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Background: Although high tibial osteotomy (HTO) has emerged as a powerful intervention for treating symptomatic medial osteoarthritis and varus malalignment, it can result in an increase in knee joint line obliquity (KJLO) in the frontal plane. Limited current evidence hinders understanding of the effect of increased KJLO on HTO survivorship. Purpose: To investigate the influence of KJLO and other potential risk factors on the survivorship of lateral closing-wedge HTO. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with symptomatic medial knee osteoarthritis and varus malalignment treated with lateral closing-wedge HTO at a single hospital were screened with a minimum follow-up of 5 years. HTO survival rate was assessed using Kaplan-Meier survival analysis. The influence of postoperative increased KJLO (medial proximal tibial angle ≥95°), age (≥55 years), sex (female), preoperative malalignment (hip-knee-ankle angle ≥10° of varus), postoperative untargeted alignment (hip-knee-ankle angle <2° or >6° of valgus), and preoperative osteoarthritis severity (Kellgren-Lawrence grade ≥3) on survivorship of HTO was evaluated using Cox regression analysis. A failure of HTO was defined as a conversion to total knee arthroplasty (TKA). Results: A total of 410 patients (463 knees) were included, with a mean follow-up of 13.0 years (range, 5.0-18.1 years) and a mean survival time of 11.2 years (range, 1.2-18.1 years) for patients who reached the endpoint of TKA. HTO survival rates at 5, 10, and 15 years postoperatively were 91%, 78%, and 60%, respectively. Multivariate Cox regression analysis showed no significant difference in survivorship between patients with increased KJLO and those with acceptable KJLO (178 vs 285 knees; hazard ratio [HR], 0.8; 95% CI, 0.6-1.1; P =.148), with no significant between-group difference observed in the mean follow-up length (12.9 ± 3.0 years vs 13.1 ± 3.3 years; P =.105). Female sex (HR, 2.0; P <.001) and postoperative untargeted alignment (HR, 1.6; P =.003) were risk factors for a conversion to TKA. Conclusion: Increased postoperative KJLO (medial proximal tibial angle ≥95°) had no significant influence on the survivorship of lateral closing-wedge HTO. Men demonstrated superior survival outcomes compared with women, and it was important to achieve a targeted postoperative alignment (HKA 2°-6° of valgus) to ensure favorable HTO survivorship. [ABSTRACT FROM AUTHOR]

BACKGROUND: Given the increasing numbers of young patients with knee osteoarthritis there is a need for treatments that can postpone a joint prosthesis (total knee replacement). OBJECTIVE: As an alternative to the effective yet invasive knee joint distraction procedure, a knee orthosis was developed aiming to unload the affected knee and improving synovial fluid flow. The aim of this study was to examine the effectiveness of using a load-reducing orthosis for two months on functioning, pain, and disease progression (e.g. amount of damaged cartilage) in patients with symptomatic osteoarthritis of the knee for at least one year. METHODS: This is an interventional single-center pilot study. Ten patients with symptomatic osteoarthritis of one knee (5 males/5 females; median age 57; age range 42–59) used a custom-made orthosis for 60 days during daily life activities that involved knee loading (e.g. standing, walking, but not during stair climbing). Cycling was not allowed. Clinical outcomes were assessed up to 24 months after intervention at 6 timepoints using patient reported-outcome measures Western Ontario and McMaster Universities Osteoarthritis (WOMAC) range 0–100; Visual Analogue Scale (VAS), range 0–100 for pain. Minimum joint space width (mJSW) was assessed using knee images digital analysis (KIDA) and articular cartilage volume with magnetic resonance imaging (MRI) using custom software at baseline and at 12 and 24 months follow-up. RESULTS: Clinically beneficial effects were found for functioning (WOMAC improvement compared to baseline ranged between 18 points at 3 months follow-up and 31 points at 12 months follow-up, with only the 24-months follow-up (improvement of 27 points) not reaching statistical significance (p < 0.05)) and for pain (VAS improvement compared to baseline at follow-up time points ranged between 41–56 points; all p < 0.05). No improvements in mJSW- or MRI-derived parameters were found. CONCLUSION: This study demonstrates that use of a custom-made knee-unloading orthosis for 60 days can result in improved functional ability and decrease in pain in relatively young patients with knee osteoarthritis. No effect on disease progression could be evidenced. [ABSTRACT FROM AUTHOR]

Background and purpose -- Whether or not to resurface the patella during primary total knee arthroplasty (TKA) remains controversial. We aimed to investigate the association between patellar resurfacing and patient-reported outcome measure (PROM) improvement 1 year postoperatively in terms of physical functioning and pain following TKA. Patients and methods -- We performed an observational study using the Dutch Arthroplasty Register on prospectively collected PROM data (n = 17,224, years 2014-2019). Preoperative and 1-year PROM pain scores (NRS at rest; during activity) and physical functioning scores (KOOS-PS, OKS) were examined. Stratification was performed for cruciate-retaining (CR) and posterior-stabilized (PS) and for the 4 most frequently used TKA implants in the Netherlands (Nexgen, Genesis II, PFC/Sigma, Vanguard) using multivariable linear regression adjusting for age, ASA classification, preoperative general health (EQ VAS), and preoperative PROMs. Results -- 4,525 resurfaced and 12,699 unresurfaced patellae in TKA were analyzed. Overall, no significant difference in 1-year PROM improvement was found between the 2 groups. In CR TKAs, resurfacing resulted in less improvement in KOOS-PS and OKS (adjusted difference between groups (B) -1.68, 95% confidence interval (CI) -2.86 to -0.50 and B -0.94, CI -1.57 to -0.31. Fewer improvements for patellar resurfacing in TKA were found for the Genesis TKA on NRS pain at rest (B -0.23, CI-0.40 to -0.06) and Oxford knee score (B -1.61, CI -2.24 to -0.98). Conclusion -- No significant differences were found in 1-year improvement of physical functioning and pain between TKA with resurfaced and unresurfaced patellae. [ABSTRACT FROM AUTHOR]

Total knee arthroplasty is increasingly performed on working-age individuals, but little is known about their recovery process. Therefore this study examined recovery courses of physical and mental impairments, activity limitations and participation restrictions among working-age total knee arthroplasty recipients. Associated sociodemographic and health-related factors were also evaluated. A prospective study among working total knee arthroplasty patients (aged <65 years) (n = 146). Surveys were completed preoperatively and 6 weeks and 3, 6, 12, and 24 months postoperatively. Outcomes represented domains of the International Classification of Functioning, that is, physical impairments (pain, stiffness, vitality), mental impairments (mental health, depressive symptoms), activity limitations (physical functioning), and participation restrictions (social-, work functioning, working hours). Covariates included age, gender, education, home situation, body mass index, and comorbidity. Largest improvements in physical and mental impairments and activity limitations were observed until 3 months postoperatively. Participation in social roles improved early after surgery, and improvements in work participation occurred from 6 to 12 months. Older age, being male and fewer comorbidities were associated with better recovery courses. Working-age total knee arthroplasty patients recover soon from physical and mental impairments, activity limitations, and participation in social roles, but participation at work occurs later. Younger patients, females, and those with musculoskeletal comorbidities appear at risk for suboptimal recovery after total knee arthroplasty. An increasing number of working-age patients are asking for total knee arthroplasty and have high expectations of total knee arthroplasty, in particular, to participate in the workforce again; Recovery after total knee arthroplasty (TKA) does not occur in the short term and is not limited to clinical improvements for working-age TKA recipients only, as an important part of recovery, that is, participation occurs in the long term (>6 months); Closer collaboration between occupational physicians and orthopedic surgeons might result in increased and earlier ability to work full contractual hours; Rehabilitation after TKA should focus on patients with multiple comorbidities, whereby musculoskeletal diseases may even need additional preoperative treatment to optimize outcomes and prevent work disability. [ABSTRACT FROM AUTHOR]

Introduction: Effective rehabilitation after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) is often impeded by pain and swelling. Beneficial short-term effects in terms of pain and opioid use after a short period of cryotherapy (±compression therapy) have been demonstrated. The effectiveness of a longer intervention period on longer-term postoperative outcomes is unclear. This study aims to assess the effects of 6 weeks of cryotherapy plus compression therapy on pain, functioning and patient satisfaction after TKA or UKA., Methods and Analysis: A single-centre, single-blind randomised controlled trial will be conducted at a teaching hospital in the Netherlands. Patients over age 18 with end-stage osteoarthritis planned for a TKA or UKA are eligible; 104 UKA and 104 TKA patients will be included. Both groups will be randomly allocated (1:1) into an intervention group receiving 6 weeks of cryotherapy plus compression therapy (commencing after discharge from hospital) or a control group (usual care). The primary endpoint is perceived pain at rest at 6 weeks postoperatively. Secondary outcomes include compliance with cold protocol, pain at rest during the first six postoperative weeks and at 6 and 12 months postoperatively, pain on weight bearing, opioid use, functioning, patient satisfaction and complications., Ethics and Dissemination: The local medical ethics committee MEC-U approved the study protocol (R22.095/NL-number NL81956.100.22). The study will be conducted in accordance with the Declaration of Helsinki and Good Clinical Practice regulations, and personal data will be handled in agreement with the Dutch Personal Data Protection Act (AGV). Written informed consent will be obtained prior to performing any of the study procedures. We will disseminate study results through multiple peer-reviewed publications and through conference presentations., Trial Registration Number: NCT05572359., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In the case of persistent complaints of instability due to a rupture of the anterior cruciate ligament (ACL), surgical treatment can be opted for, in which reconstruction with a body's own tendon graft (autograft) is the gold standard. New information has created renewed interest in the primary repair of an ACL rupture. Potential advantages of repair of the ACL rupture compared with a reconstruction are the restoration of the complex natural anatomy including the proprioception of the native ACL, and no donor site morbidity. Biomechanical studies show that when suturing an ACL rupture, intra-articular augmentation is important to protect the repaired ACL during healing. Given the results of randomized studies comparing the ACL suture technique including augmentation with the ACL reconstruction, it can be concluded that the nowadays used suture technique in combination with an augmentation could be an alternative treatment to the current gold standard, the ACL reconstruction.