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Knee Arthroplasty Surgery: Management and Future Opportunities
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Knee Arthroplasty Surgery: Management and Future Opportunities

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (25 November 2024) | Viewed by 7207

Special Issue Editors

Dr. Joaquín Moya-Angeler

E-Mail Website
Guest Editor
1. Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Reina Sofía, 30003 Murcia, Spain
2. Instituto de Cirugía Avanzada de la Rodilla (ICAR), 30005 Murcia, Spain
Interests: knee preservation; knee replacement; osteotomies; sports medicines; ACL reconstruction; patellofemoral disorders; trochlear dysplasia; meniscus
Prof. Dr. Francisco Forriol

E-Mail Website
Guest Editor
School of Medicine, Universidad San Pablo CEU, Ctra. Boadilla del Monte, Km. 5 300, 28925 Alcorcon, Madrid, Spain
Interests: knee surgery; orthopedic surgery; muscle; bone; limb salvage

Special Issue Information

Dear Colleagues,

We find ourselves standing at a pivotal moment in the realm of knee arthroplasty surgery. For nearly half a century, the landscape of this surgical field has seen limited transformations. However, in recent times, we have witnessed a surge of innovations propelled by the development of more advanced techniques and implants. Our early endeavors revolved around mitigating severe complications and ensuring the durability of implants through the refinement of bearing surfaces, enhanced biological fixations, precise instrumentation systems, and less invasive approaches. Yet, it is equally evident that the once universally accepted principles now demand a more evidence-based evaluation.

This profound transformation currently underway focuses on the integration of personalized medicine principles into knee arthroplasty. Clinicians and researchers now champion diverse philosophies of component alignment and knee prosthesis biomechanics. These philosophies acknowledge the uniqueness of each joint, advocating for a tailored approach to suit individual patients. Our ultimate goal is to enhance arthroplasty longevity and functionality, elevate each patient's health-related quality of life, and achieve a sense of normalcy in the operated knee. We aim for our patients to forget they underwent surgery.

With these changes, we have witnessed an abundance of data and insights. This Special Issue endeavors to serve as an inclusive platform for disseminating these innovative contributions and expanding our knowledge.

Topics to be explored include:

  • New concepts in alignment;
  • The integration of technology in knee arthroplasty;
  • Advancements in customized surgery;
  • Exploring extended reality and immersive technologies;
  • Defining the limits and unveiling future challenges.

We invite you all to be part of this transformative journey. Together, let us delve into the forefront of knee arthroplasty, redefining the landscape of this discipline and improving the lives of our patients.

Dr. Joaquín Moya-Angeler
Prof. Dr. Francisco Forriol
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • knee
  • knee replacement
  • knee arthroplasty
  • knee alignment techniques
  • robotic knee arthroplasty

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Published Papers (5 papers)

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Research

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9 pages, 1096 KiB  
Article
Does Patellar Height Influence Range of Motion and Anterior Knee Pain after Distal Femur Endoprosthesis Reconstruction?
by Andrea Sambri, Chiara Paganelli, Stefania Claudia Parisi, Matteo Filippini, Luca Cevolani, Davide Stimolo, Marta Bortoli, Andrea Guarino, Alessandro Bruschi, Michele Fiore, Domenico Andrea Campanacci, Davide Maria Donati and Massimiliano De Paolis
J. Clin. Med. 2024, 13(14), 4194; https://doi.org/10.3390/jcm13144194 - 18 Jul 2024
Viewed by 799
Abstract
Objectives: This study aims to evaluate the patellar height changes after distal femur (DF) endoprosthetic replacement (EPR) and its impact on anterior knee pain (AKP) and range of motion (ROM). Methods: A retrospective review of three institutions’ databases was performed. The patellar [...] Read more.
Objectives: This study aims to evaluate the patellar height changes after distal femur (DF) endoprosthetic replacement (EPR) and its impact on anterior knee pain (AKP) and range of motion (ROM). Methods: A retrospective review of three institutions’ databases was performed. The patellar height was determined using the modified Insall–Salvati ratio (MIS), the Blackburne–Peel (BP) and the Caton–Deschamps (CD) indexes. Data regarding AKP and ROM were collected. Results: A total of 199 patients were included. The mean age at presentation was 37.9 ± 23.1 years. The mean one-year follow-up MIS, BP and CD were 1.52 (sd: 0.41), 0.82 (sd: 0.33) and 0.93 (sd: 0.33). Patellar height decreased significantly compared to the pre-operative values according to all three scores (p < 0.001). AKP was reported by 34 (17.1%) patients at 1 year follow-up. Patients with patella baja (MIS < 1.2) or pseudo patella baja (CD < 0.6) had a higher incidence of AKP (p = 0.037 and p = 0.024, respectively). The mean flexion ROM was 91°, with a direct correlation with patellar height (MIS p = 0.020, BP p = 0.036 and CD p = 0.036). Conclusion: The restoration of the native position of the joint line in DF EPR is important to maintain optimal patellofemoral biomechanics. Despite surgeons’ tendency toward a reduction in patellar height with respect to pre-operative values, an increase in patellar height might help to achieve better knee flexion and reduce AKP. Full article
(This article belongs to the Special Issue Knee Arthroplasty Surgery: Management and Future Opportunities)
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10 pages, 1195 KiB  
Article
Analysis of the Initial Learning Curve for Robotic-Assisted Total Knee Arthroplasty Using the ROSA® Knee System
by Inmaculada Neira, Rafael Llopis, Luis Cuadrado, David Fernández, Enrique Villanueva, Néstor Nuño and Francisco Forriol
J. Clin. Med. 2024, 13(11), 3349; https://doi.org/10.3390/jcm13113349 - 6 Jun 2024
Viewed by 1267
Abstract
Background/Objectives: Total knee arthroplasty (TKA) is a frequent procedure in orthopedic surgery. Advances in TKA include the development of robotic-assisted systems. Training in raTKA entails a learning curve to achieve proficiency comparable to conventional manual TKA (maTKA). Methods: We conducted a prospective study [...] Read more.
Background/Objectives: Total knee arthroplasty (TKA) is a frequent procedure in orthopedic surgery. Advances in TKA include the development of robotic-assisted systems. Training in raTKA entails a learning curve to achieve proficiency comparable to conventional manual TKA (maTKA). Methods: We conducted a prospective study of the learning curve in raTKA using the Robotic Surgical Assistant (ROSA) Knee System. The study included 180 patients (90 raTKAs; 90 maTKAs) and three surgeons (one with >15 years of experience in maTKA). The cumulative sum control chart method (CUSUM) was used to define the transition from the learning phase to the mastered phase in raTKA. Results: The learning curves were 43 cases (experienced surgeons) and 61 cases (all surgeons). Mean operative times for both phases in raTKA were longer than in maTKA (p < 0.001). In raTKA, operative times in the learning phase were longer compared to those in the mastered phase (p < 0.001). Operative times in the learning and mastered phases for all surgeons in raTKA were significantly longer compared to those in maTKA (p < 0.001); however, operative times of the experienced surgeon in the mastered phase of raTKA and in maTKA showed no differences. Conclusions: The learning curve in raTKA is dependent upon the surgeon’s previous experience in maTKA. Full article
(This article belongs to the Special Issue Knee Arthroplasty Surgery: Management and Future Opportunities)
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13 pages, 953 KiB  
Article
Impact of a Novel Antiseptic Lavage Solution on Acute Periprosthetic Joint Infection in Hip and Knee Arthroplasty
by Luca Andriollo, Rudy Sangaletti, Calogero Velluto, Loris Perticarini, Francesco Benazzo and Stefano Marco Paolo Rossi
J. Clin. Med. 2024, 13(11), 3092; https://doi.org/10.3390/jcm13113092 - 24 May 2024
Cited by 2 | Viewed by 1206
Abstract
Background: Periprosthetic joint infection (PJI) represents a challenge following hip or knee arthroplasty, demanding immediate intervention to prevent implant failure and systemic issues. Bacterial biofilm development on orthopedic devices worsens PJI severity, resulting in recurrent hospitalizations and significant economic burdens. The objective of [...] Read more.
Background: Periprosthetic joint infection (PJI) represents a challenge following hip or knee arthroplasty, demanding immediate intervention to prevent implant failure and systemic issues. Bacterial biofilm development on orthopedic devices worsens PJI severity, resulting in recurrent hospitalizations and significant economic burdens. The objective of this retrospective cohort study is to evaluate the efficacy of this novel antiseptic solution, never previously evaluated in vivo, in managing early post-operative or acute hematogenous PJI following primary hip and knee joint replacements. Methods: The inclusion criteria consist of patients with total hip arthroplasty (THA) or knee arthroplasty diagnosed with acute PJI through preoperative and intraoperative investigations, in accordance with the MSIS ICM 2018 criteria. The minimum required follow-up was 12 months from the cessation of antibiotic therapy. This novel antiseptic lavage solution is composed of ethanol, acetic acid, sodium acetate, benzalkonium chloride and water. Data included demographic characteristics, diagnostic criteria, surgical techniques, post-operative treatment and follow-up outcomes. Results: A total of 39 patients treated with Debridement, Antibiotics Pearls and Retention of the Implant (DAPRI) procedures using this solution between May 2021 and April 2023 were analyzed. At a mean follow-up of 24.6 ± 6.4 months, infection recurrence-free survival rates were 87.2%, with no local allergic reactions or relevant systemic adverse effects detected. Persistent PJI necessitated two-stage revision surgery. Conclusions: This novel antiseptic lavage solution shows promise as an adjunctive tool in the treatment of PJI, demonstrating support in infection control while maintaining a favorable safety profile. Full article
(This article belongs to the Special Issue Knee Arthroplasty Surgery: Management and Future Opportunities)
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10 pages, 266 KiB  
Article
Evaluating the Minimum Clinically Important Difference and Patient Acceptable Symptom State for the Womac Osteoarthritis Index after Unicompartmental Knee Arthroplasty
by Umile Giuseppe Longo, Rocco Papalia, Stefano Campi, Sergio De Salvatore, Ilaria Piergentili, Benedetta Bandini, Alberto Lalli and Vincenzo Denaro
J. Clin. Med. 2023, 12(24), 7618; https://doi.org/10.3390/jcm12247618 - 11 Dec 2023
Viewed by 1697
Abstract
Patient-Reported Outcome Measures (PROMs) are standardized questionnaires that gather information on health-related quality of life directly from patients. Since a significant statistical mean change may not correspond to a clinical improvement, there is a need to calculate a considerable change in scores. This [...] Read more.
Patient-Reported Outcome Measures (PROMs) are standardized questionnaires that gather information on health-related quality of life directly from patients. Since a significant statistical mean change may not correspond to a clinical improvement, there is a need to calculate a considerable change in scores. This is done by the Minimum Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS). The objective of this article is to report the MCID and the PASS values of the WOMAC (Western Ontario and McMaster University) osteoarthritis index for patients undergoing Unicompartmental Knee Arthroplasty (UKA). A total of 37 patients (25 females and 12 males; mean age 68 ± 8.1 years and mean BMI 28.7 ± 4) who underwent UKA were enrolled. All patients were assessed using the WOMAC and the Oxford Knee Score (OKS) questionnaires before and six months following the procedure. To measure the cut-off values for MCID, distribution methods and anchor methods were applied, while the PASS was assessed only via anchor approaches. The MCID related to the WOMAC average global score was 90.7 ± 7.6, the average pain dimension score was 93.2 ± 6.6, the average stiffness dimension score was 92.6 ± 17, and the average physical function dimension score was 89.7 ± 7.6. In terms of PASS, the normalized WOMAC was 82.8, the pain dimension was 87.5, the stiffness dimension was 93.7, and the functional dimension was 83.1. A 34.5 amelioration in the WOMAC score, from initial evaluation to final follow-up, using change in OKS > 5 as anchor, indicates that the patients’ health state improved to a clinically significant degree. A value at least of 82.8 in WOMAC score after treatment denotes that the symptom state is deemed acceptable by most of the patients. Full article
(This article belongs to the Special Issue Knee Arthroplasty Surgery: Management and Future Opportunities)

Review

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11 pages, 402 KiB  
Review
Why Kinematic Alignment Makes Little Sense in Valgus Osteoarthritis of the Knee: A Narrative Review
by Christian Manuel Sterneder, Martin Faschingbauer, Lyubomir Haralambiev, Maximilian F. Kasparek and Friedrich Boettner
J. Clin. Med. 2024, 13(5), 1302; https://doi.org/10.3390/jcm13051302 - 25 Feb 2024
Cited by 2 | Viewed by 1559
Abstract
There is a debate about the best alignment strategies in total knee arthroplasty (TKA). Mechanical alignment (MA) targets in combination with necessary soft tissue releases are the gold standard for TKA in end-stage valgus osteoarthritis. Some authors propagate kinematic alignment (KA) with the [...] Read more.
There is a debate about the best alignment strategies in total knee arthroplasty (TKA). Mechanical alignment (MA) targets in combination with necessary soft tissue releases are the gold standard for TKA in end-stage valgus osteoarthritis. Some authors propagate kinematic alignment (KA) with the aim of restoring the patient’s native alignment and minimizing the need for soft tissue releases. Our previous studies showed that MA with standardized soft tissue release produces reproducible results, and that the preoperative phenotype does not influence the results of patients with valgus osteoarthritis. These data suggest that there is no functional advantage to preserving valgus alignment in patients with valgus osteoarthritis. Many patients with valgus osteoarthritis present with a compromised medial collateral ligament and leaving the knee in valgus could increase the risk of secondary instability. The current literature supports MA TKA with soft tissue release as the gold standard. While using more sophisticated enabling technologies like robotic surgery might allow for aiming for very slight (1–2°) valgus alignment on the femoral side, any valgus alignment outside this range should be avoided. This review paper summarizes our current knowledge on the surgical techniques of TKA in patients with valgus osteoarthritis. Full article
(This article belongs to the Special Issue Knee Arthroplasty Surgery: Management and Future Opportunities)
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