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Background: While the effectiveness of patient-reported outcome measures (PROMs) as an intervention to impact patient pathways has been established for cancer care, it is unknown for other indications. We assessed the cost-effectiveness of a PROM-based monitoring and alert intervention for early detection of critical recovery paths following hip and knee replacement., Methods and Findings: The cost-effectiveness analysis (CEA) is based on a multicentre randomised controlled trial encompassing 3,697 patients with hip replacement and 3,110 patients with knee replacement enrolled from 2019 to 2020 in 9 German hospitals. The analysis was conducted with a subset of 546 hip and 492 knee replacement cases with longitudinal cost data from 24 statutory health insurances. Patients were randomised 1:1 to a PROM-based remote monitoring and alert intervention or to a standard care group. All patients were assessed at 12-months post-surgery via digitally collected PROMs. Patients within the intervention group were additionally assessed at 1-, 3-, and 6-months post-surgery to be contacted in case of critical recovery paths. For the effect evaluation, a PROM-based composite measure (PRO-CM) was developed, combining changes across various PROMs in a single index ranging from 0 to 100. The PRO-CM included 6 PROMs focused on quality of life and various aspects of physical and mental health. The primary outcome was the incremental cost-effectiveness ratio (ICER). The intervention group showed incremental outcomes of 2.54 units PRO-CM (95% confidence interval (CI) [0.93, 4.14]; p = 0.002) for patients with hip and 0.87 (95% CI [-0.94, 2.67]; p = 0.347) for patients with knee replacement. Within the 12-months post-surgery period the intervention group had less costs of 376.43€ (95% CI [-639.74, -113.12]; p = 0.005) in patients with hip, and 375.50€ (95% CI [-767.40, 16.39]; p = 0.060) in patients with knee replacement, revealing a dominant ICER for both procedures. However, it remains unclear which step of the multistage intervention contributes most to the positive effect., Conclusions: The intervention significantly improved patient outcomes at lower costs in patients with hip replacements when compared with standard care. Further it showed a nonsignificant cost reduction in knee replacement patients. This reinforces the notion that PROMs can be utilised as a cost-effective instrument for remote monitoring in standard care settings., Trial Registration: Registration: German Register for Clinical Studies (DRKS) under DRKS00019916., Competing Interests: The project was funded by the Innovation Fund of the of Joint Federal Committee Germany (01NVF18016). Project funding was paid to the consortium institutions and covered the employment positions of LS, VS, LW, BL and CP. CP reports a salaried position with MedTech company Stryker that is separate and independent from his university research employment and position. FC reports an employment relation with Heartbeat Medical Solutions GmBH. GM reports receiving royalties or contracts, grants, consulting fees, payments for lectures and leadership in other boards, all outside the submitted work. RB reports being member of the government commission on modern and needs-based hospital care, outside the submitted work. DS reports receiving payments for lectures from Zimmer Biomet outside the submitted work. All other authors declare no competing interests., (Copyright: © 2024 Schöner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: This retrospective study aimed to assess the effects of two differing revision total knee implants designs (condylar and rotating hinge) on joint line height., Method: The use of distal augmentation and pre and post revision radiographic joint line heights were compared in 19 condylar type knee replacements (Zimmer NexGen Legacy Constrained Condylar Knee - LCCK) and 40 LINK-Endo-rotating hinge knee replacements. Joint line and patellar heights were determined for each implant using four validated methods. For comparison within a group a two tailed paired Student's t-test was used, for comparison between the groups an unpaired, two tailed Student's t-test was used. A p value of less than 0.05 was deemed statistically significant., Results: In 15 of 19 NexGen revision knee replacements distal augments were used. No distal augments were used in the LINK-Endo RHK group. In both systems there was no tendency to elevate the joint line relative to the tibia. The joint line was distalised relative to the femur in the NexGen group and proximalised in the rotating hinge knee group. Measurements using antero-posterior radiographs were found to be the most reliable method of assessing joint line height when compared to lateral radiographs., Conclusion: Both revision knee implant systems adequately restored joint line height. In condylar type knee revision implants elevation of the joint line height may be avoided through the use of distal augmentation. We found AP radiographs to be the most reliable method of accurately assessing joint line height., Competing Interests: 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., (© 2023 Delhi Orthopedic Association. All rights reserved.)

Importance: Although remote patient-reported outcome measure (PROM) monitoring has shown promising results in cancer care, there is a lack of research on PROM monitoring in orthopedics., Objective: To determine whether PROM monitoring can improve health outcomes for patients with joint replacement compared with the standard of care., Design, Setting, and Participants: A 2-group, patient-level randomized clinical trial (PROMoting Quality) across 9 German hospitals recruited patients aged 18 years or older with primary hip or knee replacement from October 1, 2019, to December 31, 2020, with follow-up until March 31, 2022., Interventions: Intervention and control groups received the standard of care and PROMs at hospital admission, discharge, and 12 months after surgery. In addition, the intervention group received PROMs at 1, 3, and 6 months after surgery. Based on prespecified PROM score thresholds, at these times, an automated alert signaled critical recovery paths to hospital study nurses. On notification, study nurses contacted patients and referred them to their physicians if necessary., Main Outcomes and Measures: The prespecified outcomes were the mean change in PROM scores (European Quality of Life 5-Dimension 5-Level version [EQ-5D-5L; range, -0.661 to 1.0, with higher values indicating higher levels of health-related quality of life (HRQOL)], European Quality of Life Visual Analogue Scale [EQ-VAS; range, 0-100, with higher values indicating higher levels of HRQOL], Hip Disability and Osteoarthritis Outcome Score-Physical Function Shortform [HOOS-PS; range, 0-100, with lower values indicating lower physical impairment] or Knee Injury and Osteoarthritis Outcome Score-Physical Function Shortform [KOOS-PS; range, 0-100, with lower values indicating lower physical impairment], Patient-Reported Outcomes Measurement Information System [PROMIS]-fatigue [range, 33.7-75.8, with lower values indicating lower levels of fatigue], and PROMIS-depression [range, 41-79.4, with lower values indicating lower levels of depression]) from baseline to 12 months after surgery. Analysis was on an intention-to-treat basis., Results: The study included 3697 patients with hip replacement (mean [SD] age, 65.8 [10.6] years; 2065 women [55.9%]) and 3110 patients with knee replacement (mean [SD] age, 66.0 [9.2] years; 1669 women [53.7%]). Exploratory analyses showed significantly better health outcomes in the intervention group on all PROMs except the EQ-5D-5L among patients with hip replacement, with a 2.10-point increase on the EQ-VAS in the intervention group compared with the control group (HOOS-PS, -1.86 points; PROMIS-fatigue, -0.69 points; PROMIS-depression, -0.57 points). Patients in the intervention group with knee replacement had a 1.24-point increase on the EQ-VAS, as well as significantly better scores on the KOOS-PS (-0.99 points) and PROMIS-fatigue (-0.84 points) compared with the control group. Mixed-effect models showed a significant difference in improvement on the EQ-VAS (hip replacement: effect estimate [EE], 1.66 [95% CI, 0.58-2.74]; knee replacement: EE, 1.71 [95% CI, 0.53-2.90]) and PROMIS-fatigue (hip replacement: EE, -0.65 [95% CI, -1.12 to -0.18]; knee replacement: EE, -0.71 [95% CI, -1.23 to -0.20]). The PROMIS-depression score was significantly reduced in the hip replacement group (EE, -0.60 [95% CI, -1.01 to -0.18])., Conclusions and Relevance: In this randomized clinical trial, the PROM-based monitoring intervention led to a small improvement in HRQOL and fatigue among patients with hip or knee replacement, as well as in depression among patients with hip replacement., Trial Registration: Deutsches Register Klinischer Studien ID: DRKS00019916.

Despite considerable research efforts, the influence of contact line tension during wetting at the nanoscale and its experimental determination remain challenging tasks. So far, molecular dynamics simulations and atomic force microscope measurements have contributed to the understanding of these phenomena. However, a direct measurement of the size dependence of the contact angle and the magnitude of the apparent line tension has not been realized so far. Here, we show that the contact angle is indeed dependent on the drop size for small drop diameters and determine the magnitude of the apparent line tension via liquid-metal based measurements of advancing and receding contact angle inside a scanning electron microscope. For this purpose, a robotic setup inside an electron microscope chamber and oxide-free Galinstan droplets-produced via an electromigration-based and focused ion beam irradiation-assisted process-are employed. Using the first-order correction of Young's equation, we find an apparent line tension value of 4.02 × 10 -7 J/m for Galinstan© on stainless steel.

Background: The use of hinged designs is usually reserved for severe deformities or instability in contemporary total knee arthroplasty (TKA). Results have been mixed with some authors reporting relatively high incidences of complications. The aim of this study is to present the results of primary TKA performed with a hinged prosthesis with a minimum 10-year follow-up. We also examined the factors that influence survivorship of this prosthesis., Methods: A total of 238 primary TKA procedures were performed using hinged prostheses. Indications included osteoarthritis, rheumatoid arthritis, posttraumatic deformity, and arthritis. Clinical outcomes were assessed using the Hospital for Special Surgery score. Radiologic assessment was performed at each follow-up. Survivorship was calculated based on the Kaplan-Meier method. All complications were documented., Results: Mean follow-up was 13.5 years (standard deviation [SD], 3.4). Mean flexion at final review was 118° (SD, 20°). Fifty-four percent and 20% reported excellent and good functional scores, respectively. Survivorship was 94% at 13.5 years in patients over 60 years of age and 77% in patients less than 60 years of age. Survivorship in patients with preoperative varus deformity was 96% and that in valgus knees was 79%., Conclusions: The results of this study suggest that when rotating hinges are used for primary TKA, the best results are achieved in patients over 60 years old. The indications for this design in the setting of primary TKA include significant deformities, severe bone loss, and ligamentous laxity., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2020 by The Korean Orthopaedic Association.)

van der Waals forces, electrostatic interactions, and capillary forces are the dominant force interactions at the micro- and nanoscale. This complex ensemble of surface forces is oftentimes summarized as adhesion and is important for various applications and research fields. So far, numerous measurement techniques have evolved in this field. However, there is still a lack of experimental insight into the complex interplay of van der Waals, electrostatic, and capillary forces for small force ranges below 10 nN, as this is the order of magnitude of the latter, which can shadow other interactions in ambient and even inert gas environments. To exclude capillary forces and thus to turn the van der Waals and electrostatic forces into the most significant interactions, we develop an interferometric force spectroscopy setup based on a scanning probe technique, featuring a sub-nanonewton resolution, and integrate it into the vacuum chamber of a scanning electron microscope. In this work, we describe the setup integration, show the long-term drift behavior and resolution capabilities, and conduct first measurements of adhesion energies between a silica colloidal probe and a silicon substrate. The presented setup shows its capability to reliably measure adhesive interactions in vacuum and an ambient environment with a sub-nanonewton resolution proving its potential to allow for the investigation of the separate contribution of capillary, van der Waals, and electrostatic interactions to adhesion and for a systematic experimental validation of the established adhesion theories and approximations on the micro- and nanoscale.

The focused ion beam (FIB) has proven to be an extremely powerful tool for the nanometer-scale machining and patterning of nanostructures. In this work, we experimentally study the behavior of AISI 420 martensitic stainless steel when bombarded by Ga + ions in a FIB system. The results show the formation of nanometer sized spiky structures. Utilizing the nanospiking effect, we fabricated a single-tip needle with a measured 15.15 nanometer curvature radius and a microneedle with a nanometer sized spiky surface. The nanospikes can be made straight or angled, depending on the incident angle between the sample and the beam. We also show that the nanospiking effect is present in ferritic AISI 430 stainless steel. The weak occurrence of the nanospiking effect in between nano-rough regions (nano-cliffs) was also witnessed for austenitic AISI 316 and martensitic AISI 431 stainless steel samples.

There still is no consensus on the treatment of choice in revision knee arthroplasty associated with severe femoral and/or tibial bone loss. A total of 44 patients underwent revision knee arthroplasty procedures using porous tantalum cones (TM cones) to reconstruct tibial and/or femoral bone defects. At latest follow up after 37 months (32-48), 38 patients remained in the study. Tibial and femoral bone loss was categorized according to the AORI-Classification. The average preoperative KSS improved from 34 (range, 6-90) to 63 points (range, 7-90 points). The VAS improved from 7.5 to 4.8. Two patients required a re-revision due to aseptic loosening. There was no correlation between the different types of knee prosthesis implanted. Our study shows favourable clinical and radiological outcomes using TM cones in managing significant bone loss in revision total knee surgery., (Copyright © 2013. Published by Elsevier Inc.)

Introduction: Total ankle arthroplasty is increasingly used as an alternative to arthrodesis to treat advanced ankle arthritis. However, the outcomes and postoperative complications are poorly described., Patients and Methods: Between March 2005 and May 2010 114 S.T.A.R. prostheses were implanted by one surgeon at our institution. We retrospectively analysed the demographics, clinical outcomes and radiographic characteristics of 100 ankle prostheses (97 patients)., Results: The average follow up was 36 months. The average preoperative AOFAS score of 36.87 (22-58) significantly increased to 75.99 postoperative. A total of 87 % of the patients reported a better life quality. Twenty-seven ankles incurred complications after primary surgery, and 21 prostheses required revision surgery, including four patients who required arthrodesis., Conclusion: Our study shows a high satisfaction rate after total ankle replacement and clear pain relief. Patients with a body mass Index higher than 30 showed a higher rate of complications. Compared with ankle fusion, the rates of complications are comparable.

Complete knee dislocation is a rare and severe injury and usually follows high-energy trauma. Non-traumatic knee dislocations are exceedingly rare, while severe overweight appears to be the main cause of the knee dislocation. We here report on a spontaneous knee dislocation in a patient with severe osteoarthritis of the left knee. A 68-year-old woman was admitted to our hospital for an elective total knee replacement. One year prior to admission, a planned joint replacement was not performed due to an existing ulcus cruris. After healing of the ulcus cruris, the patient presented with progressive pain and instability of the left knee without any trauma. The clinical examination showed a multidirectional instability of the left knee with a restricted range of motion (ROM) with 0-0-40 degrees for extension and flexion. The performed radiological examination revealed an anterior knee dislocation of the left knee. Intraoperative findings suggest a non-traumatic aetiology. We suspect that osteoarthritis of the left knee has caused the dislocation. Therefore, we recommend, even in usually "harmless" osteoarthritis, close clinical and radiological follow-up examinations to detect and treat possible complications., (Georg Thieme Verlag KG Stuttgart · New York.)

We report a single-surgeon experience with a noncemented modular revision shaft (Modular Prosthesis; LINK, Hamburg, Germany) with clinical and radiographic results of 63 patients after 10 years. The Harris Hip Score improved from 51 to 84 points. Intraoperative complications included 11 fractures. Four patients had postoperative femoral fractures. Further shaft revisions were necessary: 1 subsidence, 1 late fracture, 1 late deep infection. Sixty-eight percent of cases showed revision defects as graded 3° by Mallory; 95 % did not show signs of loosening or subsidence; 38 patients showed adequate bone remodeling in the shaft and proximal femur; 21 patients showed excellent recovery of preoperative osteolytic areas, and 5 patients did not show signs of remodeling. The Modular Prosthesis stem shows adequate fixation and tendency toward satisfactory bone remodeling after 10 years., (Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.)

Background: Total knee arthroplasty (TKA) revisions are increasing due to the rising numbers of primary cases, younger patients and an aging population. The technical demand of these procedures is incomparable higher than in primary cases. Also the expectable clinical results are inferior. Measures to improve the clinical results are desireable. PATIENTS/MATERIAL: 203 unconstrained knee arthroplasties were explanted in 2009 in a single centre. In 150 cases those were TKAs. Fractures were excluded. These cases were analysed with special attention to the reason for the failure. Clinical and radiological data were included., Results: Survival of revised implants was in the mean 55 months (range: 0,5-125 months). In 46 cases components showed an aseptic loosening (30.7 %), 37 TKAs were unstable (24.7 %), in 26 cases stiffness was detected (17.3 %), and nine misplaced TKA components (five femoral, two tibial, two combined; total 6 %) as well as three broken inlays (2 %) were encountered. In 25 cases deep infection was observed (16.7 %) and four patients complained of an unspecific anterior knee pain (2.6 %). Three TKAs were removed for a two-staged procedure. In five cases an inlay exchange was performed and in another five cases a conversion from cruciate retaining to posterior stabilised state was performed. In 60 cases a rotating hinged TKA was implanted (40 %) and in 42 a pure hinge (28 %). In 45 cases a condylar constrained TKA system (CCK, 30 %) was used. Range of movement increased with the procedure. Plain radiographs were inferior in detecting all loosening in advance., Conclusion: This study demonstrated that in more than one third of the cases the revision could have been avoided and was due to technical errors during the primary procedure. Infection and arthrofibrosis were besides unspecific complaints less often observed than is described in the literature. This study supports the high demand on the technical issues during the primary procedure which should be conducted by experienced surgeons. Registry data from Germany should allow the provision of more specific information in the future., (Georg Thieme Verlag KG Stuttgart · New York.)

Secondary patella resurfacing is a controversial procedure which is applied in patients with anterior knee pain after a bicondylar knee arthroplasty (with unresurfaced patella). A group of 46 patients were submitted to this procedure and their satisfaction, range of motion and pain improvement was evaluated. 52.2% of the patients were satisfied with the procedure, with an improvement in pain (Visual Analogue Scale) of 65% and an improvement in range of motion in 56,5%, with roundabout half of the patients having no resolution to their complaints. Whilst an improvement was not achieved in all patients, as it was initially hypothesised, this procedure should be considered when a revision knee arthroplasty is performed with an unresurfaced patella.

A consecutive series of 100 primary total hip arthroplasties were performed at a single institution on 87 patients using a cementless collared titanium press-fit stem. Of patients, 87% received a hemispheric porous-coated cup, and 13% received a nonmodular titanium fibermesh press-fit cup. Ten hips were excluded from the longer-term evaluation: 6 were lost to follow-up, and 4 patients were deceased. Ninety hips, with an average follow-up of 81 +/- 12 months, were retrospectively reviewed. The average postoperative hip score was 94, compared with an average preoperative hip score of 42. No postoperative infections were observed, but there were 2 cases of postoperative dislocation (2%) and 1 case of thigh pain (1%) at last follow-up. There were 2 revisions, both for cup failures. There were no femoral component loosenings or revisions. There was no evidence of stem subsidence or instability. These midterm results are encouraging with this stem design.