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Debopadhaya S, Acosta E, Ortiz D. Trends and outcomes in the surgical management of young adults with knee osteoarthritis using high tibial osteotomy and unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05362-x. [PMID: 38771360 DOI: 10.1007/s00402-024-05362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION A significant portion of knee osteoarthritis is diagnosed in patients under the age of 55, where greater activity demands make total knee arthroplasty less desirable. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are useful alternatives, but there is little understanding of which procedure is advantageous. Hence, this study examines the utilization, complication, and reoperation rates among the HTO vs. UKA in young patients with primary osteoarthritis. METHODS A retrospective review of the National Surgical Quality Improvement Program was performed to identify 2318 patients < 55 years of age who received either a HTO or UKA for primary osteoarthritis between 2011 and 2021. Bivariate analyses compared preoperative and intraoperative characteristics among each procedure. Then, multivariate analyses examined if either procedure was associated with worse 30-day postoperative complications or need for reoperation, independent of the statistically significant pre- and intraoperative disparities. RESULTS UKAs were performed 14.2 times more commonly than HTOs, and the patients selected for HTO were more likely to be younger, have a lower BMI, have the healthiest ASA Class score, and less likely to have hypertension requiring medication (p < 0.001). HTOs took 17.5% longer to perform and had a longer average length of stay (p < 0.001), while UKAs were more likely to be performed out-patient (p < 0.001). HTOs also had higher rates of serious complications (p = 0.02), overall complications (p = 0.004), and need for reoperation (p = 0.004). Multivariate modelling demonstrated that procedure type was not a predictor of serious complications, but the use of HTO was significantly associated with any complications (odds ratio = 3.63, p = 0.001) and need for reoperation (3.21, p = 0.029). CONCLUSION Although healthier patients were selected for HTOs, UKAs were found to have a lower risk of complications and immediate reoperation. Additionally, UKAs had the advantage of lower operative burden, shorter length of stay, and a higher efficacy in outpatient settings.
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Affiliation(s)
- Shayom Debopadhaya
- Department of Orthopaedics, Albany Medical College, 49 New Scotland Ave, Albany, NY, 12208, USA
| | - Ernesto Acosta
- Department of Orthopaedics, Albany Medical College, 49 New Scotland Ave, Albany, NY, 12208, USA
| | - Dionisio Ortiz
- Department of Orthopaedics, Albany Medical College, 49 New Scotland Ave, Albany, NY, 12208, USA.
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Bensa A, Sangiorgio A, Deabate L, Illuminati A, Pompa B, Filardo G. Robotic-assisted unicompartmental knee arthroplasty improves functional outcomes, complications, and revisions. Bone Jt Open 2024; 5:374-384. [PMID: 38690670 PMCID: PMC11061807 DOI: 10.1302/2633-1462.55.bjo-2024-0030.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Aims Robotic-assisted unicompartmental knee arthroplasty (R-UKA) has been proposed as an approach to improve the results of the conventional manual UKA (C-UKA). The aim of this meta-analysis was to analyze the studies comparing R-UKA and C-UKA in terms of clinical outcomes, radiological results, operating time, complications, and revisions. Methods The literature search was conducted on three databases (PubMed, Cochrane, and Web of Science) on 20 February 2024 according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Inclusion criteria were comparative studies, written in the English language, with no time limitations, on the comparison of R-UKA and C-UKA. The quality of each article was assessed using the Downs and Black Checklist for Measuring Quality. Results Among the 3,669 articles retrieved, 21 studies on 19 series of patients were included. A total of 3,074 patients (59.5% female and 40.5% male; mean age 65.2 years (SD 3.9); mean BMI 27.4 kg/m2 (SD 2.2)) were analyzed. R-UKA obtained a superior Knee Society Score improvement compared to C-UKA (mean difference (MD) 4.9; p < 0.001) and better Forgotten Joint Score postoperative values (MD 5.5; p = 0.032). The analysis of radiological outcomes did not find a statistically significant difference between the two approaches. R-UKA showed longer operating time (MD 15.6; p < 0.001), but reduced complication and revision rates compared to C-UKA (5.2% vs 10.1% and 4.1% vs 7.2%, respectively). Conclusion This meta-analysis showed that the robotic approach for UKA provided a significant improvement in functional outcomes compared to the conventional manual technique. R-UKA showed similar radiological results and longer operating time, but reduced complication and revision rates compared to C-UKA. Overall, R-UKA seems to provide relevant benefits over C-UKA in the management of patients undergoing UKA.
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Affiliation(s)
- Alessandro Bensa
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano, Switzerland
| | - Alessandro Sangiorgio
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Luca Deabate
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | | | - Benedetta Pompa
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano, Switzerland
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Harris CG, Ziemba-Davis M, Deckard ER, Sonn KA, Meneghini RM. Implant Position, Survivorship, and Patient-Reported Outcomes in Manual Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2024; 39:632-637. [PMID: 37717834 DOI: 10.1016/j.arth.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Two related recent reports described high error rates for implant positioning and reduced implant survivorship in manual unicompartmental knee arthroplasty (MUKA) compared to robotic-assisted unicompartmental knee arthroplasty (RUKA). The present study scientifically replicated these reports by comparing MUKAs similarly performed by an experienced high-volume surgeon in similar patients using the same study methods as these reports. METHODS A total of 216 consecutive MUKAs were retrospectively evaluated radiographically for achievement of implant positioning targets. Achievement of targets was compared to the published MUKA and RUKA outcomes and correlated with revision rates and patient-reported outcome measures. RESULTS There were 20% of study MUKAs compared to 88.1% of comparison MUKAs (P < .001) and 31.4% of comparison RUKAs (P < .048) that failed to meet all 7 implant positioning targets. The MUKA revision rates were significantly lower in the study sample than for comparison MUKAs (3.2% versus 14.2%, P < .001). Implant survivorship was 91.7% (95% confidence interval 84.9, 98.5%) at 8.9 years compared to 70.0% (95% confidence interval 56.0, 80.0%) at 10.2 years, respectively. Most patient-reported outcome measures did not differ based on achievement of implant positioning targets (P ≥ .072). CONCLUSIONS Present study findings indicate that observations in the 2 recent reports may not be generalizable to all UKA surgeons. Additional data on the relationship between implant positioning and revision as well as functional outcomes are needed to identify appropriate robotic arthroplasty applications.
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Affiliation(s)
- Colin G Harris
- Department of Graduate Medical Education, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mary Ziemba-Davis
- Indiana University Health Saxony Hip and Knee Center, Fishers, Indiana
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - Kevin A Sonn
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - R Michael Meneghini
- Indiana Joint Replacement Institute, Indianapolis, Indiana; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Guo X, Wang D, Li J, Zhang H. Global research status and trends in orthopaedic surgical robotics: a bibliometric and visualisation analysis study. J Robot Surg 2023:10.1007/s11701-023-01579-x. [PMID: 37017859 DOI: 10.1007/s11701-023-01579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/18/2023] [Indexed: 04/06/2023]
Abstract
This study aimed to investigate and summarise the current state of research and trends in orthopaedic surgical robots. Data on publicly available publications related to orthopaedic surgical robots were extracted by abstract searches of the Web of Science Core Collection database. A bibliometric analysis and detailed reading of the publications were then carried out and the information was visualised using co-authorship analysis, coupling analysis, co-citation analysis and co-occurrence analysis in VOSviewer. With 436 publications included in the study from 1993 to 2022, the overall contribution of publications to the world showed an increasing trend year by year, with a particularly pronounced after 2017, and a geographical trend of predominantly East Asia, North America, and Western Europe. Of these, China was the largest contributor (n = 128). Overall, the UK affiliates and their scholars were leaders in the field, with a high number of publications, total citations, average citations per article and H-index. The most published institutions and authors were Imperial College London (n = 21) and Professor Fares Sahi Haddad of University College London (n = 12), respectively. Journals with a high overall impact on robotic orthopaedic surgery were the Journal of Arthroplasty, Bone Joint Journal, International Journal of Medical Robotics and Computer Assisted Surgery. Keyword co-occurrence network analysis revealed four main clusters: robot-assisted knee, hip arthroplasty, spine surgery, and robotic technology research and development. The top three most common sites for robot-assisted surgery use were the knee, hip and spine. The most used robot types were the knee and spine, with Mako and Arobot being the most used robots for the knee and TiRobot for the spine. This study comprehensively reveals the current status and trends of global research on orthopaedic surgical robots, covering countries, institutions, authors, journals, research hotspots, robot types and surgical sites, providing directional guidance and research ideas for further research on the technological development and clinical evaluation of orthopaedic surgical robots.
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Affiliation(s)
- Xinmeng Guo
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Jiantao Li
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Hao Zhang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
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Adamska O, Modzelewski K, Szymczak J, Świderek J, Maciąg B, Czuchaj P, Poniatowska M, Wnuk A. Robotic-Assisted Total Knee Arthroplasty Utilizing NAVIO, CORI Imageless Systems and Manual TKA Accurately Restore Femoral Rotational Alignment and Yield Satisfactory Clinical Outcomes: A Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020236. [PMID: 36837438 PMCID: PMC9963242 DOI: 10.3390/medicina59020236] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 01/28/2023]
Abstract
Background and objectives: The introduction of novel techniques in total knee arthroplasty (TKA) aiming to enhance outcomes and satisfaction of the procedure is constantly ongoing. In order to evidence a priority of one, we have conducted a randomized controlled trial with the aim of comparing patient-reported functional outcomes, radiographic outcomes and intraoperative measures between imageless (NAVIO and CORI), robotic-assisted (ra)- TKA (ra-TKA) and manual TKA (mTKA) for primary knee osteoarthritis (KOA). Materials and Methods: A total of 215 patients with the diagnosis of KOA of the knee were randomly assigned to one of the three groups: NAVIO (76 patients) or CORI (71 patients) robotic-assisted TKA, or manual technique (68 patients) TKA. The primary outcome (Knee Injury and Osteoarthritis Outcome Study [KOOS]), Visual Analogue Scale (VAS), Range of motion (ROM), femoral component rotational alignment and the secondary outcomes (surgery time, blood loss, complications, and revision at 12 months after surgery) were compared between three groups. KOOS and VAS were collected at particular follow up visits from each patient individually and ROM in flexion and extension was assessed during the physical examination. Femoral component rotational alignment was measured on the CT scan performed postoperatively utilizing the Berger's method. Statistical significance was set at p < 0.05. Results: Both the ra-TKA groups and mTKA group displayed significant improvements in the majority of the functional outcome scores at 12 months. Despite having more prominent surgery time (NAVIO: mean +44.5 min in comparison to mTKA and CORI: mean +38.5 min in comparison to mTKA), both NAVIO and CORI tend to achieve highly accurate femoral component rotational alignment with mean radiographic scores in NAVIO vs. CORI vs. mTKA of 1.48° vs. 1.33° vs. 3.15° and lower blood loss (NAVIO: 1.74; CORI: 1.51; mTKA: 2.32. Furthermore, the investigation revealed the significant difference in femoral component rotational alignment between mTKA-NAVIO and mTKA-CORI and significantly different KOOS scores in NAVIO vs. CORI vs. mTKA of 87.05 vs. 85.59 vs. 81.76. Furthermore, the KOOS analysis showed between group significant statistical differences, but did not reach minimal clinically significant difference. There were no differences in postoperative ROM and VAS. There were no differences in complications between groups. Conclusions: To achieve a successful TKA, the precise tool and individualised objective is of great importance. The results suggest satisfactory results after both ra-TKA methods and mTKA. Ra-TKA and mTKA stand for a safe and reliable treatment method for OA. Patients reported excellent alleviation in functional outcomes and the radiological results revealed that the better precision does not necessarily lead to a better outcome. Therefore, ra-TKA does not imply strong enough advantages in comparison to the manual method, especially in terms of cost-efficiency and surgical time.
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Affiliation(s)
- Olga Adamska
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
- Correspondence:
| | - Krzysztof Modzelewski
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
| | - Jakub Szymczak
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
| | - Jakub Świderek
- Faculty of Medicine, Medical University of Bialystok, 1 Jana Kilińskiego St., 15-089 Bialystok, Poland
| | - Bartosz Maciąg
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
| | - Paweł Czuchaj
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
| | | | - Artur Wnuk
- Hospital in Ostrow Mazowiecka, 68 Dubois St., 07-300 Ostrów Mazowiecka, Poland
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Reduced Early Revision Surgery and Medical Complications in Computer-assisted Knee Arthroplasty Compared With Non-computer-assisted Arthroplasty. J Am Acad Orthop Surg 2023; 31:87-96. [PMID: 36580050 DOI: 10.5435/jaaos-d-22-00596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/12/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Computer assistance can help surgeons achieve mechanical accurate alignment, but the clinical effect of this technology in different arthroplasty types remains controversial because of conflicting functional outcomes, revision rates, and complication rates. The goal of this study was to compare 90-day medical complications and 1 and 2-year revision surgeries after computer-assisted patellofemoral arthroplasty, unicompartmental knee arthroplasty (CA-UKA), bicompartmental knee arthroplasty (CA-BKA), and total knee arthroplasty (CA-TKA) with non-computer-assisted procedures. METHODS A retrospective cohort analysis was conducted using the Mariner data set of the PearlDiver Patient Records Database from 2010 to 2018. Current Procedural Terminology codes were used to identify patients who underwent patellofemoral arthroplasty, unicompartmental knee arthroplasty, bicompartmental knee arthroplasty, and total knee arthroplasty with or without computer assistance for osteoarthritis. All included patients were followed up for 2 years. Univariate and multivariable analyses were conducted. RESULTS On multivariable analysis, revision within 1 year was decreased in patients who underwent computer-assisted patellofemoral arthroplasty (odds ratio [OR]: 0.541, P = 0.031), CA-UKA (OR: 0.798, P = 0.019), and computer-assisted bicompartmental knee arthroplasty (OR: 0.186, P = 0.025) compared with the same surgeries without technology assistance. CA-TKA had decreased odds of revision for aseptic loosening at 2 years (OR: 0.789, P < 0.001). CA-UKA and CA-TKA had decreased risk of overall 90-day medical complications (OR: 0.838, P < 0.001; OR: 0.903, P < 0.001, respectively) and major complications (OR: 0.750, P = 0.004; OR: 0.822, P < 0.001, respectively). DISCUSSION Complication rates and revision surgeries for all arthroplasty types were equivalent or more favorable when computer assistance was used during surgery. Our results quantify some early benefits to using computer assistance in total and partial knee arthroplasties.
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Fuller SI, Cohen JS, Malyavko A, Agarwal AR, Stake S, Golladay GJ, Thakkar SC. Knee arthroplasty utilization trends from 2010 to 2019. Knee 2022; 39:209-215. [PMID: 36215923 DOI: 10.1016/j.knee.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/24/2022] [Accepted: 09/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Interest in partial knee arthroplasty procedures including unicompartmental arthroplasty (UKA), patellofemoral arthroplasty (PFA), and bicompartmental knee arthroplasty (BKA) has increased due to their bone and ligament preservation compared to total knee arthroplasty (TKA). Implant designs, changing thoughts on appropriate indications for partial knee arthroplasty, and availability of navigation also impacted the field over the last decade. The aims of this study were to evaluate trends over the last decade in utilization of 1) partial and total knee arthroplasty; and 2) computer-assistance in knee arthroplasty. METHODS A retrospective cohort analysis was conducted using the PearlDiver database. Patients who underwent PFA, UKA, BKA, and TKA for an indication of osteoarthritis (OA) were identified using Current Procedural Terminology (CPT) codes. Trends analysis from 2010 to 2019 was conducted to compare utilization based on procedure type and computer-assistance. Statistical analysis was conducted using Compounded Annual Growth Rates (CAGR) and linear regression. RESULTS From 2010 to 2019, there was a significant decrease in utilization of PFA (CAGR: -5.73 %; p = 0.011) and BKA (CAGR: -10.49 %; p = 0.013), but no significant difference in that of UKA (p = 0.224) and TKA (p = 0.421). There was a significant increase in the utilization of computer assistance for both UKA (CAGR: +19.81 %; p = 0.002) and TKA (CAGR: +3.90 %; p = 0.038), but there was no significant difference for computer-assisted PFA (p = 0.724) and BKA (p = 0.951). CONCLUSIONS TKA is still the most common arthroplasty procedure for OA. Decreased utilization of PFA and BKA may be explained by reported failure and revision rates for PFA and BKA compared to TKA.
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Affiliation(s)
- Samuel I Fuller
- Department of Orthopaedic Surgery, George Washington University Hospital, 2300 M St NW, Washington DC 20037, USA
| | - Jordan S Cohen
- Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market St, Philadelphia, PA 19104, USA
| | - Alisa Malyavko
- Department of Orthopaedic Surgery, George Washington University Hospital, 2300 M St NW, Washington DC 20037, USA.
| | - Amil R Agarwal
- Department of Orthopaedic Surgery, George Washington University Hospital, 2300 M St NW, Washington DC 20037, USA
| | - Seth Stake
- Department of Orthopaedic Surgery, George Washington University Hospital, 2300 M St NW, Washington DC 20037, USA
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Box 98053, 1200 E. Broad St., Richmond, VA 23298, USA
| | - Savyasachi C Thakkar
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, 10700 Charter Dr, Suite 205, Columbia, MD 21044, USA
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Potential New Treatments for Knee OA: A Prospective Review of Registered Trials. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112211049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We aimed to evaluate potential new treatments for knee osteoarthritis (OA). The National Institute of Health ClinicalTrials.gov database was searched for “Osteoarthritis, Knee”. We found 565 ongoing interventional studies with a total planned enrollment of 111,276 subjects. Ongoing studies for knee OA represent a very small fraction of the registered clinical trials, but they are over a quarter of all knee trials and over two thirds of all OA studies. The most researched topic was arthroplasty, with aspects such as implant design changes, cementless fixation, robotic guidance, pain management, and fast track recovery. Intraarticular injections focused on cell therapies with mesenchymal stem cells sourced from adipose tissue, bone marrow, or umbilical cord. We could see the introduction of the first disease modifying drugs with an impact on knee OA, as well as new procedures such as geniculate artery embolization and geniculate nerve ablation.
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