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Abstract: The results of 24 modular Genesis II (Smith & Nephew, Memphis, TN, USA) total knee arthroplasties, performed in 20 patients with haemophilia were prospectively reviewed. The hypothesis that the use of a new-generation implant and advanced, more aggressive hematological care, will result in a decrease rate of complications and better functional results for the haemophilic patients with TKA was tested. The mean age at the time of surgery was 36 years (25 to 44). All the patients were reviewed clinically and radiologically with an average follow-up of 4.4 years (2 to 7 years). At the final follow-up the knee score improved from an average of 23 points (11 to 45) to 86 points (62 to 100; p <0.001). The mean knee flexion contracture improved from 22° (0° to 45°) to 3° (0° to 10°; p <0.0001). The mean total flexion arc improved from 69° (5° to 130°) to 92° (80° to 145° p <0.001). The results of our study confirm that the introduction of modular design may improve the functional results of TKA in haemophilic arthropathy which results in a better range of motion and lower flexion contracture. [Copyright &y& Elsevier]

Background: Although predictable implant longevity in total knee replacement (TKR) is now established, work continues to satisfy the demands of patients who seek full restoration of the painless function of the native knee following TKR. This prospective study examines the early clinical outcomes of 156 patients implanted with a novel 'kinematic-retaining' (KR) implant., Methods: 156 Physica KR TKRs were implanted for primary osteoarthritis at three European centres. Patients were reviewed up to two years using radiographic, clinical and functional evaluations., Results: Of the 137 patients retained at two years' follow up, none had been revised. Within 6 post-operative months, 51.7% and 79.9% had excellent clinical and functional KSS values respectively, increasing to 81.8% and 88.3% beyond two years. Mean KSS improvement was 34.8 (from 48.6 to 83.4). All KOOS sub-scores improved significantly with total KOOS improving from a mean of 35.5 (SD ±13.0) to 86.5 (±13.7) at two years post-operatively. Pain and sports KOOS sub-scores improved rapidly during the early post-operative periods, with sustained improvements beyond this. Mean OKS improved by 44.1 (±5.1) at two years. VAS satisfaction scores improved significantly at all time points beyond six weeks. Mean FJS-12 was 75.7 at two years, with no significant effects of age or gender. No progressive adverse radiographic features were noted., Conclusions: Early clinical and radiographic outcomes of this kinematic-retaining knee prosthesis are promising, with improvements in clinical parameters similar to, or exceeding those published in other contemporary TKR designs., Level of Evidence: II, Multicentre Prospective cohort study., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Oxidized zirconium (OxZr) has demonstrated excellent mechanical properties in vitro when used against articular cartilage; less coefficient of friction and less chondral damage have been found when compared with cobalt-chromium (CoCr) implants. However, controversy exists as to whether implants with a zirconium femoral component articulate safely with a native patella in total knee arthroplasty (TKA). To answer this question, the clinical and radiographic results were analysed from a group of patients who underwent a TKA with patella retention; the OxZr versus CoCr femoral components were compared., Methods: The present study prospectively evaluated 83 knees of 74 patients from 2009 to 2010. Each patient was evaluated clinically (visual analogue scale, Knee Society score, patellar score) and radiographically (long leg standing radiograph, anterior-posterior and latero-lateral projections, axial view of the patella) pre-operatively and postoperatively with a mean follow-up of 4.47years. The patellar tilt and shift, and progression of patellofemoral osteoarthritis were calculated with the axial view., Results: There were no patient reported adverse reactions and none of the evaluated prostheses failed. Both the clinical and radiographic evaluations showed no statistically significant between-group differences., Conclusion: No adverse events were observed clinically or radiologically. These results justify pursuing the use of oxidized zirconium as an alternative bearing surface for a femoral component associated with patellar retention in TKA., (Published by Elsevier B.V.)

Background: New bearing surfaces for total knee replacement have been described in an attempt to reduce polyethylene wear and secondary osteolysis and improve longevity of implants. Oxidized zirconium is a new material that combines the strength of a metal with the wear properties of a ceramic. However, there are no reports as to who documents the long term results. We report a 10 year follow-up note of a selected series of TKAs with an oxidized zirconium femoral component., Methods: We prospectively follow 98 TKAs performed in 94 patients with an oxidized zirconium femoral component. Five patients (5 knees) had died and 6 (6 knees) were lost to follow-up at a minimum of 2 years (mean, 6.3 years; range, 2-9 years) after the operation. For the remaining 83 patients (87 knees), the minimum follow-up was 10 years (mean, 11.3 years; range, 10.0-12.6 years). In 51 cases (58.6%), a cruciate-retaining implant with a deep-dished, more conforming PE was used, and in 36 cases (41.4%), a posterior-stabilized design was used. The patellae were resurfaced in 32 cases (36.7%) and in 55 cases (63.3%) were left unresurfaced., Results: Survivorship was 97.8% at 10 years postoperatively. Two knees were revised for aseptic loosening of the femoral component. No major complication was observed clinically or radiologically. Mean Knee Society score improved from 36 to 84 and functional score from 37 to 83., Conclusions: Oxidized zirconium femoral component in TKA performs well over the first 10 years following implantation, with excellent survival rates and good clinical and radiological outcomes., Level of Evidence: Level IV, therapeutic study., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Elevation of the joint line frequently occurs in revision total knee arthroplasty (RTKA) because of a wider flexion space than extension space. One solution to balance this flexion-extension space involves the introduction of couplers between the stem and femoral components, and the use of posteriorly offset femoral stems that we hypothesized would improve gap balancing and facilitate joint line restoration., Methods: We retrospectively reviewed a selected series of 43 RTKA. Postoperative joint line height was subtracted from intended height using postoperative lateral radiographs. The value was negative if the joint line position was lowered, and positive if raised., Results: Forty knees were followed for a mean of 3.5years. Mean postoperative joint line position change from intended position was 1.5mm (range -2.5-7.5mm). In 28 knees (70%), the joint line position was restored to within ±2mm of the intended position; in eight knees (20%), from 2-4mm; and in four knees (10%), >4mm. Joint line position was raised in 32 knees (80%) and lowered in eight (20%). In the offset stem knees, the intended joint line position was 0.9mm (range -1.2-3.4mm) as compared with 3.2mm (range -2.5-7.5mm) for the straight stem knees., Conclusions: A coupler system between the femoral stem and femoral component restored the joint line in 70% of cases. The posterior offset stem provided increased posterior condylar offset, addressed the wider flexion space, provided better positioning of the stem, and restored the joint line., Level of Evidence: Therapeutic Study Level IV., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Introduction: Haemophilic arthropathy is the most common clinical manifestation of haemophilia, secondary to recurrent haemarthrosis and chronic synovitis, and the knee represents the main target joint. Modern bleeding prevention has significatively limited the incidence of severe arthropathy, and primary approach is usually conservative. Viscosupplementation is felt as one of the most efficient treatments for the early stages of knee haemophilic arthropathy, based on short-term follow-up studies. The aim of this prospective case series study is to assess the clinical effectiveness of intra-articular administration of hyaluronic acid in the knee, evaluating long-term results, and focusing on the necessity of further treatments after viscosupplementation., Methods: Twenty-seven haemophilic patients with knee arthropathy underwent at least two cycles of injections of hyaluronians between 2003 and 2009. They were evaluated with VAS, SF-36, WFH, Pettersson score, and WOMAC, with a seven-year follow-up., Results: All patients showed improvement in pain relief and functional recovery without any complications. Considering the severity of arthropathy in haemophilic patients, only a limited number of subjects (five) underwent total knee arthroplasty for persistent pain or functional limitation., Conclusions: Viscosupplementation is a safe and effective therapeutic strategy in knee haemophilic arthropathy, with no complications, persisting good clinical results, and determining in most cases a delay of surgery., (Copyright © 2012 Elsevier B.V. All rights reserved.)