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The number of revision total knee arthroplasty (TKA) surgeries has increased over the years and it is expected that its number will keep rising. Most frequent reasons for revision are known to be aseptic loosening, infection, instability, periprosthetic frac- ture, arthrofibrosis and component malposition. The influence of the indication for revision on the outcome scores is not fully understood. Therefore, this work will evaluate and review the existing literature regarding outcome scores after revision TKA surgery. We conducted a sensitive and comprehensive search for published and unpublished studies relevant to the review question. We restricted our search to English studies published between January 2008 and December 2018. Our systematic review was done according to PRISMA guidelines. We withheld 19 studies (1419 knees) for inclusion. Of these, 9 papers reported outcome scores after TKA revision for aseptic loosening, 10 reported on revision for instability, 10 reported on stiffness or arthrofibrosis and 4 papers reported on component malposition. Although we found some papers suggesting that there is no difference in postoperative outcome scores depending on the aetiology of revision surgery, the majority of the included studies suggest differently. This review suggests there is a tendency for relative higher outcome scores after revision for aseptic loosening. Revision for malrotation might give comparable postoperative outcome scores and satisfaction ratios. Revision for instability tends to give lower postoperative outcome scores than aseptic loosening, although certain subgroups of instability show comparable results. Lowest postoperative scores might be found after revision for stiffness and arthrofibrosis.

Osteoarthritis of the knee causes chronic knee pain, loss of function and disability in the ageing population. When no treatment is applied, a guaranteed onset of symptoms and/or structural damage can be observed in the diseased knee. This work reviewed the different published guidelines, proposing combinations of weight reduction, physical therapy and rehabilitation, self-management education programs and pharmacological treatment. Randomized clinical trials, systematic reviews and guidelines were identified using the databases PubMed and Web of Science. Specific journals and reference lists were investigated. Sixty high quality articles were included concerning the conservative treatment of knee osteoarthritis. Weight loss when BMI > 28kg/m 2 ; aerobic, proprioception and strengthening training; NSAIDs (ibuprofen, diclofenac, aceclofenac), IA corticosteroid and IA hyaluronic acid has the highest evidence. To achieve the greatest positive clinical and structural outcome, a combined conservative therapy is recommended.

It has been reported that balance impairments and asymmetrical movement patterns occur in patients after total kne arthroplasty (TKA). The purpose of this study was to evaluate if force- and weight-bearing asymmetry correlate with patient-reported outcomes (PROMs). Twenty patients were prospectively analysed up to 6 months after TKA. Quadriceps- and hamstring force were measured using a hand-held dynamometer. Vertical ground reaction forces during sit-to-stand, stair descending and squatting were assessed by force plates. Patients were asked to complete the KOOS, OKS and 2011 KSS. The symmetry-ratios during sit-to-stand, squat and stair-descent improved significantly. Preopera-tive quadriceps-force was positively correlated with KOOS-Symptoms (r=0.583, p=0.037). The pre-operative load-symmetry ratio during STS was negatively correlated with improvement in KOOS Pain (r=-0.675, p=0.011) and Symptoms (r=-0.674, p=0.008). In deep flexion, preoperative bodyweight ratio was positively correlated with postoperative OKS (r=0.601, p=0.039), KSS-Satisfaction (r=0.675, p=0.011) and improvement in KSS-Satisfaction (r=0.684, p=0.029). Weight bearing and force asymmetry do exist before TKA and take up to at least 6-months to fully recover. The more symmetry in muscle-force and weight-bearing is found preoperatively, the better the PROMs will be at 6 months after surgery.

We conducted a multivariate regression analysis (including both radiographic and activity related variables) in patients with osteoarthritis of the hip and structural changes related with femoroacetabular impingement. The purpose of this study was to investigate whether the age at which total hip arthroplasty may have to be performed, can be predicted in patients with femoroacetabular impingement (FAI). In 121 patients with FAI-related osteoarthritis, radiographic variables describing FAI-related parameters were obtained and the patients were questioned about their activity during early adulthood by means of the validated Baecke et al questionnaire. None of the variables significantly correlated with the final outcome parameter : age at surgery. As expected, based on the low correlation ratios of the different parameters investigated, a multiple-regression model was not accurate enough to allow any prediction on the natural course of FAI. We found that it is difficult to accurately predict the age at which a patient with FAI will develop early osteoarthritis. From our findings it appears that a hip with FAI is not always prone to early end-stage osteoarthritic degeneration, not even in patients with a high level of physical activity. Hence, considering the high prevalence of FAI-related radiographic findings, we conclude that not every radiographic abnormality requires treatment.