Journal of Arthroplasty最新文献

{"title":"The Influence of Obesity on Unicondylar Knee Arthroplasty.","authors":"Kevin B Fricka, Tobenna N Nwankwo, Robert A Sershon, Nancy L Parks, Alexander V Strait, William G Hamilton","doi":"10.1016/j.arth.2025.02.070","DOIUrl":"10.1016/j.arth.2025.02.070","url":null,"abstract":"<p><strong>Background: </strong>Some prior studies suggest obesity increases unicondylar knee arthroplasty (UKA) failure risk. This study evaluated obesity's impact on UKA outcomes at a single institution.</p><p><strong>Methods: </strong>We analyzed 4,973 primary cemented medial UKAs performed by eight surgeons from 2000 to 2022. The primary outcome was implant survivorship. Secondary outcomes included revision rates, reasons for revision, patient-reported outcomes, and clinical metrics. The mean age was 66 years (range, 33 to 96), 54.6% were women, body mass index (BMI) averaged 29.9 (range, 15.6 to 63.4), and follow-up averaged 5.1 years. Outcomes were stratified by BMI cutoffs (BMI: 30; 35; 40), yielding group sizes of ≤ 30 (N = 2,858), > 30 (N = 2,115), ≤ 35 (N = 4,137), > 35 (N = 836), ≤ 40 (N = 4,680), and > 40 (N = 293).</p><p><strong>Results: </strong>At 5 and 10 years, implant survivorship was 95.7 and 92.8%, respectively. At 5 years, survivorship remained high but declined slightly with increased BMI for the 30 and 35 cutoffs (≤ 30: 96.7%, > 30: 94.2%, P < 0.001; ≤ 35: 95.8%, > 35: 94.9%; P = 0.005), while a slight, nonsignificant increase occurred for BMI > 40 (≤ 40: 95.7%, > 40: 96.0%; P = 0.325). Arthritis progression was the most common revision reason, and it increased with BMI. Infection rates remained low across all BMIs. There was no difference in the percentage of patients achieving a minimal clinically important difference using the Knee Osteoarthritis Outcome Score, Joint Replacement with each BMI cutoff, but Knee Osteoarthritis Outcome Score, Joint Replacement score changes were significantly greater in the higher BMI patients using the BMI 30 cutoff (P = 0.034).</p><p><strong>Conclusions: </strong>While higher BMI patients had marginally higher rates of revision, we remain enthusiastic about UKA in these patients due to low infection rates across all BMI cohorts and improvements in patient-reported outcome measures.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Analysis of Costs in the Year Before and After Total Knee Arthroplasty.","authors":"Elizabeth A Abe, Saad Tarabichi, Juan D Lizcano, Nihir Parikh, Matthew B Sherman, Chad A Krueger, P Maxwell Courtney","doi":"10.1016/j.arth.2025.02.071","DOIUrl":"10.1016/j.arth.2025.02.071","url":null,"abstract":"<p><strong>Background: </strong>While insurance claims database studies have reported on costs before total knee arthroplasty (TKA), the cost-efficacy of nonoperative treatment remains unclear in patients who eventually undergo TKA. Furthermore, we hypothesized that patients undergoing primary TKA would have lower costs in the year following surgery than if patients continued nonoperative treatment. The purpose of this study was to determine the costs of various nonoperative treatment modalities in the year before and following primary TKA.</p><p><strong>Methods: </strong>We reviewed a consecutive series of 13,117 patients undergoing primary TKA from 2020 to 2022 at a single institution with claims data from Medicare and a single commercial payer. We recorded all office visits, intra-articular injections, bracing, physical therapy, and imaging in the 12 months before and immediately following the patient's primary TKA, analyzing costs by the payer. Patient-reported outcome scores, readmissions, and reoperations were also noted, and costs were included in the 12-month postoperative analysis.</p><p><strong>Results: </strong>There were 5,516 (42.1%) patients who were insured by Medicare, 5,044 (38.5%) commercially insured and 2,557 (19.4%) insured by Medicare Advantage The mean total cost in the year before and after TKA declined from $760 to $598 (commercial), $583 to $351 (Medicare Advantage), and $580 to $370 (Medicare). Medicare patients had the greatest number of nonoperative treatments (6.5 versus 5.3 versus 5.1, P < 0.001) in the year before TKA. Patients in all three groups achieved the minimum clinically important difference for the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement at similar rates (74.8 versus 75.6 versus 72.7%, P = 0.35).</p><p><strong>Conclusions: </strong>Patients undergoing primary TKA had lower costs in the year following surgery than they did with trial nonoperative treatment in the year prior. Further studies are needed to evaluate the cost-efficacy of nonoperative treatment modalities.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and Survival of a Single Model of Modular-Neck Primary Total Hip Arthroplasty at a Mean of Eight Years.","authors":"L R Benaroch, J Allen, E M Vasarhelyi, D Naudie, B A Lanting, J L Howard","doi":"10.1016/j.arth.2025.02.067","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.067","url":null,"abstract":"<p><strong>Background: </strong>We report the outcomes and survival of a recalled modular neck primary total hip arthroplasty (THA). This study's purpose was to describe the survival, complications, patient-reported outcome measures and serum metal ion levels at a mean of eight years.</p><p><strong>Methods: </strong>We identified 89 hips that received a modular neck THA between May 2010 and March 2012. Failure was defined as the removal of the femoral component for any reason, excluding infection. The PROMs including the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Harris Hip Score (HHS), and Veterans RAND 12 Physical (VR12-PCS) and Mental Score (VR12-MCS), and serum metal ion levels were recorded and compared between unrevised and revised patients.</p><p><strong>Results: </strong>The mean time to the most recent follow-up and revision surgery was 7.79 years and 4.31 years, respectively. The mean survivorship was 10.0 years with a survival of 51% at 13 years. There were 33 infection-free failures identified, with symptomatic adverse local tissue reaction or pseudotumor being the most common (62.5%). Of the patients who underwent revision surgery, six required repeat revisions. When comparing unrevised and revised cases, the unrevised group had significantly greater HHS function (P = 0.002), HHS total (P = 0.003), and VR12-PCS (P = 0.04) scores. Metal ion analysis showed that mean serum Cobalt (Co) ion levels were significantly higher for the revised patients compared to the unrevised patients (P < 0.001).</p><p><strong>Conclusion: </strong>This study demonstrated that the taper corrosion-related failure continues to be an issue with this specific modular neck primary THA implant. Functional data demonstrated poorer outcomes in patients who required revision and following revision surgery compared to patients who did not require a revision surgery. Patients who have received this implant should continue to be monitored on a routine basis, and care providers should have a low threshold to investigate symptoms.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Trends of Surgical Approach and Use of Enhancing Technology in Total Hip Arthroplasty: A Comparison of Early Career and More Experienced Surgeons Using the American Board of Orthopaedic Surgery Oral Examination and Recertification Data.","authors":"Charles L Nelson, John J Harrast, Joshua J Jacobs, David F Martin, Kevin L Garvin","doi":"10.1016/j.arth.2025.02.069","DOIUrl":"10.1016/j.arth.2025.02.069","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) has been among the most successful procedures in medicine, but the preferred approach and use of enhancing technologies are evolving. This study was conducted to define current THA practice (surgical approach and use of enhancing technologies) among early-career and more experienced surgeons. A secondary goal of this study was to identify differences in 6-month Patient-Reported Outcome Measurement Information System (PROMIS) pain interference or function scores and early complications.</p><p><strong>Methods: </strong>In 2022 and 2023, 35,068 THAs were submitted to the American Board of Orthopaedic Surgery by candidates for the part II oral certification examination (14,993) and by Diplomates as part of the recertification process (20,075). The average patient age was 66 years, and 54% of patients were women. Baseline and 6-month PROMIS pain interference and function surveys were obtained from 2,019 patients in the Part II group. Postoperative complications were reported by the candidates or diplomates for all patients.</p><p><strong>Results: </strong>Part II candidate surgical approach was direct anterior (DA) (69%), posterior (26%), direct lateral (2%), and other (2%). For recertification candidates, the surgical approach was DA (43%), posterior (43%), direct lateral (6%), and other (7%). Robotics or navigation was utilized in 18 and 15%, respectively. There were equivalent improvements in the PROMIS function in all groups. The surgeon-reported significant surgical complications were higher in part II candidates (8.4%) than in candidates undergoing recertification (2.7%, P < 0.001), with bone fracture the most common in each group (part II: 2.3%; recertification at 0.6%).</p><p><strong>Conclusions: </strong>The part II candidates are more likely to utilize the DA approach compared to recertification candidates. The Part II candidates report higher rates of postoperative complications. However, there was no difference in the rate of surgeon-reported surgical complications or fractures based on surgical approach. Robotics and navigation are utilized in less than 20% of THA cases. The PROMs improved equally in all THA groups.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tibial Components Placed in Constitutional Varus Alignment in Primary Total Knee Arthroplasty: A 5-Year Survivorship Analysis.","authors":"Rohat B Bhimani, John E Whitaker, Maunil Mullick, Gavin W Clark, Serene Lee, Dermot M Collopy, Langan S Smith, Arthur L Malkani","doi":"10.1016/j.arth.2025.02.073","DOIUrl":"10.1016/j.arth.2025.02.073","url":null,"abstract":"<p><strong>Background: </strong>Placing tibial components in varus alignment has been controversial due to concerns of loosening and subsequent revision. The purpose of this study was to compare 5-year survivorship of tibial components placed in 3° or greater of varus alignment versus neutral mechanical alignment (nMA).</p><p><strong>Methods: </strong>This was a retrospective matched cohort study of 530 patients with 265 patients who underwent primary robotic-assisted total knee arthroplasty (TKA) with tibial components intentionally placed in varus matched to a control group of 265 patients who underwent TKA using manual instrumentation with tibial components placed in nMA. Both cementless and cemented implants were used in both groups. There was no difference between groups with respect to patient sex or age. There were 100 and 87.5% of patients who had a minimum 5-year follow-up in the tibial varus and nMA groups, respectively. Outcomes included survivorship, complications, revisions, and patient-reported outcome measures.</p><p><strong>Results: </strong>All-cause survivorship at 5 years postoperatively was 98% in the group with constitutional tibial varus and 96% in the nMA group (P = 0.12). There were no cases of aseptic loosening in the group with tibial component varus. There were five patients who required revision in the varus group versus 14 in the nMA group (P = 0.02). There was a significant difference in nonrevision intervention for stiffness between the two groups in favor of the varus group (three versus 14, P = 0.003).</p><p><strong>Conclusions: </strong>Similar survivorship was demonstrated at a mid-term 5-year follow-up between patients undergoing primary TKA using a functional alternative alignment concept with tibial components intentionally placed in 3° or greater of varus compared to nMA. Tibial components placed in constitutional or anatomic varus, in an attempt to restore the native oblique joint line along with well-balanced gaps, demonstrated 98% survivorship at 5 years.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Compartment Phenotype Concept of Total Knee Arthroplasty Alignment: Mismatch Between Distal Femoral, Posterior Femoral, and Tibial Joint Lines.","authors":"Silvan Hess, Chelli Sabrina, Vincent Leclercq, Sebastien Lustig, Heiko Graichen, Michael T Hirschmann","doi":"10.1016/j.arth.2025.02.015","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.015","url":null,"abstract":"<p><strong>Background: </strong>The purpose of the study was to assess whether patients who have different coronal alignment variations (functional knee phenotypes (FKP)) have distinctly different rotational alignment variations to justify an extension of the FKP concept to include rotational alignment parameters. The goals of the study were to: 1) determine the frequency of bony congruence between the anterior, distal, and posterior femoral and proximal tibial joint lines using the extended FKP concept; and 2) connect these findings to clinical practice by simulating the impact of different alignment concepts on the most common FKP.</p><p><strong>Methods: </strong>The posterior condylar angle (PCA) and anterior trochlear angle (ATA) were measured in 265 knees without osteoarthritis (OA). The PCA measurements of 2,692 OA knees with OA were extracted from the database. The patients were categorized into phenotypes based on these parameters. A phenotype represents an alignment variation of either the posterior (= PCA) or anterior femoral joint line (= ATA) in the axial plane. Rotational phenotypes (i.e., combination of alignment variations of the anterior and posterior femoral joint lines) were linked with the coronal phenotypes of these patients. The effect of three alignment concepts (mechanical, restricted, and unrestricted kinematic) on the most common FKPs was assessed.</p><p><strong>Results: </strong>The distribution of the five most common coronal phenotypes did not differ among rotational phenotypes. The ATA and PCA were aligned parallel in 14.3% of the non-OA population. Distal femoral joint line (FMA), proximal tibial joint line (TMA), and PCA were aligned in parallel in 17.0 and 11.2% of the non-OA and OA populations, respectively. All four joint lines (FMA, TMA, PCA, and ATA) were aligned in 2.3% of the non-OA population.</p><p><strong>Conclusion: </strong>It is crucial to emphasize that preoperative assessment of a patient's anatomy should include the anterior and posterior femoral joint lines. The extended FKP concept could aid in this assessment and help identify patients at risk of complications due to malalignment or those likely to benefit from a particular alignment concept.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Surgical Approach Impact Wound Complication Rates after Revision Total Hip Arthroplasty?","authors":"Nihir Parikh, Alan D Lam, Elizabeth A Abe, R Craig Juniewicz, Hunter Warwick, Chad A Krueger","doi":"10.1016/j.arth.2025.02.062","DOIUrl":"10.1016/j.arth.2025.02.062","url":null,"abstract":"<p><strong>Background: </strong>While some literature suggests that wound complications are increased for primary total hip arthroplasty (THA) procedures utilizing the direct anterior (DA) approach, the impact of the surgical approach on wound complications after revision THA cases remains unknown. This study aimed to compare wound complications between different surgical approaches in revision THA.</p><p><strong>Methods: </strong>The retrospective study identified 1,749 consecutive patients who underwent revision THA at a single institution between 2017 and 2023. Patients were categorized based on components revised (acetabular only, femur only, both-component, head-liner exchange) during revision THA and by surgical approach (DA, direct lateral (DL), postero-lateral (PL)) for each category. The primary outcome of the study was wound complications within 90 days of surgery.</p><p><strong>Results: </strong>The wound complication rates for acetabular-only revisions were 0.83 for DA approach, 4.64 for DL approach, and 3.9% for PL approach (P = 0.149). Femoral component revisions had wound complication rates of 9.68 for DA approach, 5.06 for DL approach, and 13.2% for PL approach (P = 0.065). For both component revisions, the wound complication rates were 5.83 for DA approach, 4.49 for DL approach, and 8.47% for PL approach (P = 0.28). Also, head and liner exchange wound complication rates were 6.94 for DA approach, 6.21 for DL approach, and 11.3% for PL approach (P = 0.301). Readmission rates and reoperation rates were similar for all approaches in all revisions except for femoral component revisions performed through the PL approach, which had an increased risk of readmission (12.3%, P = 0.008) and reoperation (10.4%, P = 0.012) compared to DA approach (8.6 and 6.45%, respectively) and DL approach (2.53 and 1.9%, respectively).</p><p><strong>Conclusions: </strong>The surgical approach appears to have minimal impact on the likelihood of developing wound complications in revision THAs. The need for readmission and reoperation was also similar across surgical approaches for various revision THA procedures.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reinfection Patterns Following Two-Stage Exchange for Periprosthetic Joint Infection: A Retrospective Analysis.","authors":"Calvin C Chandler, Andrew J Clair, Rory W Metcalf, Kayla T Hietpas, Thomas K Fehring, Jesse E Otero","doi":"10.1016/j.arth.2025.02.068","DOIUrl":"10.1016/j.arth.2025.02.068","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) is a challenging complication following total joint arthroplasty. A two-stage exchange has been the gold standard in the treatment of chronic PJI. However, when this fails, further treatment options become limited. In patients who fail two-stage exchange, the reinfecting organism is different from the original in 50 to 80% of the occurrences. This study aimed to understand reinfection patterns in an attempt to better predict reinfecting organisms to improve the management of PJI.</p><p><strong>Methods: </strong>A retrospective query of our institution's PJI registry identified 185 patients (188 procedures, 110 knees, and 78 hips) who underwent a first-time two-stage exchange for culture-positive chronic PJI of total knee and hip arthroplasties from January 2010 to December 2020. Patients who had polymicrobial infections, culture-negative results, or fungal infections were excluded. The primary outcome variable was reoperation for reinfection and comparing the index organism to the reinfecting organisms.</p><p><strong>Results: </strong>Of the 188 procedures, 31 (16.5%) failed due to reinfection. Among reinfections, 30 (96.8%) were gram-positive, with Staphylococcus aureus species accounting for 22 (71.0%) of the cases. The most common organisms cultured were for methicillin-sensitive S. Aureus, methicillin-resistant S. Aureus, coagulase-negative staphylococcus, and streptococcus. Of reinfections, 19 (61.3%) had a different organism, eight (25.8%) had the same organism, and four (12.9%) were culture-negative. Patients experiencing reinfection were significantly younger (P = 0.012), with no other patterns or predictors identified.</p><p><strong>Conclusions: </strong>The majority of reinfections following a two-stage exchange for PJI occur with a different organism than the index infection. We did not find a reliable method to predict the reinfecting organisms based on the initial infecting organism alone. However, the same four gram-positive organisms were the most frequently encountered in both the primary infection and the reinfection. Further research is required to understand factors contributing to reinfection and help guide prevention strategies.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The John N. Insall Award: Functional Versus Mechanical Alignment in Total Knee Arthroplasty: A Randomized Controlled Trial.","authors":"Simon W Young, Mei Lin Tay, Kohei Kawaguchi, Rupert van Rooyen, Matthew L Walker, William J Farrington, Ali Bayan","doi":"10.1016/j.arth.2025.02.065","DOIUrl":"10.1016/j.arth.2025.02.065","url":null,"abstract":"<p><strong>Background: </strong>Mechanical alignment (MA) in total knee arthroplasty is regarded as a gold standard; however, some patients report dissatisfaction postsurgery. Functional alignment (FA) is a potential alternative, integrating kinematic alignment (KA) principles with preresection bone balancing within defined boundaries. The use of FA aims to improve outcomes by restoring native joint lines and optimizing soft-tissue balance. However, comparative evidence is limited.</p><p><strong>Methods: </strong>This prospective, randomized controlled trial compared MA (n = 121) and FA (n = 123) in robotic-assisted total knee arthroplasty. For MA, components were positioned perpendicular to the limb mechanical axis, with soft-tissue releases to achieve balance. For FA, initial virtual component positioning was used to match native knee anatomy, with adjustments for soft-tissue balance before bone cuts. The primary outcome was the forgotten joint score (FJS). Outcomes were compared with a mixed-model analysis of variance.</p><p><strong>Results: </strong>At the 2-year follow-up, the mean FJS was comparable (MA: 64.4 ± 30.1 versus FA: 70.1 ± 25.6, P = 0.10). The MA cases had more soft-tissue releases than FA (65 versus 16%, P < 0.001). Compared to MA patients, FA patients had higher Knee Injury and Osteoarthritis Outcome (KOOS) Symptoms (86.6 ± 12.9 versus 82.5 ± 14.0, P = 0.01) and KOOS-Quality of Life scores (76.1 ± 20.3 versus 70.7 ± 22.7, P = 0.03). More FA patients \"would recommend\" the procedure (94 versus 82%, P < 0.01). For patients who had preoperative Coronal Plane Alignment of the Knee Type I, FA had higher FJS (71.3 ± 24.8 versus 56.8 ± 31.6, P = 0.02) and KOOS-Quality of Life (76.4 ± 21.7 versus 64.2 ± 19.2, P = 0.02) than MA. No other differences were seen in patient-reported outcomes (Oxford Knee Score, KOOS, EuroQol-5 Dimensions, Pain Visual Analog Scale), clinical outcomes (length of stay, functional physio tests), reoperations, or implant survivorship (FA: 1 versus MA: 0 revisions).</p><p><strong>Conclusions: </strong>While FA required fewer soft-tissue releases compared to mechanical alignment, at 2 years patient-reported and clinical outcomes were similar. The use of FA may provide improved outcomes for a specific subgroup of patients based on their preoperative alignment.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial Laxity Leads to Inferior Postoperative Clinical Outcomes and Function in Total Knee Arthroplasty.","authors":"Shinichiro Nakamura, Shinichi Kuriyama, Kohei Nishitani, Yugo Morita, Yugo Morita, Shuichi Matsuda","doi":"10.1016/j.arth.2025.02.063","DOIUrl":"10.1016/j.arth.2025.02.063","url":null,"abstract":"<p><strong>Background: </strong>Achieving proper soft-tissue balance is essential for improving total knee arthroplasty outcomes. This multicenter study aimed to analyze the effects of the gap angle and medial and lateral component gaps on clinical outcomes.</p><p><strong>Methods: </strong>This retrospective multicenter cohort study was conducted on 656 knees in 11 centers. A tensor device was used to measure the joint gap and varus-valgus angle of the joint gap, and medial and lateral component gaps were determined by subtracting the polyethylene thickness. Correlations between the gap angle, component gap, and clinical outcomes using the Knee Society Score (KSS) and the new Knee Society Score (2011 KSS) were analyzed.</p><p><strong>Results: </strong>The varus gap angle in flexion positively correlated with the KSS knee score (r = 0.118, P = 0.0183), KSS function score (r = 0.164, P = 0.0009), 2011 KSS symptoms (r = 0.148, P = 0.0030), and 2011 KSS functional activities (r = 0.129, P = 0.0099). The medial component gap in extension negatively correlated with the KSS function score (r = -0.113, P = 0.0241) and that in flexion negatively correlated with the 2011 KSS symptoms (r = -0.127, P = 0.0078) and the 2011 KSS patient satisfaction score (r = -0.119, P = 0.0126). The lateral component gap had no correlation with clinical outcomes. The valgus gap group in flexion showed poorer clinical outcomes than the severe varus, varus, and/or balanced gap groups. The slightly loose group of the medial component gap in extension showed lower 2011 KSS symptoms (P = 0.0352) and functional activities (P = 0.0085) than that in the tight group.</p><p><strong>Conclusions: </strong>The valgus joint gap and medial looseness are negatively correlated with clinical outcomes, and residual varus joint gap and lateral laxity can be tolerated. Bone resection and soft-tissue release should be performed carefully to prevent medial looseness.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}