Comparison of screw and screwless fixation in cementless total knee arthroplasty. To Cement or Not? Two-Year Results of a Prospective, Randomized Study Comparing Cemented Vs. Cementless Total Knee Arthroplasty (TKA). Results of cementless total knee arthroplasty in an older rheumatoid arthritis population. Excellent fixation achieved with cementless posteriorly stabilized total knee arthroplasty. Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Clinical outcome using a ligament referencing technique in CAS versus conventional technique Knee Arthroplasty in the Young Patient: Survival in a Community Registry The effect of tourniquet release timing on perioperative blood loss in simultaneous bilateral cemented total knee arthroplasty: a prospective randomized study. Minimally Invasive Computer-Assisted Total Knee Arthroplasty Compared With Conventional Total Knee Arthroplasty: A Prospective 9-Year Follow-Up. Unicompartmental knee arthroplasty versus total knee arthroplasty: Which type of artificial joint do patients forget? The role of presurgical expectancies in predicting pain and function one year following total knee arthroplasty Continuous passive motion after primary total knee arthroplasty. Does it offer any benefits? Survival analysis of a cementless, cruciate-retaining total knee arthroplasty. Clinical and radiographic assessment 10 to 13 years after surgery. Short-Term Outcome after Computer-Assisted versus Conventional Total Knee Arthroplasty: A Randomised Controlled Trial A systematic review of psychological interventions in total hip and knee arthroplasty Residual Symptoms and Function After Unicompartmental and Total Knee Arthroplasty: Comparable to Normative Controls? Effect of the timing of tourniquet release on perioperative blood loss associated with cementless total knee arthroplasty: a prospective randomized study. Navigated total knee arthroplasty: a radiological analysis of 42 randomised cases. Small Increase of Actual Physical Activity 6 Months After Total Hip or Knee Arthroplasty
This study compared two groups of consecutive patients undergoing total knee arthroplasty ( TKA ) with an identical cementless tibial baseplate supplementally fixated with and without screws . In 58 TKAs , two 6.5-mm cancellous screws were used for fixation , and in 58 TKAs , screwless fixation was used . Clinical evaluation was performed using the Hospital for Special Surgery knee score , and fluoroscopically guided radiographs were evaluated for radiolucencies . In the screw fixation group , average follow-up was 82+/-6 months ( range , 59 - 89 months ) and average patient age at surgery was 63 years . For the screwless fixation group , average follow-up was 67+/-5 months ( range , 48 - 76 months ) and average patient age at surgery was 62 years .  Average knee score was 97 for the screw fixation group and 98 for the screwless fixation group . This study demonstrated stability in cementless TKA both with and without screw fixation in the mid-term using the Natural-Knee II tibial component The optimal mode of fixation in total knee arthroplasty ( TKA ) is a subject of debate . We enrolled 100 TKA patients r and omized to cemented or cementless fixation .  Knee Society Scores ( KSS ) , Oxford scores and pain visual analog scales ( VAS ) were collected pre-operatively and post-operatively . Two-year follow-up was obtained for 93 patients . The mean VAS trended higher for the cementless group at 4 months ( P=0.06 ) . At 2 years , the KSS functional scores , Oxford scores , and self-reported questions for satisfaction , less pain and better function were similar but the cemented group had higher KSS clinical scores ( 96.4 vs. 92.3 , P=0.03 ) . More radiolucencies were seen in cementless knees ( P<0.001 ) . The cementless group had one revision for instability and one cemented knee was revised for infection .  Cementless TKA showed equivalent survivorship ( revision for any reason as the endpoint ) compared to cemented TKA at this early follow-up . Close monitoring of radiolucencies is important with continued follow-up Fifty-five total knee arthroplasties ( TKAs ) in thirty-nine adult ( mean age , 62 years ) patients with rheumatoid arthritis were studied prospect ively for a period of 1 - 7 years . All of the procedures were performed using cementless fixation of the tibial and femoral components . The Knee Society clinical rating system mean knee scores increased 56 points after operation ( mean , 88 points ) , and the mean functional scores increased 28 points ( mean , 64 points ) . Two revisions ( 4 % ) have been required , one for secondary late infection and one for failure of a cementless metal-backed patellar component . Good bone stock was retained in both , allowing for uneventful cementless revision . Forty-two arthroplasties ( 76 % ) were completely pain-free , twelve ( 22 % ) had mild , occasional discomfort with weight-bearing , and one ( 2 % ) had moderate pain at last examination . In this older rheumatoid population , cementless TKA offers good or excellent early clinical results and excellent preservation of bone stock should revision become necessary Cementless posteriorly stabilized ( PS ) total knee arthroplasty has not been widely accepted primarily because of prior unpredictable results and concern about micromotion at the tibial fixation interface caused by the cam/post interaction . A prospect i ve consecutive series of 114 cementless , tricompartmental periapatite-coated single-radius PS implants in 110 patients with a mean age 62 years was performed to determine if initial stability and biologic fixation could be achieved . At a mean follow-up of 36 months , all implants demonstrated radiographic evidence of stable biologic fixation with no evidence of loosening , osteolysis , stress shielding , or progressive radiolucent lines . Based on these early results , cementless , periapatite-coated single-radius PS total knee arthroplasty offers marked promise The viability of  unicondylar knee arthroplasty ( UKA )  as a st and -alone or temporising option for the management of  gonarthrosis  is a topic of considerable contention . Despite recent advances in prosthesis design and surgical technique , as well as mounting evidence of long-term survivorship , UKA remains infrequently used , accounting for just 8 - 15 % of all knee arthroplasties . Instead this group is more typically managed using total knee arthroplasty ( TKA ) . For UKA to warrant increased usage the c and idacy for UKA must be prevalent , the outcome must be equivalent or superior to that of TKA , and the costs should be comparatively low . Here we address three issues regarding UKA : 1 ) a prospect i ve assessment of the proportion of knees needing arthroplasty that are c and i date s for UKA ; 2 ) retrospective outcome measures comparing TKA , UKA and controls ; and 3 ) an estimation of the difference in costs between TKA and UKA from a hospital perspective . We show in a series of 200 knees that c and idacy for UKA is widespread ; representing 47.6 % of knees . Furthermore , we also show for the first time , that not only is UKA functionally superior to TKA ( based on Total Knee Question naire ( TKQ ) scores ) , but scores in medial and lateral UKA knees do not differ significantly from normal , non-operative age- and sex-matched knees ( t=1.14 [ 38 ] , p=0.163 ; and t=1.16 [ 38 ] , p=0.255 respectively ) . Finally , we report that UKA offers a substantial cost saving over TKA ( pound 1761 per knee ) indicating that UKA should be considered the primary treatment option for unicompartmental knee arthritis Purpose Computer-assisted surgery ( CAS ) for total knee arthroplasty ( TKA ) has become increasingly common over the last decade . There are several reports including meta-analyses that show improved alignment , but the clinical results do not differ . Most of these studies have used a bone referencing technique to size and position the prosthesis . The question arises whether CAS has a more pronounced effect on strict ligamentous referencing TKAs . Methods We performed a prospect i ve cohort study comparing clinical outcome of navigated TKA ( 43 patients ) with that of conventional TKA ( 122 patients ) . Patients were assessed preoperatively , and 2 and 12 months postoperatively by an independent study nurse using vali date d patient-reported outcome tools as well as clinical examination . Results At 2 months , there was no difference between the two groups . However , after 12 months , CAS was associated with significantly less pain and stiffness , both at rest and during activities of daily living , as well as greater overall patient satisfaction . Conclusion The present study demonstrated that computer-navigated TKA significantly improves patient outcome scores such as WOMAC score ( P = 0.002 ) and Knee Society score ( P = 0.040 ) 1 year after surgery in using a ligament referencing technique . Furthermore , 91 % were extremely or very satisfied in the CAS TKA group versus 70 % after conventional TKA ( P = 0.007 ) Operative options for the younger patient with an arthritic knee remain controversial . We prospect ively followed 1047 patients 55 years old or younger who underwent knee arthroplasty in a community joint registry over a 14-year period . Patients were implanted with 1047 joints of three predominant design s by 48 surgeons in four hospitals associated with a community joint registry . The mean age for this cohort was 49.8 years , and 62.8 % ( 657/1047 ) of the patients were female . There were a total of 73 revisions performed , 5.6 % ( 37/653 ) in women and 9.2 % ( 36/394 ) in men . Cemented TKAs performed best , with a cumulative revision rate of 15.5 % , compared to 32.3 % in unicompartmental knee arthroplasty ( UKA ) patients and 34.1 % in cementless design s. Men had a higher cumulative revision rate than women , 31.9 % compared to 20.6 % . Adjusting for implant type and gender , there was no difference in cumulative revision rate based on diagnosis ( OA versus other ) or age group ( ≤40 , 41 - 45 , 46 - 50 , 51 - 55 years ) or between cruciate-retaining and -substituting design s. Eighty five percent of cemented TKA implants survived at 14 years in the population under 55 years of age in this community registry . Cementless design s and UKA increased revision risk independently . Level of Evidence : Level II , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence Today the use of pneumatic tourniquet is commonly accepted in total knee arthroplasty ( TKA ) to reduce perioperative blood loss . There are a few prospect i ve r and omised and nonr and omised studies that compare the effect of tourniquet release timing in cementless or cemented unilateral TKA . However , many of these studies show an inadequate reporting and methodology . This r and omized prospect i ve study was design ed to investigate the efficiency of tourniquet release timing in preventing perioperative blood loss in a simultaneous bilateral TKA study design . To our knowledge , this is the first study of its kind , in which the effect of tourniquet release timing on perioperative blood loss was investigated in simultaneous bilateral cemented TKA to compare both techniques intraindividually . In 20 patients ( 40 knees ) one knee was operated with tourniquet release and hemostasis before wound closure , and the other knee with tourniquet release after wound closure and pressure dressing . We found no significant difference in total blood loss between both techniques ( p=0.930 ) , but a significant difference in operating time ( p=0.035 ) . There were no postoperative complications at a follow-up of 6 month . Other studies report an increase the blood loss in early tourniquet release and an increase the risk of early postoperative complications in deflation of tourniquet after wound closure . In this study we found no significant difference in perioperative blood loss and no increase of postoperative complications . Therefore , we recommend a tourniquet release after wound closure to reduce the duration of TKA procedure and to avoid possible risks of extended anaesthesia BACKGROUND Studies on minimally invasive computer-assisted total knee arthroplasty ( MICA-TKA ) have shown promising results , but are limited by short follow-up . The purpose of this study was to compare the midterm radiographic features and functional outcomes between patients who underwent MICA-TKA and conventional TKA .  METHODS A total of 108 patients who were r and omized to undergo MICA-TKA or conventional TKA during 2004 and 2005 were contacted for a prospect i ve follow-up review . Patients who were lost to contact , have passed away , or declined to participate in the study were excluded . Objective functional measurements and radiographs were obtained for assessment . RESULTS By the time of this study , 2 patients from the conventional group had undergone revision TKA , one due to infection and one due to aseptic loosening . A total of 67 patients ( 62.04 % ) were followed up for an average period of 9.07 years ( 8.51 - 9.61 years ) . At follow-up , functional scores were comparable between the 2 groups . No significant intergroup differences were found in mechanical knee alignment and component placement angle in the coronal views . No statistical or clinical significance were noticed in radiographic signs of component loosening . CONCLUSIONS MICA-TKA provided similar clinical , functional , and radiographic outcomes compared with conventional TKA after an average of 9-year follow-up . This technique can be used to exploit its short-term advantages without compromising midterm outcomes Abstract Purpose During recent years , there has been an intensive growth of interest in the patient ’s perception of functional outcome . The Forgotten Joint Score ( FJS ) is a recently introduced score that measures joint awareness of patients who have undergone knee arthroplasty and is less limited by ceiling effects . The aim of this study was to compare the FJS between patients who undergo medial unicompartmental knee arthroplasty ( UKA ) and patients who undergo total knee arthroplasty ( TKA )  1 and 2 years post-operatively . Methods This prospect i ve study compares the FJS at a minimum of one ( average 1.5 years , range 1.0–1.9 ) and a minimum of 2 years ( average 2.5 years , range 2.0–3.6 ) post-operatively between patients who underwent medial UKA and TKA .  Results One-hundred and thirty patients were included . Sixty-five patients underwent medial UKA and 65 patients underwent TKA . At both follow-up points , the FJS was significantly higher in the UKA group ( FJS 1 year 73.9 ± 22.8 , FJS 2 year 74.3 ± 24.8 ) in contrast to the TKA group ( FJS 1 year 59.3 ± 29.5 ( p = 0.002 ) , FJS 2 year 59.8 ± 31.5 , ( p = 0.004 ) ) . No significant improvement in the FJS was observed between 1- and 2-year follow-up of the two cohorts . Conclusion Patients who undergo UKA are more likely to forget their artificial joint in daily life and consequently may be more satisfied . Level of evidence II Summary Patients ’ behavioral outcome expectancies assessed presurgically predicted pain severity and physical function 1 year after total knee arthroplasty ( TKA ) and partially mediated the relation between catastrophizing and TKA outcomes . Abstract The present study examined the prospect i ve value of response expectancies ( ie , pain , sleep ) and behavioral outcome expectancies ( ie , return to function ) in the prediction of pain severity and functional limitations 12 months after total knee arthroplasty ( TKA ) . The study sample consisted of 120 individuals ( 73 women , 47 men ) with osteoarthritis of the knee who were scheduled for TKA .  Measures of expectancies , pain severity , pain catastrophizing , pain‐related fears of movement , and depression  were completed prior to surgery . Participants also completed measures of pain severity and functional limitations 12 months following surgery . Analyses revealed that behavioral outcome expectancies were stronger predictors of follow‐up pain and functional limitations than response expectancies . Consistent with previous research , analyses also revealed that pain catastrophizing , pain‐related fear of movement , and depression predicted follow‐up pain and function . In a multivariate analysis , only pain catastrophizing contributed significant unique variance to the prediction of follow‐up pain and function . Behavioral outcome expectancies partially mediated the relation between catastrophizing and follow‐up pain and function . The relation between catastrophizing and follow‐up pain severity and functional limitations remained significant even when controlling for behavioral outcome expectancies . The results suggest that interventions design ed to specifically target behavioral outcome expectancies and catastrophizing might improve post‐surgical outcomes We report a prospect i ve r and omly controlled trial to examine the effectiveness of continuous passive motion ( CPM ) in improving postoperative function and range of movement  after total knee arthroplasty ( TKA ) . We allocated 53 patients ( 57 knees ) to one of three postoperative regimes : no CPM ( n = 19 ) ; CPM at 0 to 40 degrees ( 0 to 40 CPM ; n = 18 ) ; and CPM at 0 to 70 degrees ( 0 to 70 CPM ; n = 20 ) . Those in the CPM groups had CPM for 48 hours and all patients had an identical regime of physiotherapy . There was an even distribution of various cemented and cementless TKAs in each group . Patients were assessed preoperatively and at one week and at one year postoperatively . At one week , there was a statistically significant increase in the range of flexion and total range of movement in the 0 to 70 CPM group compared with the no-CPM group . At one year we found no significant differences in mean flexion , overall range of movement , fixed flexion deformity or functional results in the three groups . Those who had CPM had a significant increase in analgesic requirement ( p = 0.04 ) . There was an increased mean blood drainage postoperatively in those who had 0 to 70 CPM ( 1558 ml ) compared with those with no CPM ( 956 ml ) ( t = 2.96 , p = 0.005 ) and with 0 to 40 CPM ( 1017 ml ) ( t = 2.62 , p = 0.01 ) . Our findings show that CPM had no significant advantage in terms of improving function or range of movement , and that its use increased blood loss and analgesic requirements We performed a prospect i ve study of 54 patients ( 76 knees ) who underwent Osteonics series 3000 cruciate-retaining cementless total knee arthroplasty between December 1990 and June 1993 . Five patients ( seven knees ) were lost to follow-up ( 90.7 % completion ) . One patient required revision at 10.5 years after operation . The rate of survival was 100 % at ten years and 96.7 % at 13 years . The mean ten-year knee and function scores were 79 and 59 respectively . Both were significantly better than the pre-operative scores . The range of movement also improved . Although a radiolucent line around the tibial component enlarged in six knees ( 20.7 % ) at ten years , the clinical outcome was generally good . In a patient who died after 5.5 years , post-mortem examination of the knee showed no bony ingrowth into the tibial component . Despite poor bony ingrowth , press-fit fixation was satisfactory and good results can be obtained with this cementless , cruciate-retaining prosthesis Purpose . To compare the short-term functional outcome after computer-assisted total knee arthroplasty ( TKA )  versus conventional TKA . Methods . 23 men and 67 women aged 48 to 80 years were r and omised to undergo ( 1 ) conventional TKA using an intramedullary guide , ( 2 ) conventional TKA using an extramedullary guide , or ( 3 ) computer-assisted TKA . Two senior surgeons performed all the TKAs using the same TKA system and the st and ard anteromedial arthrotomy with eversion of the patella . Patients were assessed by physiotherapists before and 6 months and 2 years after TKA using the Short Form-36 Health Survey , Oxford Knee Score , and Knee Society Score . Results . Of the 90 patients , 67 and 70 were assessed at 6 months and 2 years after TKA , respectively . No patient developed deep infection or required revision surgery . Functional outcomes of the 3 groups did not differ significantly at the corresponding follow-ups . Conclusion . Significant improvement in the functional outcome was not shown in patients treated with  computer-assisted TKA  , compared with conventional TKA . Thus , computer-assisted TKA has limited additional short-term benefits . Further studies with longer follow-up are required to examine the benefits of computer-assisted TKA Background The current practice in elective orthopaedics does not routinely include psychological interventions despite evidence that psychological factors such as personality , anxiety , depression and negative thinking styles can influence outcomes and recovery from surgery . The objective of this paper was to review the effectiveness of psychological interventions used in conjunction with total hip ( THA ) and knee arthroplasty ( TKA ) , in improving patient reported joint outcomes . Methods An extensive literature search was conducted according to Preferred Reporting Items for Systematic review s and Meta-Analyses guidelines . Search terms included psychology , interventions , and orthopaedics . Articles were included if they were r and omised controlled trials ( RCTs ) of psychological interventions involving active patient participation measured with patient reported joint outcomes in patients undergoing hip or knee arthroplasty . Results A total of 19,489 titles were screened . Seven studies met the inclusion criteria and were included . Five of seven studies did not show improvements in patient reported outcomes after surgery . Specifically , psycho-education alone was not effective at improving patient reported joint outcomes in two out of two studies . Conclusion The current literature does not support routine psychological interventions for TKA and THA . However , it should be noted that the literature for psychological interventions in conjunction with TKA and THA is still in its infancy . This gap in the literature is surprising , considering the importance of the role of psychological factors in recovery . Further RCTs with long term follow ups , multidisciplinary involvement , and more comprehensive and focused interventions that go beyond educating patients are needed . Future studies should account for the dem and effect , include measures of psychological variables to determine whether psychological interventions are more beneficial for some patients compared to others , and compare the different modes of delivery and timing of interventions to determine the optimal nature and duration of psychological interventions for TKA and THA BACKGROUND Whether patient-reported symptoms and function after  total knee arthroplasty ( TKA ) and medial unicompartmental knee arthroplasty ( UKA )  compare favorably to similar individuals without a diagnosis of knee pathology has not been investigated . METHODS A retrospective , multicenter study was design ed in which 4 centers contributed patients between ages 18 and 80 years undergoing knee arthroplasty .  Data were collected by an independent , third-party survey center that administered a question naire assessing patient satisfaction and function . The survey center identified a " control " population of the same age range using a " r and om digit dial call method " with no prior knee interventions or major problems with their knees limiting their activity . Comparisons were performed using multivariate logistic regression analyses accounting for differences in demographic variables among the 3 cohorts . RESULTS Overall , 1456 TKAs , 476UKAs , and 409 controls were included for analysis . Controls reported a surprisingly high incidence of pain ( 30 % ) , a limp ( 26 % ) , stiffness ( 22 % ) , and noise ( 21 % ) in their knee . However , the likelihood of reported noise ( odds ratio [ OR ] , 1.3 ) , swelling ( OR , 1.4 ) , stiffness ( OR , 1.8 ) , and difficulty getting in and out of a chair ( OR , 2.5 ) was increased after TKA vs controls ( P < .001-.03 ) . The likelihood of swelling ( OR , 1.8 ) , stiffness ( OR , 1.5 ) , and difficulty getting in and out of a chair ( OR , 1.7 ) was increased after UKA vs controls ( P = .002-.005 ) . CONCLUSION When interviewed by an independent , third party , a substantial percentage of control patients reported the presence of knee symptoms , but to a lesser degree than patients after a knee arthroplasty The control of perioperative blood loss is a major concern in cementless knee arthroplasty surgery . We r and omized retrospectively 55 patients ( 60 knees in total ) who had undergone cementless total knee arthroplasty and determined the efficacy of tourniquet release either " before " ( 30 knees ) or " after " ( 30 knees ) wound closure . Measurements of total blood loss showed significant differences between the groups ( " Before " group , 906 + /- 238 mL ; " After " group , 731 + /- 332 mL ; P = .0225 ) . The levels of red blood cells , hemoglobin , and hematocrit recovered to the preoperative levels by 3 months after surgery in both groups . In summary , we recommend that the tourniquet be released after wound closure and that a compressive dressing be applied with the aim of limiting or reducing perioperative blood loss without significant effects of the transfer requirement in the 2 groups , provided that tourniquet time is kept below 60 minutes to avoid ill effects of the tourniquet The purpose of this study was to evaluate the use of a  navigation device  in a cohort of 42 total knee arthroplasties ( TKA ) . The patients were r and omised into two groups . Total knee arthroplasties performed using the conventional technique formed the control group ( 21 knees ) ; the experimental group included 21 knees performed with the aid of a computed navigation system .  Postoperative mean values for the various measurements showed no significant difference in component alignment . However , the range of individual measurements for coronal and sagittal plane positioning was smaller in the navigated group , in which there were no outliers . Rotational alignment was not different between the two groups . This confirms the advantages and limitations of navigated TKA presented in larger studies Abstract Limitation in daily physical activity is one of the reasons for total hip arthroplasty ( THA ) or total knee arthroplasty ( TKA ) . However , studies of the effects of THA or TKA generally do not determine actual daily activity as part of physical functioning . We determined the effect of THA or TKA on patients ’ actual physical activity and body function ( pain , stiffness ) , capacity to perform tasks , and self-reported physical functioning . We also assessed whether there are differences in the effect of the surgery between patients undergoing THA or TKA  and whether the improvements vary between these different outcome measures . We recruited patients with long-st and ing end-stage osteoarthritis of the hip or knee awaiting THA or TKA .  Measurements were performed before surgery and 3 and 6 months after surgery . Actual physical activity improved by 0.7 % . Patients ’ body function , capacity , and self-reported physical functioning also improved . The effects of the surgery on these aspects of physical functioning were similar for THA and TKA . The effect on actual physical activity ( 8 % ) was smaller than on body function ( 80%–167 % ) , capacity ( 19%–36 % ) , and self-reported physical functioning ( 87%–112 % ) . Therefore , in contrast to the large effect on pain and stiffness , patients ’ capacity , and their self-reported physical functioning , the improvement in actual physical activity of our patients was less than expected 6 months after surgery . Level of Evidence : Level I , prospect i ve study . See the Guidelines for Authors for a complete description of levels of evidence
Implant survivorship for cementless TKA was comparable to the current gold st and ard cemented TKAs
Cementless  total knee arthroplasty ( TKA )  has had limited use in the United States , however , recent reports have demonstrated promising results , but there has been no meta- analysis to examine these outcomes in the past 5 years .