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At least 19 recordsLinked to original sources
PubMed1977

Current status of total knee arthroplasty.

Total knee arthroplasty has become an acceptable method of surgical management for severe, disabling gonarthropathy. The three major biomechanical classifications of total knee prostheses are minimally constrained, partially constrained, and fully constrained. The major indication for total knew arthroplasty is pain, followed in a much lower frequency by instability, loss of motion, and deformity. The principal contraindications for the various types relate solely to the residual or restorable ligamentous stability of the knee and the degree of bone loss. In general, the greater the instability and bone loss, the more constrained the prosthesis must be Theoretically, loosening rates increase with increasing shear stresses, which are generally highest with the most constrained prostheses. The major complications are sepsis, loosening, and instability. Various prostheses have incorporated patellofemoral resurfacing as the final dimension in producing a total knee arthroplasty. Knee arthroplasty is very effective in preserving functional knee motion, with relief of pain as an alternative to arthrodesis.

Arthroplasty↗
PubMed1977

Polycentric total knee arthroplasty.

Polycentric total knee arthroplasty in 56 patients provided significant relief of pain in 90.7% and a stable knee in 92.7%. Postoperative increase in range of motion averaged 13.7 degrees for all patients (18.5 degrees in rheumatoid arthritis and 8.7 degrees in degenerative arthritis). This increase in excursion is attributed to the design of the prosthesis, a vigorous postoperative rehabilitation program, and careful surgical technic. A failure rate of 12.7% was due to infection, mechanical instability and unexplained pain. Contraindications to surgery and technical recommendations are noted.

Arthritis, Rheumatoid↗
PubMed1978

Simultaneous and staged bilateral total knee arthroplasty.

Bilateral total knee arthroplasties were performed in twenty-six patients with severe rheumatoid arthritis and osteoarthritis. Twelve had simultaneous operations bilaterally and fourteen had separate, staged procedures. The improvement in the two groups of patients was statistically comparable to the relief of pain and the over-all restoration of function. There were no intraoperative complications. The postoperative morbidity was minimum and was not predominant in either group. Costs were greatly increased with the staged procedure.

Arthritis, Rheumatoid↗
PubMed1975

Total knee arthroplasty after septic arthritis.

Total knee arthroplastie were performed as salvage procedures in 1- patients with irreversible knee destruction secondary to bacterial arthritis. All now have functioning knees that are pain-free and average 85 degrees of motion. None has evidence of clinical infection at present. These patients are not yet regarded as cured. They may remain at risk for the development of late reinfections. This procedure is not advocated as the operation of choice for patients with knee joint destruction secondary to bacterial arthritis. We emphasize the risk involved and the necessity for obtaining the informed consent of the patient before proceeding with total knee arthroplasty when there has been previous infection.

Aged↗
PubMed2026

Extended Reality Interventions for Osteoarthritis of the Knee and Recovery After Total Knee Arthroplasty: Systematic Review and Meta-Analyses.

BACKGROUND: Nonpharmacologic interventions are important for treating knee pain due to osteoarthritis or after total knee arthroplasty (TKA), and extended reality (XR) technology may enhance treatments for these indications. OBJECTIVE: This systematic review aimed to evaluate XR interventions for pain due to knee osteoarthritis (KOA) or for recovery after TKA. METHODS: Databases were searched through May 2023 and updated in December 2025. Eligible trials evaluated XR interventions to treat KOA pain or after TKA. We classified interventions by depth of immersion and clinical mechanism. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria to determine the certainty of evidence for prioritized outcomes. Meta-analyses were performed when ≥3 studies evaluated similar comparisons, outcomes, and time points. RESULTS: Eligible trials addressed KOA (k=12) or recovery after TKA (k=9). Sample sizes ranged from 36 to 306 participants, and most studies had a follow-up of ≤3 months. Nineteen studies assessed pain-related functioning and pain intensity, and 5 assessed adverse events (AEs). For KOA, 10 studies examined interactive digital rehabilitation (IDR), and 2 examined virtual reality (VR)-digitally augmented exercise (DAE). IDR for KOA may result in better pain-related functioning (low certainty of evidence [COE]; pooled standardized mean difference [SMD] -0.59, 95% CI -1.11 to -0.06; prediction interval [PI] -1.72 to 0.55; k=5) and lower pain intensity at 6-8 weeks (low COE; pooled SMD -0.46, 95% CI -0.92 to 0.00; PI -1.39 to 0.47; k=4). VR-DAE for KOA (k=2) produced inconsistent results (very low COE). For post-TKA studies, 5 examined IDR, 2 examined VR-DAE, 1 examined VR-distraction, and 1 examined VR-psychoeducation. Post-TKA IDR may result in better pain-related functioning (low [k=4] and moderate COE [k=1]) but little to no difference in pain intensity (low-moderate COE; pooled SMD at 3-4 months -0.12, 95% CI -0.75 to 0.52; PI -1.63 to 1.27; k=3). VR-psychoeducation probably results in lower pain at 4 weeks (moderate COE; k=1), and VR-distraction may result in 6 months (low COE; k=1), whereas VR-DAE produced mixed findings (k=2; very low COE). IDR was not associated with AEs, and VR may not be associated with AEs for KOA (high and low COE), though AE reporting was uncommon (k=5) and evidence was very uncertain for post-TKA. CONCLUSIONS: IDR may augment treatment for KOA and post-TKA recovery, and VR may benefit post-TKA rehabilitation. This review is the first to stratify by level of immersion, clinical mechanism, and follow-up duration and to systematically evaluate AEs. IDR may be ready for integration into KOA care, while use after TKA needs more evidence. Randomized controlled trials with implementation outcomes could determine how XR interventions can be used for KOA, whereas trials evaluating efficacy and AEs are needed before their use for post-TKA.

Humans↗
PubMedDate not supplied

Polycentric total knee arthroplasty: a prognostic assessment.

Polycentric total knee arthroplasty has been performed at the Mayo Clinic on more than 1,600 knees since July 1970. Two groups of 106 and 101 knee arthroplasties performed between July 1970 and July 1971 and June 1971 and January 1972, respectively, were compared at 5 and 7 years. The technique used exposed the joint to methacrylate particles, yet, despite this, wear did not prove to be a problem. Failures occurred because of infection, loosening of the tibial components, settling of the tibial components, subluxation or dislocation, ligamentous laxity, progression of patellofemoral arthritis, and persistence of pain. We did not encounter patellar problems in our patients with osteoarthritis. In the first group with 106 knees, 45 patients with 58 rheumatoid knees survived 7 years; 79% of knees had good results at 5 years and 72% had good results at 7 years. Twenty-one patients with 28 osteoarthritic knees survived 7 years; 75% of knees had good results at 5 years and 61% had good results at 7 years. In group 2 with 101 knees, 43 patients with 64 rheumatoid knees survived 7 years. The results were good in 83% at 5 years and in 64% at 7 years. Among the 20 patients with osteoarthritic knees who survived 7 years, 92% of knees had good results at 5 years and 62.5% had good results at 7 years. This figure is somewhat misleading because 7 patients were lost to follow up in group 2 after 5 years. There is still a need for a well-tolerated resurfacing procedure by means of a nonconstrained prosthesis.

Arthritis↗
PubMed1976

The evolution of total knee arthroplasty.

The current status of knee replacement surgery suggests that high density polyethylene and chrome cobalt alloy or stainless steel are acceptable materials for use in the intra-articular environment of the knee; that prosthetic components of knee units can be firmly fixed in bone with methylmethacrylate; and that a wide range of prosthetic units are available which will provide acceptable clinical results if used within the limits for which they have been designed. The indications for total knee arthroplasty have been designed. The indications for total knee arthroplasty have become reasonably simple and straightforward. Contraindications for the use of the various units available are relatively obscure and very seldom stressed. Each unit available will fail, however, if used under conditions of bone loss, deformity, and ligamentous instability for which it was not designed. The importance of the surgeon understanding and respecting the limitations of the total knee unit he chooses, and skillfully adapting it to the pathologic anatomy and pathophysiology of the patient's knee cannot be overemphasized.

Arthroplasty↗
PubMedDate not supplied

Two-part total knee arthroplasty: evolution and present status.

The inception of a 2-part total knee arthroplasty consisting of a Vitallium femoral component and a polyethylene tibial component occurred in 1970. It was termed "geometric," because it was not anatomic in design. This geometric design was altered during the ensuing years to allow better fixation of the tibial unit, because loosening of this unit became apparent in an appreciable percentage of patients. As biomechanical research and clinical evidence progressed, less need for the constraint built into the geometric prosthesis became evident. So a less constrained, more anatomic total knee, called the "anametric" total knee arthroplasty, was developed. There was duplication of the normal anatomic configuration of the femoral component for both left and right sides, a femoral flange so that the patella could be surfaced with polyethylene, and a flatter surface for the tibial unit. The tibial unit was first anchored with the geomatric triflanged system, but eventually comprised a medullary stem and a metal T-tray to contain the polyethylene. At this time, we believe that sufficient constraint necessary in the usual total knee arthroplasty is realized with the anametric design. The anametric design has proved itself and is now our prosthesis of choice.

Biomechanical Phenomena↗
PubMed1979

Patellar complications following total knee arthroplasty.

We studied the complications involving the patella following total knee arthroplasty in eighty-six knees in which thirty-four unconstrained and fifty-two offset hinge prostheses had been implanted. The abnormalities that we studied included: patellar dislocation, five knees; subluxation, eighteen knees; localized wear, three knees; and generalized wear, four knees. In twenty-three patients these complications were associated with patellar malalignment, and occurred predominantly when the offset hinge model of prosthesis was used. The complications were attributed partly to mechanical factors inherent in the prosthetic design and partly to anatomical abnormalities. Failure of the surgeon to compensate adequately for both of those factors at the time of operation was a factor in most of the complications.

Aged↗
PubMed2026

Alignment strategies in total knee arthroplasty and the patellofemoral joint: A systematic review.

BACKGROUND: Different alignment strategies in total knee arthroplasty (TKA) may affect the patellofemoral joint. Mechanical alignment (MA) is commonly used but may alter native anatomy. Newer strategies such as kinematic alignment (KA), restricted kinematic alignment (rKA), and functional alignment (FA) aim to better restore native joint mechanics. This study provides an overview of the effects of alignment strategies on patellofemoral outcomes after TKA. METHODS: A literature search in July 2025 identified studies comparing patellofemoral outcomes in TKA using different alignment strategies. Of 166 studies screened, eight met inclusion criteria. Three studies were considered medium quality and five studies low quality. RESULTS: KA and rKA more closely restored native trochlear morphology than MA and FA, reducing outliers in the anterior trochlear line compared with MA and FA. MA showed greater trochlear translation, suggesting worse patellar tracking. Trochlear angles were more anatomical in KA and rKA. However, KA was associated with increased internal femoral component rotation and more outliers beyond safe thresholds. FA showed more consistent rotational positioning, generally within safe limits. Lateral patellar shift and intraoperative lateral release rates did not differ significantly between KA and MA. Only one study reported patella-specific clinical outcome scores, finding no difference between FA and adjusted MA. CONCLUSION: KA and rKA better restore trochlear morphology, but risk excessive internal femoral component rotation. FA provides a more balanced approach. MA, while widely used, is linked to altered trochlear shape and worse patellar tracking. The clinical impact of these radiological differences remains unclear, and higher-quality studies are needed.

Humans↗
PubMed1976

Polycentric total knee arthroplasty. A two-year follow-up study.

Polycentric total knee arthroplasty provided significant relief of pain in 86 per cent of 500 knees. The independence and activity levels of the patients increased dramatically. The frequency of major complications as reflected by reoperation was 10 per cent in this series. There was a 2.8 per cent deep infection rate. One-third of the infected knees were salvaged and two-thirds required arthrodesis. Loosening of a component was noted in 2.4 per cent. After operation the average range of motion was from 6 to 101 degrees of flexion, for a range of 95 degrees; this was a 5-degree increase over average preoperative motion. Ninety-six per cent of the patients expressed satisfaction with the surgical result.

Adult↗
PubMed1976

Early experience with total knee arthroplasty.

Early results of 76 geometric total knee replacements were reviewed with assistance from computer analysis. A 92% patient follow-up for one to three years showed an overall satisfactory result with substantial improvement, especially in relief of severe pain. However, several problems are noted, including fractures beneath the tibial plateau and loosening. The long-term results are still unknown. The indications for total knee replacements should remain conservative until long-term results and experience have been achieved.

Age Factors↗
PubMed1979

Arthrodesis of the knee following failed total knee arthroplasty.

In forty-five patients, who had an arthrodesis because of failed total knee arthroplasty, the cause was infection in forty, instability in two, failure of the prosthesis in two, and loosening in one. The arthrodesis succeeded in twenty-nine (81%) of thirty-six patients who had had a minimally or partially constrained arthroplasty and in five (56%) of nine who had had a hinge-type prosthesis inserted. The reasons for failure were severe bone loss, persistent sepsis, and loss of bone apposition after manipulation. The technique of arthrodesis did not seem to influence the final result. External fixation most commonly had to be used because of the infections and the device was kept in place for an average of ten weeks, after which immobilization in a cast was used until the arthrodesis healed.

Adult↗
PubMed2026

The impact of absolute change in tibiofemoral morphology on patient reported outcome measures post total knee arthroplasty.

BACKGROUND: Reconstructing knee morphology and alignment is important for outcomes post total knee arthroplasty (TKA). Personalised alignment strategies are proposed to improve outcomes by replicating native alignment. However, how change in morphology affects patient outcomes is unclear. This study aimed to investigate the relationship between absolute change in morphological measures post-TKA and patient reported outcome measures (PROMs). METHOD: An observational analysis of a randomised clinical trial was conducted. Participants received preoperative and postoperative CT scans and completed PROMs at six-months post-TKA. Absolute change in hip-knee-ankle angle, medial proximal tibial angle, lateral distal femoral angle, non-weightbearing joint line convergence angle, tibial and femoral rotation, and posterior tibial slope (PTS) were calculated. PROMs included visual analogue scales of pain and satisfaction (0-100), Oxford Knee Score, Forgotten Joint Score, and the Kujala Score. Regression and principal component (PCA) analyses investigated relationships between PROMs and change in morphology. RESULTS: Sixty-one participants were included for analysis (61% women, age 66.9 ± 9.1 [mean ± SD] years, BMI 32.8 ± 6.8 kg/m2). The PCA demonstrated coronal, axial, and sagittal plane measures were interdependent, with over 65% of variability driven by change in tibial rotation (PC1) and the PTS (PC2). The regression analysis showed no relationships between morphological change and PROMs postoperatively. CONCLUSION: Tibiofemoral morphology was interrelated across coronal, axial, and sagittal planes. However, this study suggests absolute morphological change had minimal impact upon PROMs at six-months post-TKA. Future research should clearly distinguish between osteoarthritic versus prearthritic alignment and consider the influence of soft-tissue releases upon PROMs.

Humans↗
PubMed2026

Opioid-sparing anesthesia based on opioid-free principles for early recovery after total knee arthroplasty: A randomized controlled trial.

OBJECTIVE: To evaluate whether an opioid-sparing anesthesia strategy (OSA), based on opioid-free anesthesia (OFA), improves early postoperative recovery quality and optimizes functional outcomes after total knee arthroplasty (TKA), compared with conventional opioid-based anesthesia (OBA). DESIGN: A randomized controlled trial with blinding of patients, surgeons, and outcome assessors. SETTING: Single center, July 2025 to February 2026. PATIENTS: 98 adult patients scheduled for elective unilateral TKA. INTERVENTION: Patients were randomized to the OSA or OBA group. The OSA regimen used esketamine and dexmedetomidine as the primary analgesic backbone, whereas the OBA regimen was opioid-based. Both groups received preoperative femoral nerve block and were administered oxycodone at skin incision and closure. Postoperatively, both groups received the same multimodal analgesia and patient-controlled analgesia. MEASUREMENTS: The primary outcome was the 24-h postoperative Quality of Recovery-15 (QoR-15) score. Secondary outcomes included 48-h QoR-15; Oxford Knee Score (OKS) and EQ-5D-3L at 1 and 3 months; high pain at 1 month and chronic postsurgical pain at 3 months. Exploratory outcomes included postoperative C-reactive protein (CRP), and postoperative nausea and vomiting (PONV), among others. RESULTS: At 24 h postoperatively, QoR-15 was higher in the OSA group than in the OBA group (118.4 ± 11.5 vs 113.3 ± 12.2; adjusted difference 5.12, 95% CI 0.51-9.74; P = 0.029), and this advantage persisted at 48 h (adjusted difference 5.54, 95% CI 1.57-9.52; P = 0.007). The OSA group had a lower incidence of PONV (P = 0.025) and lower postoperative CRP levels (P = 0.001). At 1 month, OKS was higher in the OSA group (adjusted difference 2.31, 95% CI 0.34-4.27; P = 0.022), with no significant differences in other secondary outcomes. CONCLUSION: In TKA, this OFA-based OSA strategy improved early postoperative QoR-15 scores. However, the QoR-15 difference did not reach the minimal clinically important difference, so its clinical relevance remains uncertain.

Humans↗
PubMed1977

Rehabilitation program following polycentric total knee arthroplasty.

A rehabilitation program which has been used successfully in improving the postoperative range of motion of patient undergoing total knee arthroplasty is outlined. The specific objectives are strong quadriceps setting, straight leg raising, flexion of the knee to at least 90 degrees, and extension of the knee to 0 degrees. The program emphasizes the importance of early institution of exercises and early ambulation.

Aftercare↗
PubMed2026

Factors associated with periprosthetic joint infection following total knee arthroplasty: an updated systematic review and meta-analysis.

BACKGROUND: This study aimed to systematically evaluate factors associated with periprosthetic joint infection (PJI) following total knee arthroplasty (TKA), and thereby to provide evidence-based references for clinical prevention and perioperative risk stratification. METHODS: Computerized searches were conducted in the following databases from their inception until May 26, 2025: PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database, and Chinese Biomedical Literature Database. Two researchers independently screened the literature, extracted data, and assessed study quality. The methodological quality was assessed using the Newcastle-Ottawa Scale. Quantitative synthesis was performed when at least two studies reported comparable exposure definitions and sufficient comparator information; otherwise, narrative synthesis was used. Review Manager 5.4 software was used for the primary analysis. This study is registered on PROSPERO (CRD420251079339). RESULTS: A total of 25 observational studies were included in the qualitative synthesis, of which 24 contributed to the primary quantitative synthesis. Quantitatively pooled factors associated with PJI included male sex (OR = 1.39, 95% CI 1.27-1.51), BMI ≥30 kg/m2 (OR = 5.72, 95% CI 2.65-12.36), prolonged operative time, type 2 diabetes mellitus (OR = 2.09, 95% CI 1.45-3.01), rheumatoid arthritis (OR = 2.64, 95% CI 1.38-5.02), smoking (OR = 1.65, 95% CI 1.34-2.04), blood transfusion (OR = 2.27, 95% CI 1.59-3.25), American Society of Anesthesiologists score ≥3 (OR = 2.73, 95% CI 1.02-7.32), history of hormone therapy (OR = 4.88, 95% CI 2.90-8.22), postoperative urinary tract infection (OR = 3.59, 95% CI 1.15-11.21), intraoperative blood loss >200 ml (OR = 1.51, 95% CI 1.03-2.22), postoperative drainage tube placement duration ≥24 h (OR = 2.23, 95% CI 1.50-3.32), preoperative anemia (OR = 1.82, 95% CI 1.67-1.99), and combined pulmonary disease (OR = 5.54, 95% CI 1.93-15.96). Age was narratively summarized because its classification differed substantially across studies. CONCLUSION: Multiple demographic, comorbidity-related, and perioperative factors were associated with PJI after TKA. However, because the included studies were observational and clinically heterogeneous, these findings should be interpreted as associations rather than causal effects. Optimization of modifiable factors may help reduce the burden of PJI, but further prospective studies using standardized PJI definitions and adjusted effect estimates are required.

Humans↗