Correlation of quality of life with instrumented analysis of a total knee arthroplasty series at the long-term follow-up

Static Baropodometry for Assessing Short-Term Functional Outcome after Unilateral Total Knee Arthroplasty: Exploring Correlation between Static Plantar Pressure Measurements and Self-Reported Outcomes

This study aimed to investigate the association between objective baropodometric and radiological measurements and patient self-reported functional outcomes, assessed through the Knee Injury and Osteoarthritis Outcome Score (KOOS). Additionally, it sought to evaluate the effectiveness of static baropodometry in predicting short-term KOOS results following unilateral total knee arthroplasty (TKA). We conducted a prospective single-center study involving 32 patients who underwent unilateral TKA for knee osteoarthritis (KOA). Patients were evaluated both preoperatively and six months postoperatively, utilizing objective measurements derived from static baropodometric analysis in a normal, relaxed, bipedal standing position using a multi-platform Plantar Pressure Analysis System (PPAS) and radiographic measurements of the femorotibial angle (FTA) and subjective assessments through the national validated version of the KOOS. The study found an insignificant average correction of -0.69° ± 4.12° in the preoperative FTA at the sixth month after TKA. Moreover, there were no significant differences in the KOOS based on different types of knee alignment (KA) both pre- and postoperatively (p > 0.05). No significant correlations were observed between the KOOS, and total average affected and unaffected plantar pressures (TAAPP and TAUPP) pre- and postoperatively, as well as KA pre- and postoperatively. However, significant changes were observed in TAAPP and TAUPP measurements after unilateral TKA. TAAPP demonstrated a significant increase postoperatively (mean change (SD) = 18.60 (47.71); p = 0.035). In conclusion, this study found no significant correlation between KA, static baropodometric measurements, including pre- and postoperative differences, and KOOS outcomes. Therefore, static plantar pressure measurements alone might not serve as a reliable predictor of short-term clinical outcomes after unilateral TKA, as reported by patients.

Autologous microfragmented adipose tissue and leukocyte-poor platelet-rich plasma combined with hyaluronic acid show comparable clinical outcomes for symptomatic early knee osteoarthritis over a two-year follow-up period: a prospective randomized clinical trial

PURPOSE

The purpose of this prospective randomized clinical trial is to compare the clinical outcomes of three injections of leucocyte-poor platelet-rich plasma (LP-PRP) and hyaluronic acid (HA) to a single dose of autologous microfragmented adipose tissue (AMAT) in patients with mild osteoarthritis at a two-year follow-up.

METHODS

Eighty symptomatic knees in fifty patients (mean age: 62.38 ± 11.88 years) with Kellgren-Lawrence grade 0 to 2 osteoarthritis were non blinded, randomly allocated into two equal groups. Group 1 consisted of 40 knees that received autologous LP-PRP + HA; Group 2 consisted of 40 knees treated with a single dose of AMAT injection. The outcomes were measured by Tegner, Marx, Visual Analogue Scale (VAS) for pain, International Knee Documentation Committee, and Knee Injury and Osteoarthritis Outcome Score (KOOS) at 6 (T1), 12 (T2), and 24 (T3) months. Adverse events were recorded at each follow-up timepoint. To assess score differences among subjects of the same gender and age, a subgroup analysis was performed.

RESULTS

Both groups had significant clinical and functional improvement at 6, 12, and 24 months (p < 0.05). Comparing the two groups, the AMAT groups showed significantly higher pre-operative Marx score (3.35 ± 4.91 vs. 1.78 ± 3.91) and VAS score (5.03 ± 2.02 vs. 3.85 ± 1.68) (p < 0.05), higher VAS (3.89 ± 2.51 vs. 2.64 ± 2.00) at T2 and KOOS-ADL (79.60 ± 20.20 vs. 65.68 ± 23.62), and lower KOOS-Sports (50.30 ± 30.15 vs. 68.35 ± 30.39) at T3 (p < 0.05). No patient from either group had experienced major adverse effects. In the LP-PRP group 12 (30%) patients presented swelling, redness, and mild pain for one day after injection and two patients had synovitis for two days and required paracetamol and local ice. In AMAT group 5 (12.5%) patients had ecchymosis and bruising at the fat aspiration site for three days.

CONCLUSION

AMAT did not show significant superior clinical improvement compared with three LP-PRP combined with HA injections in terms of functional improvement at different follow-up points. Both procedures were safe with no major complications reporting good results at mid-term follow-up, improving knee function, pain, and quality of live regardless of age and gender.

LEVEL OF EVIDENCE

Level I-Prospective Randomized Clinical Trial.

The dynamic impact of Joint Awareness on Quality of Life after Total Knee Arthroplasty: a longitudinal study

BACKGROUND

Joint Awareness is thought to be closely linked to Quality of Life (QoL) for patients undergoing Total Knee Arthroplasty (TKA), yet to date there have been no longitudinal studies to explore how Joint Awareness actually affects QoL. The purpose of this study was therefore to examine the development of Joint Awareness and QoL after TKA as well as the dynamic impact of Joint Awareness on QoL.

METHODS

A total of 342 patients were followed up at 3 months (T1), 6 months (T2), and 12 months (T3) after TKA. Joint Awareness was evaluated using the Forgotten Joint Score-12 (FJS-12), and QoL was measured by SF-36. We used repeated measures analysis of variance to estimate the development of Joint Awareness and QoL and employed a cross-lagged model to examine the dynamic relationship between Joint Awareness and QoL.

RESULTS

Both Joint Awareness and QoL improved with postoperative time (p < 0.001). Importantly, T1 Joint Awareness positively predicted T2 physical QoL (p < 0.001), and T2 Joint Awareness positively predicted T3 physical QoL (p < 0.001). Nevertheless, Joint Awareness had no predictive effect on mental QoL (p = 0.082-0.931).

CONCLUSIONS

In different periods after TKA, Joint Awareness and QoL both increased monotonically, and Joint Awareness positively predicted physical QoL. These findings indicate that focusing on Joint Awareness may be a priority when trying to improve the postoperative life of patients.

A new robotically assisted system for total knee arthroplasty: A sheep model study

BACKGROUND

We investigated the accuracy and safety of a new HURWA robotic-assisted total knee arthroplasty (TKA) system in a sheep model.

METHODS

Ten male small-tailed Han sheep were used in this study. Sheep were imaged by computed tomography scan before and after bone resection and the cutting errors between actual bone preparation and preoperative planning of the femur and tibia in three dimensions were measured.

RESULTS

The overall accuracies after surgery compared with that from preoperative surgical planning of the left and right femurs were 1.93 ± 1.02° and 1.93 ± 1.23°, respectively. Additionally, similarly high overall accuracies for the left and right tibia of 1.26 ± 1.04 and 1.68 ± 0.92°, respectively, were obtained. The gap distances of the distal cut, anterior chamfer, anterior cut, posterior chamfer and posterior cut on the medial side were 0.47 ± 0.35 mm, 0.41 ± 0.37 mm, 0.12 ± 0.26 mm, 0.41 ± 0.44 mm and 0.12 ± 0.23 mm, respectively. No intraoperative complications, such as intraoperative fracture, massive bleeding or death, occurred.

CONCLUSION

This new HURWA robotic-assisted TKA system is an accurate and safe tool for TKA surgery based on the sheep model.