only one article was classified in the third category (kinematic alignment) and five articles were assigned to the fourth category (a combination of all main topics).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The literature investigating the relationship between kinematic and spatiotemporal data and clinical outcomes following KA medial pivot TKA is limited. Few studies included in the current review showed that remote measurements using wearable sensors are more informative than patients' reported outcome measurements (PROMs) regarding a patient's daily level of activities and, ultimately, gait. The current review demonstrated that combining KA and MP designs can ensure a knee kinematic closer to normal than combining MA and more traditional implant designs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level I.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647779","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}
Rodrigo Olivieri, José I. Laso, Carlos Rojas, Nicolás Franulic, Felipe Bustos, Roberto Oyarce, Nicolás Gaggero, Alberto Grassi
{"title":"No differences in patient-reported outcomes (PROMs) and complications after anterior cruciate ligament (ACL) reconstruction with bone–patellar tendon–bone (BPTB) or hamstrings (HT) in patients aged 50 or older","authors":"Rodrigo Olivieri, José I. Laso, Carlos Rojas, Nicolás Franulic, Felipe Bustos, Roberto Oyarce, Nicolás Gaggero, Alberto Grassi","doi":"10.1002/jeo2.70371","DOIUrl":"https://doi.org/10.1002/jeo2.70371","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to compare postoperative clinical outcomes, including patient-reported outcome measures (PROMs), patellofemoral symptoms, and complications, in patients over 50 years old who underwent anterior cruciate ligament (ACL) reconstruction with either bone–patellar tendon–bone (BPTB) or hamstring tendon (HT) autografts. We hypothesised no significant differences in outcomes between the two techniques in this age group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted using institutional records of patients over 50 years old who underwent isolated ACL reconstruction (defined as ACL reconstruction without associated ligament injuries), with or without concomitant meniscal procedures, using BPTB or HT autografts between January 2016 and December 2022, with a minimum follow-up of two years. Postoperative outcomes were assessed using PROMs, including the Lysholm score, Kujala score, and the Knee injury and Osteoarthritis Outcome Score Quality of Life subscale (KOOS QoL), complication rates, and the need for revision surgery. Statistical analyses included independent t-tests, Mann–Whitney <i>U</i> tests, chi-square tests and multivariate regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 83 patients met the inclusion criteria (45 HT and 38 BPTB). The mean age was 53.5 years (SD 3.0), with a mean follow-up of 56.3 months. No significant differences were found in Lysholm (HT: 83.1, BPTB: 86.1; <i>p</i> = 0.934), Kujala (HT: 82.2, BPTB: 84.5; <i>p</i> = 0.901), or KOOS QoL scores (HT: 69.0, BPTB: 68.7; <i>p</i> = 0.649). The incidence of complications and the need for revision surgery were similar between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ACL reconstruction in patients over 50 years old using BPTB or HT autografts resulted in comparable clinical outcomes, PROMs, and complication rates. In this cohort, graft type did not appear to significantly influence postoperative results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, retrospective cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70371","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647781","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}
Miguel Angel Ruiz Iban, Berte Böe, Emmanouil Brilakis
{"title":"The increasing presence and relevance of the shoulder in European Society for Sports Traumatology, Knee Surgery and Arthroscopy","authors":"Miguel Angel Ruiz Iban, Berte Böe, Emmanouil Brilakis","doi":"10.1002/jeo2.70299","DOIUrl":"https://doi.org/10.1002/jeo2.70299","url":null,"abstract":"<p>When a young orthopaedic surgery resident is introduced to the bewildering ecosystem of scientific societies in our speciality, she (or he) is soon aware of European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), a cornerstone among sports-related societies in Europe and around the World: ‘ESSKA is involved in all aspects of sports orthopaedics, from arthroscopy of any joint to sport-specific medicine, including, of course, a lot of knee surgery, including arthroplasty’. This resident probably thinks the shoulder is included in the mix: ‘There are not one but two “S” in the title, so one must be for shoulder….’. But a senior fellow soon will prove him (or her) wrong: ‘Shoulder surgeons are a quite special lot; although they deal with a lot of sport-related injuries and, indeed, they perform a lot of arthroscopic procedures, they also tend to support only a few strong, independent, national, European and worldwide shoulder societies’. This same budding resident will eventually later check for herself (or himself) and find that many top shoulder surgeons are ESSKA members, ESSKA supports a lot of shoulder-based activities, the ESSKA congress has a dozen ‘shoulder focused’ sessions, and within the society, there is a specific section focused on the shoulder: European Shoulder Associates (ESA).</p><p>The birthing of ESSKA was humble but ambitious in the divided Berlin of 1982. The founding of the society was complex and fraught with uncertainties. Still, the leadership of Dr. Ejnar Erickson and the ingenuity of the newly founded board members made the society instantly successful with surgeons, attracting 800 participants in the first congress in Berlin in 1984 [<span>3</span>]. The minutes of the first Board meeting, signed on 1 September 1982, do not mention the shoulder at all, as the focus was the knee and arthroscopic techniques [<span>4</span>], and shoulder arthroscopy was only nascent at that time [<span>5</span>]. Things changed quickly, and, already in the 6th ESSKA Congress in Berlin 1994, there were two sessions dedicated to the shoulder, one focused on arthroscopic surgery, and another focused on shoulder instability, at that time a mainly nonarthroscopy issue [<span>2</span>].</p><p>If one should select a pivotal moment in the history of the shoulder in ESSKA, it would most certainly be the founding of the ESA section in 2010, with the initial leadership of Pascal Gleyze [<span>3</span>]. The development of this section, with a focus on all things shoulder and elbow and a friendly relationship with the European Society for Surgery of the Shoulder and the Elbow, helped to define the key role that shoulder surgery had in ESSKA. ESA has been highly active inside ESSKA: it supports the development of the Congress agenda, participates in the Speciality Days, and promotes biennial closed meetings (newly renamed as Focus meetings). More recently, it has embraced the push for high-quality, evidence-based, knowledge, c","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70299","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611973","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}
Giulio Senesi, Giuseppe Barone, Salvatore Pinelli, Maria Scoppolini Massini, Raffaele Zinno, Domenico Alesi, Erika Pinelli, Laura Bragonzoni
{"title":"The relationship between stress shielding, bone density changes and implant migration, failure and fracture after total knee arthroplasty: A systematic review","authors":"Giulio Senesi, Giuseppe Barone, Salvatore Pinelli, Maria Scoppolini Massini, Raffaele Zinno, Domenico Alesi, Erika Pinelli, Laura Bragonzoni","doi":"10.1002/jeo2.70350","DOIUrl":"https://doi.org/10.1002/jeo2.70350","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Total knee arthroplasty (TKA) represent a well-established treatment for advanced osteoarthritis. Despite advancements in implant design and materials, the impact of stress shielding on bone mineral density (BMD) and its relationship with implant migration, loosening, and fracture remains insufficiently explored. This study aims to evaluate the association between stress shielding, BMD changes, and implant outcomes after TKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Four major databases (MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (WOS), EMBASE) were thoroughly reviewed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 491 studies were initially identified, of which nine met the inclusion criteria and were included in the final review. Eight were randomised controlled trials, and one was a prospective observational study. All studies were conducted in clinical settings, comprising a total of 467 patients. BMD variations due to stress shielding were most pronounced during the first 6–12 months postoperatively. However, except for one isolated case, no direct correlation was identified between BMD changes caused by stress shielding and implant migration, loosening or fracture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This systematic review highlights that variations in bone mineral density due to stress shielding are not directly correlated with implant failure, migration or loosening in TKA. Stress shielding remains a critical phenomenon, particularly in the early postoperative phases, emphasising the importance of optimised materials, fixation methods and implant designs to reduce bone loss and improve long-term stability. Due to its recognised occurrence in clinical practice, further in vivo studies would contribute to a better understanding of the stress shielding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II, systematic review of studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612011","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}
Emidio Di Gialleonardo, Guido Bocchino, Giacomo Capece, Matteo Salvini, Marco Barbaliscia, Giuseppe Malerba, Omar El Ezzo, Giulio Maccauro, Raffaele Vitiello
{"title":"Evaluation of the learning curve in robot-assisted knee arthroplasty: A Systematic review","authors":"Emidio Di Gialleonardo, Guido Bocchino, Giacomo Capece, Matteo Salvini, Marco Barbaliscia, Giuseppe Malerba, Omar El Ezzo, Giulio Maccauro, Raffaele Vitiello","doi":"10.1002/jeo2.70292","DOIUrl":"https://doi.org/10.1002/jeo2.70292","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Robot-assisted (RA) surgery has transformed total knee arthroplasties (TKA) and unicompartmental knee arthroplasties (UKA) by significantly enhancing the accuracy of prosthetic implantation and reducing complications. Different robotic systems offer unique approaches to assist surgeons during procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This systematic review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and evaluated the learning curve associated with RA technologies, focusing on their surgical efficacy. A comprehensive literature search identified and analysed studies published since 2010, ultimately selecting 28 relevant articles that addressed robotic techniques in knee arthroplasty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The findings indicate that surgeons generally require an average of 21 procedures to achieve proficiency with robotic techniques. However, the learning curve varies among robotic systems: MAKO requires 15–25 cases, ROSA 20–30 cases and NAVIO 18–28 cases for surgeons to reach proficiency. The MAKO system emerged as the most frequently used (33.3% of studies), followed by ROSA (23.3%) and NAVIO (16.7%). Evidence suggests that the adoption of these robotic systems is associated with reduced operative times and lower rates of postoperative complications, thereby improving overall surgical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>RA arthroplasties present significant advancements in surgical precision and patient outcomes. With targeted investments in training and technology, the adoption of robotic techniques could further increase, ultimately enhancing the quality of orthopaedic care and patient recovery. This review highlights the importance of addressing training needs and resource allocation to fully realise the potential of robotic surgery in knee arthroplasty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Not applicable, systematic review.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70292","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612024","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}
Francesco Bosco, Giorgio Cacciola, Virginia Masoni, Carmelo Burgio, Mariazzurra Carlino, Michele Centola, Ferdinando Tosto, Daniele Vezza, Lawrence Camarda, Luigi Sabatini
{"title":"Clinical outcomes of kinematically aligned medial pivot total knee arthroplasty: A systematic review and meta-analysis of current evidence","authors":"Francesco Bosco, Giorgio Cacciola, Virginia Masoni, Carmelo Burgio, Mariazzurra Carlino, Michele Centola, Ferdinando Tosto, Daniele Vezza, Lawrence Camarda, Luigi Sabatini","doi":"10.1002/jeo2.70348","DOIUrl":"https://doi.org/10.1002/jeo2.70348","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Kinematic alignment (KA) in total knee arthroplasty (TKA) focuses on restoring the natural joint line and ligament balance, potentially improving biomechanics and outcomes over mechanical alignment (MA). The medial pivot (MP) implant enhances joint stability by mimicking physiological knee motion. Still, its role within a KA protocol and the effects of retaining versus sacrificing the posterior cruciate ligament (PCL) are unclear. This study aimed to evaluate the clinical effectiveness, functional outcomes and biomechanical benefits of KA-TKA with MP implants based on the available literature. It also aimed to assess whether PCL retention or sacrifice leads to better postoperative function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive search of PubMed, Embase and Web of Science up to January 2025 identified studies assessing KA-TKA with MP implants. Primary outcomes included patient-reported outcome measures (PROMs), range of motion (ROM), complication rates and implant survivorship. Subgroup analysis compared PCL retention and sacrifice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fourteen studies (955 patients) met inclusion criteria. KA-TKA with MP implants resulted in significant ROM improvements (+11.35°, increased to +12.50° after sensitivity analysis) and enhanced PROMs (Oxford Knee Score +18.23, increased to +22.27 after sensitivity analysis; Knee Society Score [KSS] +49.61, functional KSS +42.50). No aseptic loosening or implant failures were reported. PCL sacrifice was associated with greater postoperative flexion (125.4° ± 12.1° vs. 116.4° ± 11.8°, <i>p</i> < 0.001), but functional outcomes were comparable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>KA-TKA with MP implants improves functional recovery, patient satisfaction, and short- to mid-term survivorship, supporting its adoption as a viable alternative to conventional TKA. Further long-term, randomized trials are needed to optimize PCL management and confirm its durability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70348","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612028","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}
David Maman, Maneesh Nandakumar, Michael T. Hirschmann, Hadas Ofir, Madlene Haddad, Butrus Samir, Yaniv Steinfeld, Yaron Berkovich
{"title":"Blood transfusion in total knee arthroplasty and total hip arthroplasty: A nationwide study of complications, costs and predictive modelling","authors":"David Maman, Maneesh Nandakumar, Michael T. Hirschmann, Hadas Ofir, Madlene Haddad, Butrus Samir, Yaniv Steinfeld, Yaron Berkovich","doi":"10.1002/jeo2.70317","DOIUrl":"https://doi.org/10.1002/jeo2.70317","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Blood transfusion during total knee and hip arthroplasty is associated with increased postoperative complications, prolonged hospital stays and greater healthcare costs. As outpatient arthroplasty expands, identifying patients at high transfusion risk is essential. This study analyses over 4 million arthroplasty procedures from the Nationwide Inpatient Sample (NIS) to assess the clinical and economic impact of transfusion and develop a machine learning-based risk prediction tool. We hypothesised that transfused patients would experience higher complication rates, longer hospital stays and increased hospitalisation costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using NIS data (2016–2019) including primary total knee arthroplasty and total hip arthroplasty cases. Propensity score matching (PSM) was used to balance clinical and demographic variables. Outcomes included length of stay (LOS), total charges, complications and mortality. Logistic regression, random forest and deep neural networks (DNNs) were trained to predict transfusion using preoperative data. Validation methods included hold-out testing, class weighting and dropout.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After matching, transfusion was linked to increased surgical site infection (TKA RR = 17.0; THA RR = 13.5), sepsis (TKA RR = 13.4; THA RR = 5.0) and pulmonary embolism (TKA RR = 6.0; THA RR = 3.5). Transfused patients had longer LOS (TKA: 4.2 vs. 2.7 days; THA: 4.0 vs. 2.9 days) and higher charges (TKA: $79,996 vs. $59,600; THA: $89,283 vs. $77,239). The DNN achieved the best predictive performance (area under the curve: 0.8644–0.8783). Top preoperative predictors of transfusion included chronic anaemia, chronic kidney disease, female gender and osteoporosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Blood transfusion significantly worsens clinical outcomes and increases costs in arthroplasty. Our machine learning tool, while not clinically implemented yet, shows promise in identifying high-risk patients and supporting preoperative planning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70317","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612023","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}