Journal of Knee Surgery最新文献

{"title":"A prospective study to compare clinical and radiological outcomes of functionally versus mechanically aligned knees following robotic total knee arthroplasty.","authors":"Amal Antony Paul, Jai Thilak","doi":"10.1055/a-2712-4085","DOIUrl":"https://doi.org/10.1055/a-2712-4085","url":null,"abstract":"<p><strong>Introduction: </strong>Total knee arthroplasty (TKA) is one of the most effective treatment options for patients with end-stage osteoarthritis (OA) of the knee. However, one out of five patients remain unhappy with the outcomes. In the recent years, more emphasis has been given to knee alignment approaches as a potential solution. The main objective of this study was to compare the clinical and functional outcomes between patients undergoing robot-assisted TKA using mechanical alignment (MA) or functional alignment (FA).</p><p><strong>Materials and methods: </strong>This prospective non-randomized study enrolled 40 patients (20 patients in each group). The procedure was performed by a single surgeon using FA or MA. In addition to other measures, the New Knee Society Score (NKSS) and Oxford Knee Score (OKS) and modified forgotten joint scores (MFJS) were recorded and the patients were followed-up until 18 months.</p><p><strong>Results: </strong>The baseline characteristics including age, gender, and body mass index, did not differ statistically between the groups. All parameters of the NKSS, the OKS, and the MFJS were improved consistently at all post-operative time-points from 6 weeks through 18 months in the FA-TKA group. The pain score and time to straight leg raise were better in the FA-TKA versus MA-TKA group (P<0.001).</p><p><strong>Conclusions: </strong>Our study showed that FA with robot-assisted TKA was associated with improvement in clinical outcomes and reduced pain. The patients experienced clinically meaningful improvement in patient satisfaction and functional abilities with FA. Due to small sample size of the current study, future studies are needed to confirm these findings.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201798","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":"The Negative Impact of High Molecular Weight Hyaluronan on Anterior Cruciate Ligament Wound Repair.","authors":"James Rogot, Lance A Murphy, Claire Pinnie, Matthew J Pellicore, Howard J Nicholson Iii, James L Cook, Clark T Hung","doi":"10.1055/a-2712-4402","DOIUrl":"https://doi.org/10.1055/a-2712-4402","url":null,"abstract":"<p><p>Surgical reconstruction of the anterior cruciate ligament (ACL) has historically been the only method by which knee stability is restored following ACL rupture. Following ACL rupture the torn ends of the ligament are exposed to the synovial environment, containing hyaluronan (HA), which has been implicated in poor migratory function of ACL fibroblasts (ACLF). We hypothesize that the HA in synovial fluid attenuates the wound healing response of the ACL by inhibition of new focal adhesions between ACLF and the surrounding environment. Juvenile bovine ACLF were isolated and cultured in the presence of endogenous and exogenous high molecular weight HA (HMWHA) to monitor in vitro wound closure. Concurrently, cells were assayed for focal adhesion formation and adhesion strength. Next, human ACLF were cast into tissue engineered constructs to assess their ability to contract within a 3D matrix after treatment with HA. A cellular viability assay was used to determine cytotoxicity of HMWHA. Co-culture of synoviocytes with ACLF wounds demonstrated that HMWHA was the primary cause for attenuated wound healing. When exogenous HMWHA was cultured with ACLF, a dose-dependent negative correlation (r = -0.65, p < 0.001) in cell migration was observed. A significant decrease in number and strength of focal adhesions was found to mirror the dose-dependent pattern. Collagen gel contraction was inhibited in the presence of HMWHA. Direct exposure of ACLF to HMWHA was shown to inhibit ACLF wound healing and contraction. As cytotoxicity remained unchanged, this decreased healing capacity is attributed to reduced focal adhesion formation and weakened adhesion strength of ACLF in the presence of HMWHA. This study identifies HMWHA exclusion as a potential therapeutic strategy and provides insight into the mechanism by which traditional primary repair of the ACL as well as graft reconstructions may fail.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201840","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":"National Trends in Use and Complications of Cemented, Cementless, Manual, and Robotic-Assisted Total Knee Arthroplasty: 2016-2022.","authors":"Daniel Finch, John Mazzocco, Gloria Coden, Hannah I Travers, David Mattingly","doi":"10.1055/a-2712-4129","DOIUrl":"https://doi.org/10.1055/a-2712-4129","url":null,"abstract":"<p><strong>Introduction: </strong>Cementless total knee arthroplasty (TKA) has become a viable option in recent years, and there has been an increase in robotic-assisted technology. While institutions may monitor their implant usage, the evolution of their use and complication rates have not been well described on a national level in the United States. Therefore, we sought to characterize the use and compare complications between cemented, cementless, manual, and robotic-assisted TKA across the United States.</p><p><strong>Methods: </strong>We retrospectively reviewed a commercial claims database and found 94,603 inpatient primary TKAs that were performed with cemented or cementless components between 1/1/2016 and 12/31/2022. Records were reviewed for demographics, use of robotics, complications, and readmissions up to 90 days postoperatively.</p><p><strong>Results: </strong>More cementless TKAs were performed each year, from 4.1% in 2016 to 12.3% in 2022 (odds ratio (OR)=1.3, p<0.001). The use of robotic technology increased each year from 7.7% in 2016 to 25.0% in 2022 (OR=1.3, p<0.001) and was more commonly used with cementless TKA (OR=1.3, p<0.001). Patient factors associated with cementless TKA included younger age (OR=1.0, p<0.001) and male sex (OR=1.3, p<0.001). Cementless TKA was a risk factor for explantation within 90 days postoperatively (OR=1.5, p=0.008), but not aseptic loosening (OR=0.8, p=0.6), periprosthetic fracture (OR=0.2, p=0.2), infection (OR=1.3, p=0.1), revision TKA (OR=1.4, p=0.1), manipulation under anesthesia (OR=1.0, p=0.9), deep vein thrombosis (OR=0.9, p=0.5), pulmonary embolism (OR=1.2, p=0.3), or blood transfusion (OR=0.3, p=0.1).</p><p><strong>Conclusion: </strong>The use of cementless and robotic TKA is increasing each year, although most inpatient primary TKAs are still performed with manual cemented technique. While cementless TKA was found to be a risk factor for revision and explanation within 90 days, it was not associated with a specific cause of revision. Further research is needed to better understand why cementless TKA increases these risks.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201825","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":"Defining a Relationship Between the Tibial Plateau and Posterior Femoral Condyles.","authors":"Kevin Chun Luk Chang, Mohamed Albana, Jeff Bischoff, Giles R Scuderi","doi":"10.1055/a-2712-4236","DOIUrl":"https://doi.org/10.1055/a-2712-4236","url":null,"abstract":"<p><p>Introduction Anatomic research has demonstrated significant differences in native knee morphology between genders and ethnicities. These studies have traditionally evaluated femoral morphology. However, no studies have yet investigated possible relationships between the posterior femoral condyles and the tibial plateau. Our study sought to demonstrate this relationship, and evaluate its strength when stratified by gender and race. Methods An international database of CT scans of non-arthritic knees was accessed, and, using computer software, length measurements of regions of interest were recorded. Measurements included medial-lateral width of the posterior femoral condyles (FW) and width of the tibial plateau (TW). These measurements were compared. Statistical analysis was performed for the entire population, and subsequently for the population stratified by gender and ethnic groupings. Results The review included 373 non-arthritic knees, each from unique patients. The cohort consisted of 184 males (49.3%), and 189 females (50.6%). 117 patients were from Japan (31.4%), 100 were from India (26.8%), 87 were from Korea (23.3%), 43 were from China (11.5%), and 26 were from North America (7.0%). Average age was 57.6 years ± 8.6 years. The width of the proximal tibia was positively correlated to posterior femoral condylar width, R2=0.83. Gender stratification weakened the correlation, with female patients demonstrating an R2 of 0.64, and male patients R2 of 0.60. Ethnic stratification strengthened relationships in Japanese (R2 = 0.87), North American (R2 = 0.89), and South Korean (R2 = 0.88) patients; and weakened them in Indian (R2 =0.72) and Chinese (R2 = 0.82) patients. Discussion This study is the first to use CT to demonstrate the strength of tibiofemoral relationships for individual demographic groups. These findings highlight important differences in morphology, and may be used to inform implant design, selection, stocking, and supply. Further, these data may help identify patients who require differentially-sized tibial and femoral components preoperatively.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201817","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":"Short-term outcomes and rehabilitation following anterior cruciate ligament reconstruction with and without lateral extra-articular tenodesis in younger patients: a prospective comparison.","authors":"Jelle P van der List, Ingmar F Blom, Dirk Jan Hofstee, Freerk J Jonkers, Joyce L Benner","doi":"10.1055/a-2712-4279","DOIUrl":"https://doi.org/10.1055/a-2712-4279","url":null,"abstract":"<p><strong>Introduction: </strong>Anterior cruciate ligament reconstruction (ACLR) is commonly performed in the younger or active population, but failure rates have been disappointing in high-risk patients. Recently, lateral extra-articular procedures such as the modified Lemaire extra-articular tenodesis (LET) have been proposed to decrease failure rates, but knowledge on short-term rehabilitation, stiffness and isokinetic strength is limited. This study aimed to assess the short-term patient-reported outcomes (PROMs) and physical performance outcomes following ACLR with and without LET.</p><p><strong>Methods: </strong>A prospective study was performed among 152 patients aged 25 years undergoing hamstring autograft ACLR with or without modified Lemaire LET between 2019 and 2022 with minimum 1-year follow-up. PROMs (Tegner, International Knee Documentation Committee, Lysholm, NRS for pain, and EQ-5D) were compared between groups preoperatively and at 3, 6, 9, 12 and 24 months, while physical performance (range-of-motion (ROM), and limb symmetry indices (LSI) of isokinetic testing, single-leg and timed-6m hop) was compared up to 9 months postoperatively.</p><p><strong>Results: </strong>Baseline characteristics and outcomes were similar, except thicker grafts in the LET group (8.9 vs 8.7 mm, p=.047). At 3 months, Lemaire patients reported less pain (NRS pain 17.1 vs 35.6, p<.001), but at 6 months, Lemaire patients had inferior LSI for timed-6m hop (87% vs 96%, p=.003). At 9 months, Lemaire patients had similar return-to-sports, PROMs, and ROM, but had lower LSI for flexion endurance strength (88% vs 97%, p=.041). At 12 months, no differences were seen in PROMs.</p><p><strong>Conclusion: </strong>Patients undergoing ACLR with LET had less pain at 3 months, but worse LSI for timed-6m hop at 6 months and worse LSI for flexion endurance strength at 9 months. Both groups showed similar performance on all other outcomes, indicating that ACLR with LET is not associated with increased stiffness, complications or significant strength deficits.</p><p><strong>Level of evidence: </strong>Level II prospective study.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193562","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":"High-Chondrocyte-Viability Osteochondral Allograft Transplantation in the Knee for Revision of Failed Cartilage Repair Procedures.","authors":"Steven F DeFroda, Julian M Moore, Kylee Rucinski, James P Stannard, Clayton W Nuelle, James L Cook","doi":"10.1055/a-2710-6069","DOIUrl":"https://doi.org/10.1055/a-2710-6069","url":null,"abstract":"<p><p>Revision osteochondral allograft transplantation (OCAT) has historically yielded inferior outcomes compared to primary procedures. This study evaluates outcomes following revision OCAT using high-chondrocyte-viability (HCV) OCAs for functional graft survival. A prospective registry was analyzed for HCV OCAT outcomes. Patients were grouped into primary (n=182) or revision (n=70) OCAT cohorts. Demographic, surgical, and follow-up data were collected. Revision cases were further subclassified based on prior cartilage procedures (marrow stimulation, osteochondral, or cell-matrix-based). Functional graft survival and validated patient-reported outcomes were assessed at a mean follow-up of 43 months. At final follow-up, functional graft survival was 79.1% for primary and 71.4% for revision OCAT. Overall survival at >2-year follow-up was 84% (primary) and 80% (revision). Patients with failed revision OCAT reported significantly lower PROMIS Physical Function scores at 1-year (mean: 40.8, p=.026). Bipolar tibiofemoral revisions conferred increased failure rates (OR 3.86, p=.033). Cell-matrix-based revision cases had significantly higher graft survival (100%) compared to osteochondral revisions (58.6%, p=.049). Satisfaction with revision OCAT was high (75.0%), and 84.1% would undergo the procedure again. With evidence-based patient selection, individuals who have failed previous cartilage defect surgical treatments and meet indication criteria are likely to benefit from revision OCAT with HCV allografts. Optimal candidates for revision OCAT in the knee are patients with a history of marrow stimulation or cell-based matrix procedures who have limited comorbidities, do not require tibiofemoral bipolar OCAT, and strictly adhere to postoperative restriction and rehabilitation protocols.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193531","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":"Effects of Osteochondral Allograft Reaming Protocols on Donor Chondrocyte Viability Prior to Transplantation.","authors":"Kylee Rucinski, Aaron M Stoker, James P Stannard, Clayton W Nuelle, Jacob S Kramer, Corder E Lehenbauer, James L Cook","doi":"10.1055/a-2695-2258","DOIUrl":"10.1055/a-2695-2258","url":null,"abstract":"<p><p>This preclinical ex vivo study was conducted to evaluate the effects of submersion in saline or the Missouri Osteochondral Preservation System (MOPS®) solution during reaming on viable chondrocyte density (VCD) of osteochondral allografts (OCAs). Distal femoral OCAs preserved with MOPS were reamed to create cylindrical \"plug\" grafts using one of three techniques: Submersion in MOPS (SG-MOPS), submersion in saline (SG-Saline), or reamer saturated with MOPS without OCA submersion (SR-MOPS). All plug reaming was performed using standardized instrumentation and technique to harvest 18-mm-diameter plugs. Pre-reaming cartilage samples were collected to confirm baseline VCD. Post-reaming plugs were bisected and stained for live/dead analysis using fluorescent microscopy. VCD was quantified via image analysis, and %Day-0 VCD was calculated. Group comparisons were made using one-way analysis of variance (ANOVA; α = 0.05). A total of 21 plugs from 9 donors were analyzed: SG-MOPS (<i>n</i> = 8), SG-Saline (<i>n</i> = 6), SR-MOPS (<i>n</i> = 7). Mean %Day-0 VCD was highest in SG-MOPS (92.6 ± 7.8%), followed by SG-Saline (83.3 ± 10.2%), and SR-MOPS (80.2 ± 9.1%), though differences were not statistically significant (<i>p</i> = 0.68). A higher proportion of SG-MOPS plugs (7/8, 88%) exceeded the minimum essential VCD threshold (70%) compared with SG-Saline (4/6, 67%) and SR-MOPS (3/7, 43%). Submerging distal femur OCAs in MOPS during 18-mm-diameter femoral condyle plug reaming had clinically meaningful beneficial effects on viable donor chondrocyte density when compared with saline-submerged or non-submerged grafts. Based on the use of this submerged reaming technique that is standardized, repeatable, readily available, cost-effective, and safe, this methodology can be considered \"best practice\" for OCA plug reaming protocols, motivating implementation of this evidence-based shift in practice at our institution.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001691","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":"Step-Off Between the Lateral Femoral Condyle and the Lateral Tibial Plateau: Association with Degenerative Lateral Meniscal Tears and Lateral Osteoarthritis of the Knee.","authors":"Masanori Terauchi, Kazuhisa Hatayama, Kenichi Saito","doi":"10.1055/a-2693-0944","DOIUrl":"10.1055/a-2693-0944","url":null,"abstract":"<p><p>A naturally occurring step-off (SO) between the lateral femoral condyle and the lateral tibial plateau creates a zone where the middle part of the lateral meniscus (LM) is not covered by the femoral condyle. We assessed the effects of this SO on the development of meniscal damage and osteoarthritis (OA). A total of 82 patients who underwent meniscectomy of the LM were retrospectively reviewed. The patients were divided into two groups based on findings of OA on radiography. The control group consisted of patients without OA who were matched to those who had acute isolated anterior cruciate ligament injuries. The size of the SO and extrusion of the LM were obtained by preoperative magnetic resonance imaging. The mean size of the SO in the LM group was significantly larger than that in the control group (4.0 ± 0.92 mm vs. 1.6 ± 1.11 mm, <i>p</i> < 0.0001). Extrusion of LM was not significantly different between the two groups. Extrusion of the tibial side in patients with OA was significantly larger than that in the non-OA group (1.9 ± 1.2 vs. 0.50 ± 0.95, <i>p</i> < 0.001). However, the size of the SO was not significantly different (4.2 ± 1.28 vs. 4.0 ± 0.92, <i>p</i> = 0.53). A large SO was identified as an anatomical risk factor for degenerative LM tears, leading to extrusion of LM and development of lateral knee OA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975281","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":"Comparative Efficacy of ChatGPT and Gemini in Addressing Patient Queries on Gonarthrosis and Total Knee Arthroplasty: A Randomized Controlled Trial.","authors":"Serhat Gurbuz, Bulent Karslioglu, Ahmet Keskin, Niyazi Igde, Mustafa Bugra Ayaz, Yunus Imren","doi":"10.1055/a-2693-0756","DOIUrl":"https://doi.org/10.1055/a-2693-0756","url":null,"abstract":"<p><p>The emergence of artificial intelligence (AI) in health care has created novel opportunities for enhancing patient education and alleviating anxiety. This study seeks to evaluate the effectiveness of two leading AI platforms, ChatGPT and Gemini, in delivering accurate and satisfactory responses to patients with gonarthrosis, considering total knee arthroplasty (TKA). A prospective, randomized controlled trial was conducted involving 100 patients diagnosed with gonarthrosis and indicated for TKA. Each patient posed five questions regarding the surgery and postoperative rehabilitation to both ChatGPT and Gemini. Responses were evaluated by two blinded orthopaedic specialists on a 10-point scale for accuracy and patient satisfaction. Patients additionally evaluated their satisfaction with each response using a 10-point scale. The main outcome measures consisted of the average accuracy scores assessed by specialists and the average satisfaction scores reported by patients. Statistical analysis revealed significant differences between ChatGPT and Gemini in both accuracy and patient satisfaction (<i>p</i> < 0.001). ChatGPT demonstrated better performance with a mean accuracy score of 8.7 ± 0.9 compared with Gemini's 7.2 ± 1.1. Patient satisfaction scores aligned with expert evaluations, with ChatGPT achieving a mean satisfaction score of 8.9 ± 0.8 versus Gemini's 7.5 ± 1.2. Notably, ChatGPT excelled in providing comprehensive explanations of surgical procedures (mean score: 9.2 ± 0.7) and postoperative care (9.1 ± 0.8), whereas Gemini performed better in offering concise summaries of recovery timelines (8.4 ± 0.9). This study demonstrates that ChatGPT offers more accurate and satisfactory responses to patient queries regarding gonarthrosis and TKA compared with Gemini. The findings suggest that AI platforms, particularly ChatGPT, can serve as valuable tools in augmenting patient education and potentially reducing preoperative anxiety. Future studies should investigate the incorporation of AI-assisted information delivery into clinical practice and its long-term effects on patient outcomes.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092903","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":"Comparable PROM Gains and Satisfaction After TKA in Medicare Advantage vs. Traditional Medicare: A Multivariable Analysis of 6,010 Patients.","authors":"Benjamin E Jevnikar, Khaled A Elmenawi, Yuxuan Jin, Shujaa T Khan, Nicolas S Piuzzi","doi":"10.1055/a-2693-0702","DOIUrl":"https://doi.org/10.1055/a-2693-0702","url":null,"abstract":"<p><p>As value-based care reshapes the landscape of orthopedic surgery, understanding how insurance type influences patient-reported outcomes (PROMs) after total knee arthroplasty (TKA) is increasingly important. While Traditional Medicare (TM) and Medicare Advantage (MA) differ significantly in structure and access, limited data exist comparing functional outcomes between these groups. This retrospective cohort study used a prospectively collected institutional registry to evaluate 6,010 Medicare beneficiaries who underwent primary TKA between 2016 and 2023. Patients were categorized by insurance type (TM or MA) at the time of surgery. Primary PROMs included the KOOS pain, physical function shortform (PS), and Joint Replacement (JR) subscales. Clinically meaningful improvement was assessed using minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) thresholds. Multivariable logistic regression was performed to evaluate the independent association between insurance type and each outcome, adjusting for demographic, clinical, and socioeconomic covariates. At baseline, MA patients had significantly lower KOOS pain, PS, and JR (<i>p</i> < 0.001). However, by 1-year follow-up, both groups achieved similar KOOS pain and PS scores, and comparable PROM improvements from baseline. MA patients had slightly lower KOOS JR scores (<i>p</i> = 0.006) at 1-year, but equivalent odds of achieving MCID, PASS, and SCB thresholds across all KOOS domains after multivariable adjustment. Patient satisfaction at 1 year also did not differ by Medicare plan type (<i>p</i> = 0.729). Despite presenting with worse baseline functional status, MA patients achieved similar postoperative outcomes, PROM gains, and satisfaction as their TM counterparts. These findings suggest that MA enrollment does not negatively impact patient-perceived benefit after TKA and may not warrant differential risk-adjustment in PROM-based value assessments.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082087","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}