Knee最新文献

{"title":"Should central osteophytes within the articular cartilage of the lateral compartment be considered when determining the indication of unicompartmental knee arthroplasty for medial osteoarthritis?","authors":"","doi":"10.1016/j.knee.2024.04.012","DOIUrl":"10.1016/j.knee.2024.04.012","url":null,"abstract":"<div><p><span><span>Patients with central osteophytes in the lateral compartment may be poor candidates for unicompartmental knee arthroplasty (UKA) for medial </span>knee arthritis given the thin overlying </span>articular cartilage above the central osteophytes that is inadequate for supporting weight-bearing after UKA. Therefore, attempts should be made to detect central osteophytes to confirm suitability for UKA.</p></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"49 ","pages":"Pages 279-280"},"PeriodicalIF":1.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201288","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":"Quantitative-MRI analysis of the effects of retrograde nailing on vascularity of the distal femur: A cadaveric study","authors":"Amarpal Cheema ,&nbsp;Aleksey Dvorzhinskiy ,&nbsp;Craig E. Klinger ,&nbsp;Jacob D. Feingold ,&nbsp;Burak Altintas ,&nbsp;Jonathan P. Dyke ,&nbsp;David L. Helfet ,&nbsp;David S. Wellman","doi":"10.1016/j.knee.2024.07.011","DOIUrl":"10.1016/j.knee.2024.07.011","url":null,"abstract":"<div><h3>Background</h3><p>Distal femur fractures remain treatment challenges with a considerable postoperative non-union rate. Concern remains that surgery may compromise osseous vascularity. This study aimed to determine effects of retrograde femoral intramedullary nailing (RFIN) on distal femur vascularity, and the locations of the middle genicular artery terminal branches in relation to the standard RFIN entry point.</p></div><div><h3>Methods</h3><p>Five lower limb cadaveric pairs were obtained (ten specimens). Experimental limbs were randomly assigned, and contralateral limbs served as controls. An 11 mm femoral nail was implanted in experimental specimens. Controls only underwent a medial parapatellar incision with capsulotomy. Quantitative pre- and post-contrast-MRI was performed to assess arterial contributions to distal femur regions. Osseous vascularity was further evaluated with contrast-CT imaging. Next, specimens were injected with latex medium, and dissection was performed to assess extraosseous vasculature.</p></div><div><h3>Results</h3><p>No statistically significant differences were found with quantitative-MRI in experimental and control groups for the entire distal femur or individual regions. The experimental group demonstrated a small mean decrease of 1.4% in distal femur arterial contributions. CT and anatomic dissection confirmed maintenance of middle genicular artery terminal branches. On average, 3.3 (±1.3) terminal branches entered along the posterior intercondylar notch. A mean distance of 15.2 mm (±6.9 mm) was found between the posterior RFIN entry point and these terminal branches.</p></div><div><h3>Conclusions</h3><p>RFIN did not significantly alter arterial contributions to the distal femur or disrupt the middle genicular artery terminal branches. However, care must be taken to ensure nail entry point accuracy given proximity of the entry point to terminal branches.</p></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"49 ","pages":"Pages 257-265"},"PeriodicalIF":1.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762963","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":"MCID achievement in staged bilateral total knee arthroplasty: Are both joints created equal?","authors":"Amy Z. Blackburn ,&nbsp;Akhil Katakam ,&nbsp;Ikechukwu Amakiri ,&nbsp;Ashish Mittal ,&nbsp;Hany S. Bedair ,&nbsp;Christopher M. Melnic","doi":"10.1016/j.knee.2024.07.013","DOIUrl":"10.1016/j.knee.2024.07.013","url":null,"abstract":"<div><h3>Background</h3><p>A notable portion of unilateral total knee arthroplasty (TKA) patients undergo arthroplasty of the contralateral knee. The aims of this study were to describe the Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W) in staged bilateral TKAs (BTKAs) and identify factors associated with these outcomes.</p></div><div><h3>Methods</h3><p>Patients with staged BTKA were retrospectively reviewed. Demographics, surgery details, and Patient-Reported Outcome Measurement Information System Physical Function Short Form 10a (PROMIS PF10a) were collected. MCID-I and MCID-W were defined for PROMIS PF10a. Patients were stratified into nine groups based on the MCID achievement of the first and second TKA: (A) MCID-I, MCID- I, (B) MCID-I, Neutral, (C) MCID-I, MCID-W, (D) Neutral, MCID-I, (E) Neutral, Neutral, (F) Neutral, MCID-W, (G) MCID- W, MCID-I, (H) MCID-W, Neutral, (I) MCID-W, MCID-W. Neutral patients did not achieve either MCID-I or MCID-W.</p></div><div><h3>Results</h3><p>The final cohort consisted of 59 staged BTKA patients. In patients who achieved MCID-I in the first TKA, 39.1% achieved MCID-I again in the second TKA (A), 39.1% were neutral (B), and 21.7% achieved MCID-W (C) in the second TKA. However, 77.8% of those who achieved MCID-W in the first joint (n = 9) went on to achieve MCID-I (G) in the second TKA. Those who achieved MCID-I after both TKAs (A) had a longer staged interval than those who achieved first MCID-I, then MCID-W (C) (15 months vs 8 months, P = 0.0113).</p></div><div><h3>Conclusion</h3><p>In staged BTKA, MCID achievement of the first TKA may not be associated with the outcome of the second TKA.</p></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"50 ","pages":"Pages 1-8"},"PeriodicalIF":1.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876782","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":"Tibiofemoral axial rotation in tibial plateau fractures: A retrospective radiographic assessment of 203 tibial plateau fractures","authors":"Hanne Bartels ,&nbsp;Han-po Tseng ,&nbsp;Nathalie Noppe ,&nbsp;Harm Hoekstra","doi":"10.1016/j.knee.2024.07.014","DOIUrl":"10.1016/j.knee.2024.07.014","url":null,"abstract":"<div><h3>Background</h3><p>Defining the injury-force mechanism in tibial plateau fractures (TPFs) could help define implant type and position, as well as soft tissues at risk. The aim of this study was to provide an analysis of injury-force-mechanisms in TPFs, including axial rotation.</p></div><div><h3>Methods</h3><p>The injury-force mechanism was determined for 203 fractures that presented over a period of 3.5 years. Fractures were classified as flexion-varus/valgus/neutral or (hyper)-extension-varus/valgus/neutral by observing articular depression area on CT/MRI. Fractures were subclassified into rotation-neutral, internal- or external-rotation according to the Gerdy-tibial-tuberosity-surgical-epicondylar-axis (GTT-SEA) angle. Soft-tissue injury was documented if MRI was performed.</p></div><div><h3>Results</h3><p>Flexion-valgus was the most common injury-force mechanism (n = 85, 41.9%), followed by extension-valgus (n = 57, 28.1%). Other mechanisms were less common (9.4% extension-varus, 5.9% flexion-neutral, 4.9% flexion-varus, 3.9% hyperextension-valgus, 3.4% extension-neutral and 2.5% hyperextension-varus). The GTT-SEA angle could be measured in 194 (95.6%) of 203 classified patients, revealing internal rotation in 83 (42.8%) and external rotation in 53 (27.3%). No significant difference was found between injury-force mechanism type and axial rotation group (<em>P</em> = 0.964) or extent of rotation (H(8) = 7.116, <em>P</em> = 0.524). Only 41 (21.1%) of 194 fully classified fractures underwent MRI, all revealing soft-tissue injury to some extent. High-grade posterolateral injuries occurred mainly in rotated TPF.</p></div><div><h3>Conclusion</h3><p>Our results describe the common forms of axial rotation present in TPF and explore their association with injury-force mechanism and soft-tissue injury. Applying the injury-force mechanism patterns and addressing rotational forces could, together with preoperative MRI and intra-operative stability assessment, help determine the need to surgically address associated soft-tissue injury.</p></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"50 ","pages":"Pages 9-17"},"PeriodicalIF":1.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876832","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":"Patellar articular overlap is better associated with patellar alignment during weight-bearing than traditional measures of patellar height","authors":"Thomas Demirjian ,&nbsp;John Crues III ,&nbsp;Kai-Yu Ho ,&nbsp;Liang-Ching Tsai ,&nbsp;Christopher Powers","doi":"10.1016/j.knee.2024.06.008","DOIUrl":"10.1016/j.knee.2024.06.008","url":null,"abstract":"<div><h3>Background</h3><p>A consequence of a high riding patella is reduced osseous stability and malalignment of the patella (i.e., lateral patellar tilt and displacement). Although quantification of patellar height is a routine part of the radiographic examination of the patellofemoral joint, it is not clear which measure of patellar height is best associated with patella alignment.</p></div><div><h3>Hypothesis/Purpose</h3><p>To determine if patellar articular overlap (PAO) is better associated with lateral patellar tilt and lateral patellar displacement compared to traditional measures of patellar height. <em>Study Design:</em> Cross-sectional.</p></div><div><h3>Methods</h3><p>Magnetic resonance images were obtained from 50 female participants (21 with patellofemoral pain and 29 healthy controls) under loaded conditions (25–35% bodyweight) at 15–20 degrees of knee flexion. Measurements of lateral patellar tilt and displacement as well as the PAO, Insall-Salvati ratio (ISV), Caton Deschamps-index (CD-index), or the Blacburn Peel-index (BP-index) were obtained from sagittal and axial plane images.</p></div><div><h3>Results</h3><p>The PAO was found to significantly correlated with lateral patellar tilt (<em>r</em> = −0.77, <em>p</em> &lt; 0.001). In contrast, the ISV, CD-index, or the BP-index were not found to be associated with lateral patellar tilt (<em>r</em> = 0.13, <em>p</em> = 0.34; <em>r</em> = −0.14, <em>p</em> = 0.33; <em>r</em> = −0.08, <em>p</em> = 0.56, respectively). Both the PAO and ISV were found to be significantly correlated with lateral patellar displacement (<em>r</em> = −0.52, <em>p</em> &lt; 0.001; <em>r</em> = 0.43, <em>p</em> = 0.002, respectively). Conversely, the CD-index and BP-index were not found to be associated with lateral patellar displacement (<em>r</em> = 0.03 <em>p</em> = 0.83; <em>r</em> = 0.05 <em>p</em> = 0.74, respectively).</p></div><div><h3>Conclusion</h3><p>Of the measures of patellar height evaluated, the PAO was found to provide the greatest association with lateral patellar tilt and displacement.</p></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"49 ","pages":"Pages 176-182"},"PeriodicalIF":1.6,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141622192","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 influence of tibial length on radiographic posterior tibial slope measurement: How much tibia do we need?","authors":"Sharif Garra,&nbsp;Zachary I. Li,&nbsp;Jairo Triana,&nbsp;Ian Savage-Elliott,&nbsp;Michael R. Moore,&nbsp;Ajay Kanakamedala,&nbsp;Kirk Campbell,&nbsp;Michael Alaia,&nbsp;Eric J. Strauss,&nbsp;Laith M. Jazrawi","doi":"10.1016/j.knee.2024.06.005","DOIUrl":"10.1016/j.knee.2024.06.005","url":null,"abstract":"<div><h3>Purpose</h3><p>The purpose of this study was to determine whether significant differences exist when comparing posterior tibial slope (PTS) measured using increasing lengths of the tibia to determine the anatomical axis.</p></div><div><h3>Methods</h3><p>Patients with full-length weight-bearing tibial radiographs were retrospectively identified from 2014 to 2022 at a single institution. Patients were excluded if there was any previous history of lower extremity fracture or osteotomy. The anatomical axis of the tibia was determined using the full length of tibial radiographs, and the “reference PTS” was measured using this axis. Using the same radiograph, the PTS was measured using four different anatomical axes at standardized tibial lengths. While the center of the proximal circle remained constant at 5-cm below the tibial plateau, the center of the distal circle was drawn at four points: a) overlapping circles; b) 10-cm distal to the tibial plateau; c) 15-cm distal to the tibial plateau; d) half the length of the tibia, measured from the tibial plateau to the tibial plafond. Bivariate correlation and frequency distribution analysis (measurements &gt;2-degrees from reference PTS) were performed between the reference PTS and PTS measured at each of the four other lengths.</p></div><div><h3>Results</h3><p>A total of 154 patients (39.8 ± 17.4 years old, 44.2% male) were included in the final analysis. Measurements at each of the four tibial lengths were all significantly different from the reference PTS (<em>p</em> &lt; 0.001). The correlation strength improved with increasing tibial length (overlapping: <em>R =</em> 0.681, 10-cm: <em>R =</em> 0.821, 15-cm: <em>R =</em> 0.937, and half-tibia: <em>R =</em> 0.963). The number of PTS measurements &gt;2-degree absolute difference from the reference PTS decreased with increasing tibial length (overlapping: 40.3%, 10-cm: 24.0%, 15-cm: 26.0%, and half-tibia: 18.8%).</p></div><div><h3>Conclusion</h3><p>Assessment of PTS is dependent on the length of the tibia utilized to obtain the anatomical axis. Accuracy and precision of PTS measurements improved with increasing length of tibia used to determine the anatomical axis.</p></div><div><h3>Study design</h3><p>Case series.</p></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"49 ","pages":"Pages 167-175"},"PeriodicalIF":1.6,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565145","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":"Increased prevalence of valgus constitutional alignment subtypes in a South African arthritic population group using the coronal plane alignment of the knee (CPAK) classification","authors":"Kaylem Coetzee ,&nbsp;Johan Charilaou ,&nbsp;Marilize Burger ,&nbsp;Jacobus Jordaan","doi":"10.1016/j.knee.2024.04.010","DOIUrl":"10.1016/j.knee.2024.04.010","url":null,"abstract":"<div><h3>Background</h3><p>Knee alignment philosophies and patient specific models to improve patient reported outcomes are gaining increasing attention. The coronal plane alignment of the knee (CPAK) classification describes nine knee phenotypes and then proposes surgical alignment strategies to achieve constitutional alignment. The CPAK classification has been validated in Australian, European, Asian and North American population groups. To date no African data has been analyzed using CPAK.</p></div><div><h3>Methods</h3><p>A total of 344 arthritic patients (608 knees) with appropriate long leg radiographs were classified based on the CPAK type. Measurements included mechanical hip-knee-angle(mHKA), medial proximal tibial angle (mMPTA) and lateral distal femoral angle (mLDFA) and the derived calculations of joint line obliquity (JLO) and arithmetic hip-knee-angle (aHKA).</p></div><div><h3>Results</h3><p>The sample population was 77.9% (<em>n</em> = 268) female with a mean age of 68.4 ± 9.2 years. The most common CPAK types in order were type 3 (<em>n</em> = 174; 28.6%), type 2 (<em>n</em> = 155; 25.5%), type 1 (<em>n</em> = 94; 15.5%) and type 6 (<em>n</em> = 80; 13.2%). The most common limb alignment types were valgus (CPAK types 3,6,9; 41.8%).</p></div><div><h3>Conclusion</h3><p>This study, which investigated arthritic patients from a single institution in South Africa, shows a divergence of CPAK phenotypic knee patterns relative to other international studies, with much higher proportions of valgus phenotypes (3 and 6). This regional difference should be further investigated in other South African and African population samples and used to adapt the surgical strategies employed by local surgeons.</p></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"49 ","pages":"Pages 158-166"},"PeriodicalIF":1.6,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0968016024000668/pdfft?md5=5399bb7e91304949b0b4cd01ae8dcf84&pid=1-s2.0-S0968016024000668-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using orthopaedic health care resources efficiently: A cost analysis of day surgery for unicompartmental knee replacement","authors":"Takhona G. Hlatshwako ,&nbsp;Cathy Jenkins ,&nbsp;Sarah Wordsworth ,&nbsp;David Murray ,&nbsp;Karen Barker ,&nbsp;Helen Dakin","doi":"10.1016/j.knee.2024.06.006","DOIUrl":"10.1016/j.knee.2024.06.006","url":null,"abstract":"<div><h3>Background</h3><p>Day surgery for unicompartmental knee replacement (UKR) could potentially reduce hospital costs. We aimed to measure the impact of introducing a day surgery UKR pathway on mean length of stay (LOS) and costs for the UK NHS, compared to an accelerated inpatient pathway. Secondly, the study aimed to compare the magnitude of costs using three costing approaches: top-down costing; simple micro-costing; and real-world costing.</p></div><div><h3>Methods</h3><p>We conducted an observational, before-and-after study of 2,111 UKR patients at one NHS hospital: 1,094 patients followed the day surgery pathway between September 2017 and February 2020; and 1,017 patients followed the accelerated inpatient pathway between September 2013 and February 2016. Top-down costs were estimated using Average NHS Costs. Simple micro-costing used the cost per bed-day. Real-world costs for this centre were estimated by costing actual changes in staffing levels.</p></div><div><h3>Results</h3><p>532 (48.5%) patients in the day surgery pathway were discharged on the day of surgery compared with 36 (3.5%) patients in the accelerated inpatient pathway. The day surgery pathway reduced the mean LOS by 2.2 (95% CI: 1.81, 2.53) nights and was associated with an 18% decrease in Average NHS Costs (p &lt; 0.001). Mean savings were £1,429 per patient with the Average NHS Costs approach, £905 per patient with the micro-costing approach, and £577 per patient with the “real-world” costing approach. Overall, moving NHS UKR surgeries to a day surgery pathway could save the NHS £8,659,740 per year.</p></div><div><h3>Conclusion</h3><p>Day surgery for UKR could produce substantial cost savings for hospitals and the NHS.</p></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"49 ","pages":"Pages 147-157"},"PeriodicalIF":1.6,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0968016024000863/pdfft?md5=8bd41016a4d99c98a189e16c00ba1cf8&pid=1-s2.0-S0968016024000863-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analgesic eluting bone cement: A novel approach for targeted pain management in total knee arthroplasty – An in-vitro study","authors":"Yuvarajan Palanisamy ,&nbsp;Arjun R. Prasad ,&nbsp;Karthik Seetharaman ,&nbsp;Hemnath Elango ,&nbsp;David V. Rajan ,&nbsp;Meena N","doi":"10.1016/j.knee.2024.05.012","DOIUrl":"10.1016/j.knee.2024.05.012","url":null,"abstract":"<div><h3>Background</h3><p>The average rate of patient dissatisfaction following total knee arthroplasty (TKA) is 10%. Multi-modal analgesia is the present standard of pain management after TKA. Studies show that with multi-modal analgesia, approximately 60% of patients experience severe knee pain following surgery, while around 30% experience moderate pain. To date, there is no literature available on targeted pain management using bone cement.</p></div><div><h3>Objectives</h3><p>To investigate the feasibility of incorporating anti-inflammatory medications and identify the analgesic with the best release pharmacokinetics from bone cement for application in pain management.</p></div><div><h3>Methods</h3><p>In an in-vitro study, 100 mg of five drugs (aceclofenac, diclofenac, naproxen, paracetamol and methyl prednisolone) were incorporated into bone cement (Palacos). Cement cubes holding each drug were made and allowed to harden for 30 min. Each drug-containing cube was placed in a beaker with saline for 72 h. Fractions of 10 ml were collected at 0, 6, 24, 48 and 72 h and analysed using high-pressure liquid chromatography to measure the percentage release of the drug from bone cement.</p></div><div><h3>Results</h3><p>Naproxen showed superior elution from bone cement, with 10.9% at 24 h and 9.08% at 72 h. Paracetamol showed 4.9% at 24 h and 3.78% at 72 h, aceclofenac 0.2% at 24 h and 0.4% at 72 h, diclofenac 3.03% at 24 h and 1.99% at 72 h, and methylprednisolone 0.26% at 24 h and 0.32% at 72 h.</p></div><div><h3>Conclusions</h3><p>Polymethylmethacrylate bone cement can elute analgesics <em>in vitro</em>. Among the five drugs studied, naproxen had the best release kinematics from polymethylmethacrylate bone cement. Analgesic eluting bone cement is a novel approach for targeted postoperative pain management in TKA.</p></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"49 ","pages":"Pages 135-146"},"PeriodicalIF":1.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141473016","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-dose vancomycin spacers provided early recovery without nephrotoxicity compared with standard-dose in MRSA-induced periprosthetic joint infection model of rats","authors":"Ahmet Ersoy ,&nbsp;Ferhat Say ,&nbsp;Orhan Tokur ,&nbsp;Efe Karaca ,&nbsp;Abdurrahman Aksoy ,&nbsp;Alper Çiftçi","doi":"10.1016/j.knee.2024.06.004","DOIUrl":"https://doi.org/10.1016/j.knee.2024.06.004","url":null,"abstract":"<div><h3>Background</h3><p>Periprosthetic joint infections (PJIs) are commonly treated with two-stage revision surgery utilising antibiotic-loaded spacers; however, antibiotic release from spacers is limited and usually drops below effective levels a few days after placement. This study compared high-dose and standard-dose vancomycin-loaded spacers in terms of efficacy, safety, and overall treatment duration in a rat periprosthetic joint infection model.</p></div><div><h3>Methods</h3><p>Thirty male Wistar albino rats (8–10 weeks old, 300–320 g) were housed individually at standard conditions. A periprosthetic infection model was established in the right knee of the rats using methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) −contaminated Kirschner wires. Two weeks later, the infection was verified, and the Kirschner wires were removed. Rats were randomly divided into three groups (<em>n</em> = 10): standard-dose (SVanc) and high-dose (HVanc) vancomycin groups had 2.5 and 7.5% vancomycin in their spacers, respectively, while the control group had no spacers. All groups received intramuscular (IM) vancomycin and gentamicin for 4 weeks after spacer implantation. Microbiological counts and vancomycin levels in the blood and joint flush samples were measured, and histopathological assessments were conducted on the femur and kidneys.</p></div><div><h3>Results</h3><p>After spacer implantation, MRSA was eliminated in the HVanc group with 4 weeks of treatment, while the SVanc group required 6 weeks of treatment (<em>P</em> &lt; 0.001). Histopathological findings of the femoral medulla and cortical samples were better in the HVanc group compared with other groups (<em>P</em> = 0.007). Vancomycin levels in serum remained within safe limits in all groups, and kidney damage was not observed.</p></div><div><h3>Conclusion</h3><p>The use of high-dose vancomycin spacers might accelerate the transition period, which in turn reduces the duration of systemic antibiotic use and mitigates the risk of nephrotoxicity. Thus, this method may decrease the medical costs associated with PJI treatment.</p></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"49 ","pages":"Pages 125-134"},"PeriodicalIF":1.6,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141438164","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}