Journal of Knee Surgery最新文献

{"title":"Planning Assistance Freeware for Surgical Management of the Multiple Ligament Knee Injury: From Historical to Modern Surgical Procedures.","authors":"Maxime Guerot, Baptiste Boukebous, Lucas Chanteux, Haroun Bouhali, Marc-Antoine Rousseau, Cédric Maillot","doi":"10.1055/a-2509-3322","DOIUrl":"10.1055/a-2509-3322","url":null,"abstract":"<p><p>Anatomical knowledge and identification of multiple ligament knee injuries have considerably evolved during the last decade. Consecutively, a trend for anatomical reconstruction of these injuries emerged. These procedures are challenging and require precise planning. Moreover, the planning itself is made difficult by the variety of techniques, whose descriptions are scattered throughout the literature. The objective is to reference and categorize the different ligament reconstruction techniques to provide free planning assistance software using a standardized graphic chart.The search for ligament reconstruction techniques on nine different databases produced 1,536 articles. After reviewing for relevance, the authors included the full papers of the remaining 306 articles. From the reference lists of the selected articles reviewed, 96 studies describing original techniques were retrieved. Techniques were extracted, drawn following the same graphics chart, and classified into conceptual categories.After selection, 10, 4, 28, 28, and 26 articles described anterior cruciate ligament, posterior cruciate ligament, posteromedial corner, posterolateral corner, and anterolateral corner procedures for reconstruction, respectively. Early techniques often used tenodesis while nowadays various grafts are fixed to isometric points or anatomic landmarks. An interactive tool was created. It allows the visualization of selected reconstructions on axial, frontal, and sagittal representations of the knee. Tunnel position, preferred transplant type, and fixation mode are represented. The freeware is available at: https://apps.medecine.u-paris.fr/multilig/.The techniques described for the reconstruction of an isolated ligament or corner cannot always be extrapolated for multiple ligament knee injuries treatment. Bone stock and tunnel convergence are two main concerns to consider during planning. Sometimes, it could be necessary to sacrifice a potentially biomechanically superior approach if simpler reconstructions provide equivalent knee kinematics. Surgical options are multiple and scattered throughout the literature. Our study provides an open-source and clinician-accessible research tool for multiple ligament injuries planification using a standardized graphic chart.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"367-374"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability of a Novel Magnetic Resonance Imaging Scoring System to Evaluate Patellofemoral Osteoarthritis.","authors":"Tyler J Uppstrom, Guilherme Palhares, Robert Cecere, Giuseppe Anzillotti, Connor F Fletcher, Emily Davidson, Alissa Burge, Sabrina M Strickland","doi":"10.1055/a-2585-4964","DOIUrl":"https://doi.org/10.1055/a-2585-4964","url":null,"abstract":"<p><p>Knee osteoarthritis is a common degenerative or posttraumatic condition associated with significant pain and disability among patients. Isolated patellofemoral osteoarthritis (PFOA) occurs in approximately 24% of women and approximately 11% of men aged >55 years presenting with knee pain. In contrast to the tibiofemoral compartments, the current literature lacks a reliable magnetic resonance imaging (MRI) scoring system for quantitative evaluation of patellofemoral cartilage degeneration.This study aimed to describe, apply, and assess the interobserver reliability of a novel MRI scoring system for assessment of the patellofemoral cartilage.Patients who underwent patellofemoral arthroplasty for isolated PFOA between January 2012 and December 2021 were identified. Preoperative MRI scans were performed on 3.0-Tesla magnets utilizing dedicated extremity coils and standardized clinical imaging protocols consistent with International Cartilage Regeneration and Joint Preservation Society (ICRS) guidelines for the assessment of articular cartilage. A novel semiquantitative MRI patellofemoral scoring system included assessment of patellar and trochlear cartilage, bony architecture, patellofemoral alignment, and synovitis. Interobserver agreement was assessed using Cohen's Kappa coefficient for categorical variables, and the intraclass correlation coefficient (ICC) was used for the total score.A total of 72 knee MRIs were included in the final analysis. Patellar bone edema (kappa = 0.61) and patellar cysts (kappa = 0.59) demonstrated moderate interobserver agreement. All cartilage features, trochlear bone edema and cysts, osteophytes, subchondral remodeling, patellar height, and synovitis demonstrated good interobserver agreement (kappa > 0.61). Patellofemoral alignment and total score demonstrated excellent interobserver agreement (kappa > 0.81).The novel MRI scoring system for PFOA proposed in this study represents a comprehensive method to assess patellofemoral joint cartilage degeneration, including evaluation of patellar and trochlear cartilage changes, bony architecture, patellofemoral alignment, and synovitis. Importantly, all features of the scoring system demonstrated at least moderate interobserver agreement, with the majority of variables and total score demonstrating good to excellent agreement.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Matters Most for Patient Satisfaction Following Total Knee Arthroplasty? A Prospective Institutional Assessment of Individual Questions Captured by KOOS and VR-12 Mental Composite Score.","authors":"Ahmed K Emara, Brian Benyamini, Ignacio Pasqualini, Alvaro Ibaseta, Alison K Klika, Shujaa T Khan, Nicolas S Piuzzi","doi":"10.1055/a-2607-9835","DOIUrl":"10.1055/a-2607-9835","url":null,"abstract":"<p><p>Patient-reported outcome measures (PROMs) are crucial in evaluating the success of primary total knee arthroplasty (TKA). This study aimed to determine the individual significance of each question of the Knee Osteoarthritis Outcome Score (KOOS) and the Veterans RAND 12 (VR-12) Mental Composite Score (MCS) in achieving a Patient Acceptable Symptom State (PASS).A prospectively collected cohort of 9,942 unilateral elective TKAs was analyzed. Responses were collected for 17 KOOS questions (KOOS-Pain subscore, KOOS-Physical Function Short form [PS], and KOOS-Joint related [JR]) and 6 MCS questions preoperatively and 1-year postoperatively. Achievement of PASS was assessed through a positive response to a binary satisfaction-related question. The association between responses to questions and outcomes was examined via multivariable logistic regression models.A poorer preoperative response to knee pain frequency (odds ratio [OR] = 0.86 [0.77-0.97], <i>p</i> = 0.017) and knee pain while sitting or lying (OR = 0.88 [0.79-0.99], <i>p</i> = 0.029) was independently associated with reduced odds of achieving PASS at 1-year post-TKA. A more favorable preoperative response in knee pain during full knee straightening was independently associated with an increased odds of PASS attainment (OR = 1.10 [1.01-1.19], <i>p</i> = 0.035). No other metric was independently associated with PASS attainment at 1 year.Individual KOOS questions evaluating knee pain frequency, knee pain while sitting or lying down, and knee pain during full knee straightening were linked to patient satisfaction 1 year following TKA. Patients experiencing frequent or persistent knee pain at rest may represent those with more advanced joint disease or heightened pain sensitivity, contributing to lower postoperative satisfaction. Conversely, patients reporting minimal or no pain during specific movements, such as full knee straightening, likely had a less severe baseline condition, making their postoperative expectations more easily attainable, thereby leading to higher satisfaction.Level of evidence III.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Femoral Notch Width, Shape, and Medial Tibial Plateau Concavity in Individuals with and without Anterior Cruciate Ligament Injury.","authors":"Nika Hajatpour, Hadi K Mobin, Reza Gerami, Shamim F Hesari, Jalal Kargar","doi":"10.1055/a-2607-9927","DOIUrl":"https://doi.org/10.1055/a-2607-9927","url":null,"abstract":"<p><p>Anterior cruciate ligament (ACL) injuries can occur in people of all ages and genders. Women are significantly more likely to experience them, particularly during their adolescent and young adult years. In the current study, we compared the width and shape of the femoral intercondylar notch and depth of the concavity of the medial tibial plateau in individuals with and without ACL injuries.In this cross-sectional study, 100 participants (50 in the ACL injury group and 50 in the no-ACL injury group) were included. Data on age, gender, shape (categorized as U, A, and Ω), and width (notch width [NW] and notch width index [NWI]) of the femoral intercondylar notch, and the concavity depth of the medial tibial plateau and bicondylar width (BCW) of all participants were obtained from magnetic resonance imaging (MRI) and recorded. All data were analyzed using SPSS version 21, and a significance level of <0.05 was considered.The prevalence of female gender in the ACL and no-ACL injury groups was 40% and 52%, respectively. The mean NWI and medial tibial plateau depth were significantly higher in the no-ACL injury group compared with the ACL injury group (<i>p</i> < 0.001). The intercondylar notch shape significantly differed between the two groups, with a higher frequency of type A notch in the ACL injury group and U shape in the no-ACL injury group (<i>p</i> < 0.001). Additionally, the mean NW was significantly narrower in the ACL injury group across the ≤30- and >40-year age groups (<i>p</i> < 0.001), although no significant difference was found in the 31- to 40-year age group (<i>p</i> > 0.05). Receiver operating characteristic (ROC) analysis indicated that NWI was the most predictive measure for ACL injuries (area under the curve [AUC] = 0.869), followed by NW (AUC = 0.763). BCW, however, had a lower predictive value (AUC = 0.431).Due to our findings, narrow NWI and A-shaped femoral intercondylar notch were more prevalent in the ACL injury group than the no-ACL injury group, suggesting a risk factor for ACL injuries.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative patellofemoral malalignment weakened the outcome of patients after total knee arthroplasty.","authors":"Nianlai Huang, Liangming Wang, Liquan Cai, Qingfeng Ke, Shiqiang Wu","doi":"10.1055/a-2618-4666","DOIUrl":"https://doi.org/10.1055/a-2618-4666","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of preoperative patellofemoral malalignment (PFM) on the prognosis of patients who underwent total knee arthroplasty (TKA) remains unknown. This study aimed to explore the effect of preoperative PFM on the prognosis of patients who underwent TKA.</p><p><strong>Methods: </strong>This retrospective observational study included patients who underwent TKA at the Second Hospital Affiliated to Fujian Medical University between February 2018 and July 2020. The primary outcome measure was the Hospital for Special Surgery Knee-Rating Scale (HSS) score. The secondary outcomes included postoperative radiographic parameters (X-rays) and the occurrence of complications.</p><p><strong>Result: </strong>A total of 94 patients (107 knees) who underwent TKA were included in the study. Of these, 37 knees had PFM and 70 had normal patellofemoral alignment (PFA). Patients with preoperative PFM showed a change in patellar outward displacement from 7.01 ± 3.91 mm preoperatively to -0.31 ± 2.86 mm postoperatively (p<0.001), and the lateral patellar tilt angle changed from 9.45 ± 7.47° to 6.06 ± 3.61° (P=0.009). Postoperative radiographic parameters between the PFM and PFA groups did not show any significant difference (p>0.05), but the postoperative HSS score in the PFM group was lower than in the PFA group (total score: 70.35 ± 8.39 vs. 80.47 ± 5.44, p<0.001). In addition, 13 (35.14%) knees in the PFM group experienced postoperative anterior knee pain compared to 10 (14.29%) knees in the PFA group (P=0.013).</p><p><strong>Conclusion: </strong>Preoperative PFM may have an impact on the HSS score and the occurrence of anterior knee pain in patients after TKA. These findings suggest that surgeons should carefully evaluate preoperative PFA in patients undergoing TKA. Furthermore, patients with PFM may require additional monitoring and management of postoperative anterior knee pain, as well as special considerations for optimizing functional outcomes.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presurgical Evaluation by a Health Behavior Psychologist Can Effectively Delineate Patient-Specific Barriers that Impact Treatment Outcomes after Osteochondral Allograft Transplantation.","authors":"Kylee Rucinski, Renee Stucky, Felicia Jones, James P Stannard, Clayton W Nuelle, James L Cook","doi":"10.1055/a-2591-9754","DOIUrl":"10.1055/a-2591-9754","url":null,"abstract":"<p><p>Osteochondral allograft transplantation (OCAT) is an effective treatment option for young, active patients with full-thickness articular cartilage defects, but long-term success is limited by treatment failures often linked to nonadherence to postoperative protocols. Validated methods for preoperative identification of patients at risk for nonadherence and/or poor outcomes following OCAT are limited. This study aimed to characterize the ability of a health behavior psychologist (HBP) to preoperatively delineate patient-specific barriers associated with nonadherence and failure following OCAT. Patients were prospectively enrolled in a lifelong, institutionally approved registry. Patients were eligible for inclusion if they had a preoperative evaluation with an HBP. Demographic, biopsychosocial, patient-reported outcomes surveys, and adherence status were collected. Risk domains (low, medium, high) were assigned by the HBP based on the presence and severity of barriers identified during HBP evaluations. OCAT patients (<i>n</i> = 99) were evaluated and assigned a risk domain: (low-risk [<i>n</i> = 41], medium-risk [<i>n</i> = 44], high-risk [<i>n</i> = 14]). Patients in medium- and high-risk cohorts reported significantly more barriers, including mental health issues, limited social support, and high-demand occupations, compared with low-risk patients. Nonadherence rates were significantly higher in medium- and high-risk cohorts; however, nonadherence was not significantly associated with treatment failure. The low-risk cohort reported better mental health and satisfaction outcomes, whereas medium- and high-risk patients had worse physical health outcomes. Preoperative HBP evaluations effectively identified patient-specific barriers to adherence, enabling targeted interventions to improve OCAT surgery outcomes. Integrating behavioral health support into orthopaedic care may improve adherence, highlighting the need for broader implementation and further studies.Level of Evidence 2, prospective cohort study.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision Total Knee Arthroplasty for Mid-Flexion or Combined Mid-Flexion and Flexion Instability: Survivorship and Outcomes.","authors":"Jordan Cohen, Praneeth Thota, Yixuan Amy Pei, Neil P Sheth","doi":"10.1055/a-2608-0053","DOIUrl":"https://doi.org/10.1055/a-2608-0053","url":null,"abstract":"<p><strong>Background: </strong>As patients place higher demand on their implants, mid-flexion instability is increasingly recognized as a contributor to dissatisfaction after total knee arthroplasty. However, the outcomes of revision surgery to address mid-flexion instability have not been categorized.</p><p><strong>Methods: </strong>The study cohort was composed of 52 patients who underwent revision surgery for mid-flexion or combined flexion and mid-flexion instability by a single surgeon between 2015 and 2022. The mean follow-up duration was 2.76 years. Patient characteristics, implants used, and complications were recorded. Range of motion and patient reported outcomes (collected using the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS Jr.) and EQ-5D-5L questionnaires) were compared before surgery and at final follow up.</p><p><strong>Results: </strong>Five patients (9.6%) required an additional operation. Causes of reoperations included component loosening, persistent wound drainage, recurrent instability, and arthrofibrosis. KOOS Jr. scores improved from 46 preoperatively to 60 postoperatively (p<0.01). EQ-5D-5L scores demonstrated a reduction in pain/discomfort and an improvement in ability to perform usual activities (p<0.05). A trend was observed toward increased mobility (p=0.05). The most common 30-day complications were transfusion (11.5%), readmission (11.5%), renal complications including acute kidney injury (9.6%), and wound complications (5.8%). Patients had improvements in maximum flexion and total arc of motion postoperatively (p<0.05).</p><p><strong>Conclusion: </strong>This study includes the largest cohort of patients undergoing revision for mid-flexion instability and demonstrates that appropriately selected patients can have improved outcomes while maintaining their range of motion.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quadriceps Tendon Ruptures After Total Knee Arthroplasty.","authors":"Gabrielle Swartz, James T Layson, Daniel Hameed, Jeremy A Dubin, Sandeep S Bains, Michael A Mont, Ronald E Delanois, Giles R Scuderi","doi":"10.1055/a-2585-4863","DOIUrl":"10.1055/a-2585-4863","url":null,"abstract":"<p><p>Quadricep tendon (QT) ruptures following total knee arthroplasty (TKA) represent a challenging complication with potentially severe consequences, including impaired function and the need for additional surgical intervention. This article reviews the relevant anatomic features, etiology, and risk factors of QT ruptures after TKA. The different treatment options and indications for nonoperative management, direct repair, augmented repair, extensor reconstruction with mesh, and complete extensor allograft reconstruction are reviewed.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior cruciate ligament Reconstruction with Lateral Extra-Articular Augmentation: A Bibliometric Analysis of The Top 100 Cited Articles.","authors":"Osama Alzobi, Hamad Almannai, Ashraf Hantouly, Loay Salman, Abdulaziz F Ahmed, Khalid A Alkhelaifi, Bashir A Zikria","doi":"10.1055/a-2608-0220","DOIUrl":"https://doi.org/10.1055/a-2608-0220","url":null,"abstract":"<p><p>Background There has been significant exploration into anterior cruciate ligament (ACL) reconstruction with lateral extra-articular augmentation, with a marked increase in research output over the past ten years. Purpose This study aims to conduct a thorough bibliometric analysis of the most influential publications on ACL reconstruction combined with lateral extra-articular augmentation. Study Design This research is a cross-sectional study, classified as Level 4 evidence. Methods In July 2024, a thorough search was conducted utilizing the Web of Science Core Collection and Google Scholar databases to identify studies related to ACL reconstruction with lateral extra-articular augmentation. The 100 most cited articles that met the established inclusion criteria were carefully selected and subjected to an in-depth bibliometric analysis. Results The top 100 cited articles were published between 1976 and 2020, with a notable concentration during the 2010s. Citation counts for these articles ranged from 125 to 1000, with citation density varying between 3.32 and 113.00. The United States led in both the number of publications and citations, followed by France and Italy. The majority of the studies focused on anatomical and biomechanical topics, with a growing presence of high-level evidence studies, including 15 classified as level 1 or 2 evidence. Conclusion The period from 2010 to 2020 witnessed a significant surge in the publication of the top 100 most cited articles, highlighting their scientific relevance in specialized areas. The diversity of study types, predominantly anatomical and biomechanical, reflects the substantial interest in this field, coupled with an increase in high-evidence-level research, with 15 articles classified as level 1 or 2. The United States stands out, contributing 31% of these articles, with notable input from France and Italy. This review provides valuable insights into global research trends and outlines potential directions for future research.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription Testosterone Increases the Risk of Reoperation for Infection and All Cause Reoperation after Primary Total Knee Arthroplasty.","authors":"Hannah I Travers, Gloria Coden, Mikhail Kuznetsov, Jacob Kirsch, James V Bono, Eric L Smith","doi":"10.1055/a-2608-0156","DOIUrl":"https://doi.org/10.1055/a-2608-0156","url":null,"abstract":"<p><strong>Introduction: </strong>The rate of total knee arthroplasty (TKA) continues to rise, and with it, the need to identify risk factors for reoperation. Additionally, supplemental testosterone use in male patients has increased across the United States. As more patients taking prescription testosterone replacement therapy (TRT) undergo TKA, there is a need to evaluate TRT as it relates to outcomes following TKA. This study aims to evaluate whether prescription supplemental testosterone is a risk factor for reoperation and reoperation for infection following TKA.</p><p><strong>Methods: </strong>A retrospective cohort study using a nationwide commercial claims databasewas conducted. 76,276 male patients who underwent TKA were identified with 1.9 years mean follow-up. Reoperations and reoperations for infections were identified using ICD-10 and CPT codes. Patients were matched based on demographic, geographic, and comorbidities data using Mahalanobis nearest neighbor matching. Statistical analysis was conducted on 3,209 male patients prescribed testosterone and 32,090 not prescribed testosterone.</p><p><strong>Results: </strong>Demographic and comorbidities including age, location of TKA, length of stay, history of diabetes mellitus, hypertension, hyperlipidemia, obesity, smoking, alcohol, and CCI score were similar (p>0.05) between male patients prescribed testosterone and men who were not. Men prescribed testosterone had a significantly higher cumulative incidence of reoperation for infection than patients not prescribed testosterone at 1 (p=0.01), 2 (p<0.001), 3 (p<0.001), 4 (p<0.001), and 5 years postoperatively (p<0.001). Men prescribed testosterone had a significantly higher cumulative incidence for all cause reoperation than patients not prescribed testosterone at 1 (p=0.01), 2 (p=0.003), 3 (p=0.01), 4 (p<0.001), and 5 years postoperatively (p<0.001).</p><p><strong>Conclusion: </strong>Male patients who were prescribed supplemental testosterone within one year prior to primary TKA were at an increased risk for both all cause reoperation and reoperation due to infection. Surgeons should consider the risks and benefits of testosterone cessation in the perioperative period for patients undergoing TKA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}