Knee osteoarthritis (KOA) is a common degenerative condition that leads to pain, disability, and reduced quality of life. Medial opening-wedge high tibial osteotomy (MOWHTO) is a surgical procedure designed to correct alignment and alleviate symptoms by redistributing load. While previous studies have focused on the coronal plane, the impact of MOWHTO on sagittal plane biomechanics and trunk posture remains unclear. The purpose of this study was to evaluate 3-dimensional biomechanical changes in the knee joint and trunk posture after MOWHTO. It was hypothesized that MOWHTO would result in significant biomechanical changes not only in the coronal plane but also in the sagittal plane, along with changes in trunk posture. Case series; Level of evidence, 4. This retrospective study included 55 patients (55 knees) with medial compartment KOA (Kellgren-Lawrence grade ≥2) who underwent MOWHTO. Preoperative and postoperative gait analyses were conducted using a 3-dimensional motion capture system and force plates to assess knee joint kinetics and kinematics including trunk posture. Knee joint moments (knee adduction moment [KAM], knee flexion moment [KFM], and knee rotation moment [KRM]) and total joint moment (TJM), along with relative contributions of each moment, were assessed. Radiographic parameters such as hip-knee-ankle (HKA) angle, percentage of mechanical axis (%MA), and femorotibial angle (FTA) were evaluated. Clinical outcomes were assessed using the Japanese Knee Osteoarthritis Measure and Knee Society Score. Paired t tests were performed for statistical analysis between pre- and postoperative results. A P value <.05 was considered statistically significant. Postoperatively, significant reductions in KAM (P < .01) and TJM (P < .001) were observed, with a shift in the proportional contribution from KAM to KFM. KFM remained unchanged pre- and postoperatively. Knee varus angles decreased (P < .01), and trunk flexion angles significantly decreased, indicating better postural alignment (P < .01). Radiographic analysis demonstrated increased HKA angles and %MA, along with reduced FTA (P < .01). Clinical outcomes showed significant pain relief and functional improvement (P < .01). MOWHTO was associated with significant changes in 3-dimensional gait biomechanics, including knee joint moments and trunk posture, highlighting its comprehensive role in restoring functional alignment in patients with medial compartment KOA, although the case series design may limit generalizability.
The direct observation of procedural skills for knee joint mobilization (DOPSknee) tool requires validation to ensure its reliability and validity for providing immediate feedback and assessing its applicability in off-site settings. We aimed to describe the implementation and clinimetric properties of DOPSkneein both on-site and off-site environments and to evaluate the preclinical competencies of physical therapy (PT) students. Following the development of DOPSknee, 42 preclinical PT students were filmed performing knee joint mobilization. Their performance was assessed by two clinical instructors using DOPSknee, in on-site and off-site conditions, with an interval of 1.5-4.5 months between assessments. DOPSknee exhibited good on-site inter-rater reliability (ICC = 0.78). However, it had poor off-site inter-rater reliability (ICC = 0.37) and intra-rater reliability differed substantially between on- and off-site evaluations (evaluator 1: ICC = 0.42; evaluator 2: ICC = 0.88). Nevertheless, DOPSknee exhibited good reliability for average measures from on- and off-site evaluations (ICC = 0.84). Average total DOPSknee scores were significantly correlated with average global rating scores in both on-site (σ = 0.47) and off-site conditions (σ = 0.75), as well as in cross-over conditions (σ = 0.54 and 0.71). The cutoff score for DOPSknee was determined to be 14 points. Construct validity analysis of both on- and off-site evaluations revealed that students who passed the DOPSknee evaluation had significantly higher average global rating scores (p < 0.05). DOPSknee exhibited good validity and reliability for assessing student performance in on‑site conditions, while average measures may improve reliability in off‑site assessments. These findings highlight its potential as a structured procedural assessment tool in physical therapy education.
Studies on the relationships among functional limitations, recurrent falls, and knee osteoarthritis remain limited. This cross-sectional observational study examined the associations among recurrent falls, functional limitations, and knee osteoarthritis and evaluated whether functional limitations mediated the relationship between recurrent falls and knee osteoarthritis. After excluding participants younger than 45 years and those with missing data for core variables and covariates, 2,278 participants from the CHARLS 2015 survey were included in complete-case analysis. Spearman correlation analysis was used to assess the correlations among recurrent falls, functional limitation score, and knee osteoarthritis. Because knee osteoarthritis was treated as a binary outcome, multivariable logistic regression was used to evaluate its association with recurrent falls. Mediation analysis was performed within a bootstrap mediation framework based on a linear mediator model and a logistic outcome model, with recurrent falls as the independent variable, functional limitation score as the mediator, and knee osteoarthritis as the dependent variable. Recurrent falls were significantly associated with higher odds of knee osteoarthritis in the adjusted model. After the functional limitation score was added to the model, recurrent falls remained significantly associated with knee osteoarthritis, and the functional limitation score was also significantly associated with knee osteoarthritis. Bootstrap mediation analysis showed a total effect of 0.093 (95% CI: 0.050-0.138), a direct effect of 0.079 (95% CI: 0.037-0.123), and an indirect effect through functional limitations of 0.014 (95% CI: 0.006-0.023), accounting for 14.92% of the total effect. These findings support a statistically significant mediation pattern in which functional limitations serve as an intermediate factor in the association between recurrent falls and knee osteoarthritis. These results highlight the importance of integrating fall-risk assessment and functional status evaluation into health management for knee osteoarthritis in middle-aged and older adults.
Soft-tissue knee abnormalities are common, yet first-line radiography provides limited soft-tissue contrast, whereas MRI or arthroscopy is more resource-intensive. We developed DeepKneeXR as a single-center, retrospective proof-of-concept AI workflow for generating probability scores for key knee abnormalities from anterior-posterior knee X-rays. This retrospective study included 3,200 adult patients selected from 5,000 initially screened cases at one medical center after predefined exclusions. Reference labels were assigned using a composite clinical-imaging standard based on clinical history, physical examination, MRI findings, and arthroscopy when clinically indicated. A unified YOLOv8 model was trained to perform knee localization and multi-label probability prediction in a single forward pass. The model generated a knee bounding box and probability scores for meniscus tears (MENI), medial collateral ligament injuries (MCL), and joint effusion (EFFU). DeepKneeXR achieved excellent knee localization (mAP@0.5=0.995). Multi-label screening performance was moderate and should be interpreted as preliminary, particularly for EFFU, whose validation AUC was limited. This proof-of-concept study shows that a unified YOLOv8 model can generate knee-localization outputs and abnormality probability scores from AP radiographs. However, prospective multi-center validation, standardized reference labeling, and clinician-facing workflow evaluation are required before clinical use can be considered.
Gustilo type IIIb fractures are severe open injuries often accompanied by extensive soft-tissue damage, bone defects, and joint destruction, posing significant therapeutic challenges. As an emerging technology, 3D printing offers a novel approach to personalized prosthesis design and bone-joint reconstruction. This case report aims to demonstrate the feasibility and clinical outcomes of applying a staged strategy combined with 3D-printed custom implants to such a complex injury. A 31-year-old Asian male sustained a severe open injury to his right lower limb following a traffic accident, presenting with extensive soft-tissue loss, exposed bone, and obvious deformity of the right knee and ankle, accompanied by active bleeding and severe pain. Gustilo type IIIb open injury of the right lower limb; destructive injury of the medial knee joint complex; and open fracture of the right medial malleolus. A multistage treatment strategy was employed: multiple planned debridements combined with vacuum sealing drainage and targeted antimicrobial therapy (e.g., linezolid and amikacin); after infection control, fracture treatment with open reduction, internal fixation, and free skin grafting was performed for the ankle. The exposed bone defect on the medial knee was filled with vancomycin-loaded bone paste and covered with a rectus femoris muscle flap transfer. Definitive joint reconstruction surgery was performed 6 months post-injury. Based on mirrored data from the contralateral healthy limb, joint reconstruction was achieved using a rotating-hinge knee prosthesis, restoring the anatomical structure of the segmental femoral and tibial bone defects and the mechanical stability of the knee joint. The patient recovered well postoperatively, with significant improvement in knee function. The custom augmentation demonstrated close apposition to the host bone with ideal bone healing. Imaging assessment showed satisfactory prosthesis positioning, restored lower-limb alignment and joint-line height, and joint stability, without early prosthesis loosening or other complications. The Hospital for Special Surgery knee score improved from 27 to 83 points, indicating rapid functional rehabilitation. For complex lower-limb trauma with severe bone defects, adhering to the multistage treatment principle combining "damage control" and "functional reconstruction" is crucial. Three-dimensional printing technology enables the customization of prostheses that precisely match individual bone defect morphologies, providing a stable and efficient solution for reconstructing complex bone defects.
Isometric strength testing is an important tool for detecting deficits in injured populations and monitoring strength changes during rehabilitation and training. However, it is unclear whether strength measurements obtained from low-cost, inline force sensors match measurements from large, expensive, lab-based dynamometers. Therefore, the purpose of this study was to investigate agreement in maximum voluntary isometric knee extension torque measurements between a lab-based dynamometer, a low-cost wireless inline force sensor, and a wired inline force sensor. Prospective cross-sectional study. Laboratory. Fourteen healthy adult participants (age >18 years) were recruited from the university community using posters, email, and social media advertisements. Peak isometric knee extension torque was measured for two repetitions at each of three knee angles (90°, 45° and 15°) using a lab-based dynamometer (Humac, CSMI Medical Solutions, USA). Then, all six trials were repeated while simultaneously recording strength using a low-cost wireless inline force sensor (Tindeq, Trondheim, Norway) and a wired inline force sensor wired (MLP, Transducer Techniques, CA, USA). Peak electromyography (EMG) magnitude was recorded for knee extensors and flexors, and electrical stimulation was used to quantify the level of voluntary activation (VA) for knee extensors. Agreement between torque measurement systems was assessed using Pearson's Correlation (r), Interclass Correlation Coefficients (ICC3,1, absolute agreement), Minimum Detectable Change, and Bland-Altman Limits of Agreement (LOA). Additionally, peak torque was compared at each knee angle using a repeated measures ANOVA, and peak EMG outputs were compared using paired t-tests. Fourteen participants completed the study (3 male, 11 female; 26 ± 8.97 years; 1.71 ± 0.11 m; 66.75 ± 15.9 kg). The mean (95% CI) difference in torque between Tindeq and Humac dynamometers was 0.16 Nm/kg (-0.07 to 0.26 Nm/kg) at a knee angle of 15 degrees, -0.02 Nm/kg (-0.19 to 0.14 Nm/kg) at 45 degrees, and -0.10 Nm/kg (-0.32 to 0.13 Nm/kg) at 90 degrees. Bland-Altman LOA were -0.86 to 0.67 Nm/kg at 15 degrees, -0.60 to 0.55 Nm/kg at 45 degrees, and -0.86 to 0.67 Nm/kg at 90 degrees. Bias and LOA were similar for the MLP device. All participants achieved >90% VA. Results were more similar between Tindeq and MLP inline force sensors (r = 1.0, ICC3,1 = 0.94-1.00) than between inline force sensors and the Humac device (r <0.81, ICC3,1 = 0.37-0.80). Although sample size was small and only a single testing session was performed, the Tindeq device showed small measurement bias, underestimating the Humac torque by less than 0.1 Nm at 45 and 90 degrees. However, relatively large LOA indicated that individual measurement errors could exceed 25%. Low-cost wireless force sensors (e.g. Tindeq) show promise for clinical use, but individual measurements should be interpreted with caution. 2 (measurement agreement and validity study).
 Unicompartmental knee arthroplasty (UKA) is advocated to achieve greater satisfaction and improved function when compared with total knee arthroplasty (TKA), but there is little evidence from large-scale cohorts to support this contention. We aimed to determine, from the patients' perspective, if UKA leads to postoperative differences in satisfaction, knee pain, function, and quality of life when compared with TKA.  Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) compared PROMs scores for patients with either a UKA or TKA. EQ-5D-5L, Oxford Knee Scores (OKS), and a knee pain rating were recorded preoperatively and 6 months after surgery with additional assessments of satisfaction and patient-perceived change. Comparisons were made for change in mean score after surgery, while percentage change and proportions achieving minimal clinically important change (MCIC) were compared using odds ratios (OR).  3,329 UKAs and 56,816 TKAs were included. UKA patients had higher mean scores for all PROMs measures before surgery, and scores increased similarly to or less than for TKA patients after surgery. Mean OKS was 39 (95% confidence interval [CI] 39-39) after UKA and 38 (CI 38-38) after TKA. Compared with TKA there was a smaller change in mean OKS for the UKA group (-1.3, CI -1.6 to -1.0), which was below the threshold for MCIC. Similar proportions of patients achieved an OKS improvement which met the MCIC threshold. Quality of life improvement after surgery was equivalent for both groups (EQ-5D-5L utility change 0.3 units) as was knee pain improvement (OR 1.1, CI 0.9-1.4) with the UKA group having higher odds of being satisfied (OR 1.2, CI 1.0-1.3) and feeling better (OR 1.12, CI 1.0-1.4), compared with the TKA group.  Based on patient assessments, the difference between UKA and TKA did not achieve the published threshold for a minimal important difference.
Knee osteoarthritis (KOA) is a prevalent and disabling disease with limited nonsurgical options for pain management. Magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive technique for targeted thermal ablation and has emerged as a potential therapy for pain control. Large-animal models that better replicate human joint anatomy are needed for translational evaluation. Although monosodium iodoacetate (MIA) is widely used to induce KOA in small animals, its application in sheep remains limited. KOA was induced in the right knees of nine sheep using intra-articular MIA injections on days 8 and 29, with contralateral knees serving as controls. Animals were monitored for 12 weeks with serial behavioral and radiographic assessments. MRgFUS treatment was performed between weeks 6 and 8 after the first MIA injection. At the study endpoint, knee joints were obtained for macroscopic and histological evaluation. MIA-treated knees demonstrated radiographic features of KOA, including joint space narrowing and osteophyte formation. Gross and histological analyses confirmed cartilage degeneration, with surface erosion, reduced proteoglycan staining, and disrupted cartilage architecture. Despite consistent structural changes, only two animals developed persistent pain-related behaviors. In these animals, MRgFUS treatment was associated with improved pain scores and activity levels. No treatment-related increases in pain, functional impairment, or tissue damage were observed. Intra-articular MIA injection produced a reproducible structural model of KOA in sheep. MRgFUS was well tolerated and exhibited preliminary potential for pain relief, supporting further evaluation in larger controlled studies.
Knee osteoarthritis (KOA) is characterized by progressive joint degeneration and biomechanical imbalance of periarticular soft tissues, leading to pain and functional limitation. However, effective biomechanically targeted manual therapy protocols for regulating soft tissue tension remain insufficiently standardized. In this study, a randomized controlled design was used to investigate the effects of tissue-bone homeostasis manipulation (TBHM) on peri-knee soft tissue tension and functional outcomes in patients with KOA. Sixty patients were enrolled and randomly assigned to the TBHM group or the control group. Primary outcomes included rectus femoris, vastus medialis, vastus lateralis muscle tension, patellar ligament tension, and knee flexion range of motion (ROM). Secondary outcomes included the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Timed Up and Go Test (TUGT). The results showed that baseline characteristics were comparable between groups (all P > 0.05), and no adverse events were observed during the intervention. Repeated measures analysis revealed significant time effects for all primary and secondary outcomes (P < 0.001). Significant group × time interaction effects were observed for rectus femoris, vastus lateralis muscle tension, patellar ligament tension, knee flexion ROM, KOOS subscales (symptoms, activities of daily living, sport/recreation, and quality of life), and TUGT (P < 0.05), indicating greater improvement in the TBHM group compared with the control group. However, no significant interaction effect was found for vastus medialis muscle tension or KOOS-pain (P > 0.05), suggesting similar trends between groups in these measures. In conclusion, TBHM demonstrates both safety and efficacy in reducing periarticular soft tissue tension and improving functional outcomes in KOA. This protocol provides a standardized and biomechanically oriented approach for manual therapy intervention and may offer a novel strategy for optimizing conservative treatment of KOA.
Differences in utilization of total knee arthroplasty (TKA) for Black patients with severe knee osteoarthritis (OA) have been well described. Understanding the factors that contribute to these differences is important when considering interventions to optimize TKA utilization. To evaluate these features, we developed a conceptual model for factors influencing TKA utilization and conducted a scoping literature review. Literature searches were conducted in April 2019 and April 2020 then updated in October 2022 and January 2024. Our primary outcomes were utilization of TKA for treatment of severe knee OA and factors affecting provider and patient decision making around TKA. We provide qualitative summaries of articles derived from our conceptual model. Black patients have lower utilization of TKA for treatment of their severe knee OA than White patients with knee OA and worse pain measures at the time of surgery. Large secondary datasets demonstrate that Black patients have increased rates of revision surgery, higher rates of non-home discharges, higher readmission rates and higher episode of care cost. As reported in qualitative studies, Black patients have less favorable perceptions of the benefits of TKA and a lower degree of trust in the healthcare system. Recent policies to reduce cost and/or improve quality of care may have unintended impact on access to care for Black patients. There are racial disparities between Black and White patients at multiple steps in the decision-making process for TKA. Efforts to reduce these disparities will need to target multiple points contributing to this differential care.
Malignant tumors around the knee pose a complex reconstructive challenge, particularly in the setting of an unreconstructable extensor mechanism. Although limb-salvage surgery with megaprosthetic reconstruction is the standard approach, its success is contingent upon extensor mechanism preservation. When this is not achievable, knee arthrodesis with modular endoprosthetic systems remains a robust salvage strategy. A 17-year-old male presented with a one-year history of progressive left knee swelling, pain, and functional impairment. Imaging demonstrated extensive involvement of the soft tissues, distal femur, and proximal tibia, with articular extension and close association with the patellar tendon. Biopsy confirmed Ewing sarcoma. The patient underwent neoadjuvant chemotherapy with vincristine, doxorubicin, and cyclophosphamide. This was followed by wide oncologic resection, including the distal femur, proximal tibia, and extensor mechanism, and reconstruction with a knee arthrodesis prosthesis. Final histopathology confirmed negative margins and 30% tumor necrosis. At 6-month follow-up, the patient remained disease-free with satisfactory functional recovery. Endoprosthetic knee arthrodesis provides a durable and oncologically sound limb-salvage option in cases where the extensor mechanism cannot be reconstructed. Optimal outcomes depend on appropriate patient selection and rigorous oncologic management.
This study aimed to develop an online pain self-management program (OPaSeMP) and evaluate its effects on home-dwelling patients with knee osteoarthritis. This study was designed with a non-equivalent control group pretest-posttest. The program was implemented from October 21, 2024, to December 2, 2024. Participants from two senior welfare centers in D city participated in this study. Data were analyzed using SPSS/WIN 27.0. Hypotheses were tested using the independent t-test, Wilcoxon signed-rank test, and Mann-Whitney U test. OPaSeMP was implemented over a 6-week period for the experimental group, with weekly themes tailored to pain management. Based on Bandura's social cognitive theory (1986), the OPaSeMP incorporates personal, behavioral, and environmental factors. There were significant differences in the severity of knee pain within a week (U = 101.50, p = .004), Knee Injury Osteoarthritis Outcome Score: symptoms (t = 2.35, p = .024), pain (t = 2.31, p = .026), function in daily living (U = 61.50, p < .001), function in sport and recreation (U = 307.00, p = .003), lower extremity muscle strength (t = 2.19, p = .035), and quality of life (t = 2.72, p = .010) between the two groups. Based on these findings, the OPaSeMP was validated as an effective intervention for pain management in patients with knee osteoarthritis. Future replication studies should be conducted to standardize the OPaSeMP and facilitate its implementation in various clinical settings.
Cartilage restoration techniques combined with high tibial osteotomy (HTO) have increasingly been used to delay conversion to total knee arthroplasty. Among these, autologous collagen-induced chondrogenesis (ACIC) and mesenchymal stem cell (MSC) therapy have gained significant research attention; however, their comparative therapeutic efficacy remains unclear. A retrospective analysis was conducted on 102 patients with medial compartment knee osteoarthritis who underwent HTO combined with cartilage repair (ACIC, n = 70; MSC, n = 32). Arthroscopic and radiographic parameters, including International Cartilage Repair Society (ICRS) grade, cartilage defect size, Kellgren-Lawrence (KL) grade, and mechanical alignment, were evaluated preoperatively and at second-look arthroscopy performed during hardware removal (mean, 27.2 ± 12.2 months). Clinical outcomes, including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), and International Knee Documentation Committee Subjective Knee (IKDC) scores, were also assessed preoperatively and at the last clinical follow-up (mean, 58.11 ± 30.85 months). ICRS grade significantly improved, and cartilage defect size significantly decreased in both groups (all p < 0.001). KL grade also showed significant postoperative improvement in both groups (p < 0.001). No significant differences were observed between groups in ICRS grade (p = 1.000), cartilage defect size (p = 0.202), and KL grade (p = 0.529). Both groups showed significant clinical improvements in WOMAC, VAS, and IKDC scores (all p < 0.001). There were no significant differences between the two groups in clinical outcomes (WOMAC, p = 0.430; VAS, p = 0.307; IKDC, p = 0.823). Both ACIC and MSC combined with HTO resulted in significant arthroscopic, radiographic, and clinical improvements in patients with varus knee osteoarthritis. No significant differences were observed, indicating comparable effectiveness of the two techniques when performed in conjunction with HTO.
Patients with a history of cerebrovascular disease may be at an increased risk for postoperative complications following knee arthroplasty; however, previous studies have been limited by small sample sizes and insufficient adjustment for confounding variables. This study aimed to evaluate whether cerebrovascular disease is associated with postoperative complications using a nationwide Japanese database. A retrospective cohort study was conducted using Japan's Diagnosis Procedure Combination database from April 2016 to March 2023. Patients who underwent total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) were identified, and postoperative complications-including deep vein thrombosis, pulmonary embolism, cerebrovascular events, surgical site infection, cognitive-related complications, and periprosthetic fractures-were evaluated. Cerebrovascular disease was defined using ICD-10 codes I60-I69. Propensity score matching (1:1) was performed using demographics, comorbidities, anesthesia type, and surgical procedure. Multivariate logistic regression was conducted to account for residual confounding. Among 259,319 eligible patients, 8298 had cerebrovascular disease. After matching, 8269 pairs were analyzed. Before matching, patients with cerebrovascular disease showed higher rates of thromboembolic and infectious complications, longer hospital stays, and greater transfusion volume. After matching, only cognitive-related complications remained significantly more frequent in the cerebrovascular disease group. Cerebrovascular disease was associated with postoperative cognitive-related complications (odds ratio (OR) 1.70; 95% confidence interval (CI) 1.28-2.26; p = 0.0003), with a risk difference of 0.62% (95% CI 0.28-0.95). Sensitivity analyses excluding patients with preoperative dementia or cognitive impairment and analyses limited to TKA cases demonstrated directionally consistent findings, although these associations did not reach the prespecified stringent significance threshold. Cerebrovascular disease does not increase the risk of recurrent cerebrovascular events after knee arthroplasty; however, it elevates the risk of postoperative cognitive-related complications, despite a low absolute incidence. Although the overall incidence was low, this finding may have implications for postoperative recovery and functional outcomes. III (retrospective cohort study).
Total knee arthroplasty (TKA) with various guidance methods for bone cuts and soft-tissue balancing yields excellent outcomes for end-stage knee osteoarthritis, offering durable pain relief and functional restoration. However, there is a growing interest in further enhancing intraoperative accuracy and consistency, with the aim of reducing complications and reducing recovery times through the introduction of robotic-assisted surgery (RAS). As with any new technology, concerns remain regarding the surgeon learning curve, operative efficiency, and safety profile of RAS compared to conventional techniques. This study evaluates the clinical utility of a RAS system (ROSA, Zimmer Biomet) in a public hospital setting, assessing its impact on procedure duration and adverse event incidence at 90 days postoperatively. A retrospective comparative cohort study was conducted at a secondary public hospital (Queen Elizabeth II Jubilee Hospital) in, Brisbane, Australia. Data was extracted from a departmental registry, electronic medical records, and intraoperative reports from September 2017 to February 2023. The study included 568 TKA cases: 173 instrumented or navigated TKAs performed before RAS introduction (Pre-RAS), 258 robotic-assisted TKAs after RAS adoption (RAS group), and 137 TKAs performed by other department surgeons who did not use RAS (non-RAS), serving as a benchmark for department-wide outcomes. The primary outcomes were procedure duration and adverse event incidence including surgical site infection (SSI), venous thromboembolism (VTE), knee stiffness, and all-cause readmission within 90 days postoperatively. Among 67 recorded adverse events, no significant differences in total adverse event incidence were observed between the pre-RAS and RAS groups (12.1% vs. 11.6%, p = 0.78). A non-significant increase in superficial infections in males undergoing RAS-TKA was observed (p = 0.062). The pre-RAS group had significantly longer operative times than the RAS group (128 ± 21.6 min vs. 121.4 ± 19.5 min, p < 0.01). The non-RAS department group had shorter procedure durations than the pre-RAS group (118.3 ± 20.1 min, p < 0.01). RAS-TKA was associated with shorter operative times and a comparable safety profile to non-robotic TKA in this cohort. Further investigation is warranted to determine whether these findings are maintained across different settings and over longer follow-up periods.
Total knee arthroplasty (TKA) is an effective treatment for end-stage knee osteoarthritis; however, postoperative recovery is frequently hindered by inadequate pain control and delayed functional rehabilitation. Conventional perioperative management often focuses primarily on surgical technique and pharmacologic analgesia, while underemphasizing other modifiable factors such as patient education, nutritional status, and psychological well-being. To address these gaps, we developed a structured multimodal perioperative strategy-the 5E management protocol-integrating Education, Exercise, Eat (nutritional optimization), Emotion (psychological support), and Ease (multimodal pain control). The purpose of this randomized controlled trial was to determine whether the 5E protocol improves early postoperative pain control and functional recovery after TKA, and whether its effects are consistent across clinically relevant patient subgroups. In this single-center randomized controlled trial, 120 patients undergoing primary TKA for osteoarthritis were randomly assigned to either the 5E management protocol (n = 60) or conventional perioperative care (n = 60). Patients in the 5E group received standardized preoperative education, optimized multimodal analgesia, early mobilization, individualized nutritional support, and structured psychological counseling, whereas the control group received routine care. Postoperative pain was assessed using the Visual Analog Scale (VAS) and Numerical Rating Scale (NRS) during postoperative days 1-5. Functional outcomes were evaluated using the Knee Society Score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) index at 30 days and 180-360 days postoperatively. Stratified subgroup analyses were performed based on body mass index (BMI), diabetic status, and Kellgren-Lawrence (K-L) grade. Patients managed with the 5E protocol demonstrated significantly better pain control during the early postoperative period compared with those receiving conventional care (VAS day 1: 1.95 vs. 3.08; P < 0.001), with similar trends observed across postoperative days 1-5. At 30 days, the 5E group achieved superior functional outcomes, including higher KSS Pain and Function Scores and lower WOMAC scores (KSS Pain: 67.48 vs. 64.23; P < 0.001). Stratified analyses showed consistent benefits of the 5E protocol across BMI categories, diabetic and non-diabetic patients, and K&L grades 3-4. No significant differences were observed between groups at long-term follow-up (180-360 days). Thrombotic complications (Intramuscular venous thrombosis) occurred in 10 of 60 patients (16.7%) in the 5E group and 8 of 60 patients (13.3%) in the control group, with no significant difference between groups (P = 0.798). The 5E management protocol significantly improves early postoperative pain control and short-term functional recovery after TKA, with consistent benefits across diverse patient subgroups. Although long-term outcomes were comparable between groups, the acceleration of early recovery highlights the clinical value of a structured, patient-centered, multimodal perioperative strategy. Importantly, the implementation of the 5E protocol did not increase thrombotic complications, indicating a comparable safety profile to conventional care. Therapeutic Study.
This study aimed to investigate associations between neuromuscular activation patterns, symptoms, muscle strength, and gait parameters across different stages of knee osteoarthritis (KOA). In this cross-sectional study, 165 unilateral KOA patients and 32 healthy controls underwent synchronized gait analysis, isokinetic strength testing, surface electromyography, and completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Muscle coactivation was quantified as the normalized electromyographic (EMG) ratio of antagonist to agonist muscles during gait phases and isokinetic contractions. Group comparisons were performed using one-way ANOVA with Bonferroni correction. Spearman correlations and multiple linear regression models examined relationships between muscle activation, biomechanical parameters, and WOMAC scores. Compared with controls, patients with KOA showed progressively deteriorating gait patterns and strength performance with increasing K-L grades (p < 0.05). A distinct compensatory neuromuscular pattern, characterized by excessive coactivation of the hamstrings (particularly the lateral hamstring) and the vastus lateralis, was identified (p = 0.002-0.048). This pattern was significantly associated with reduced knee flexion moment and elevated knee adduction moment (p = 0.004-0.038). These changes were observable from K-L II and became more pronounced in advanced KOA (K-L ≥ III), correlating with higher WOMAC pain, stiffness, and functional scores (p < 0.001-0.046). Significant inter-limb asymmetry was observed between affected and contralateral limbs (asymmetry index [ASI] = 1.72-13.84; limb symmetry index [LSI] = 56.3-92.7%). KOA is associated with an adaptive neuromuscular strategy characterized by excessive hamstring coactivation. While this pattern may aim to stabilize the joint, it correlates with biomechanical inefficiency, symptom worsening, and functional decline. This coactivation pattern may serve as a promising biomechanical marker for better understanding KOA manifestations and warrants further investigation as a potential therapeutic target.
The long-term benefits of prophylactic factor replacement following total knee arthroplasty in patients with hemophilia remain insufficiently evaluated. This retrospective cohort study included 70 patients (108 knees) with hemophilia A or B who underwent primary total knee arthroplasty (TKA) between January 2003 and October 2020. Based on their long-term postoperative pattern of factor replacement therapy, patients were classified into the prophylactic group and the on-demand group. Patient-reported outcomes (WOMAC, VAS, FJS-12, and satisfaction scores) were compared between the two groups. Kaplan-Meier survival analysis was conducted to compare prosthesis survival between groups. Over a mean follow-up period of 9.7 years (range, 5 to 22 years), the prophylaxis group demonstrated superior clinical outcomes compared to the on-demand group, with lower WOMAC total scores (14.9 vs. 20.1, p = 0.03) and higher satisfaction scores (17.7 vs. 15.2, p < 0.01), greater ROM (93.5° vs. 60.3°, p < 0.01), and less flexion contracture (5.3° vs. 13.0°, p < 0.01). Kaplan-Meier survival analysis indicated superior prosthesis survival in the prophylaxis group (HR = 0.19, 95% CI: 0.06-0.56, p = 0.01). Restricted cubic spline (RCS) demonstrated that when the annual joint bleeding rate (AJBR) exceeded 4 episodes per year, the odds ratio for adverse clinical outcomes was greater than 1. Long-term prophylactic factor replacement after primary TKA seemed to optimize surgical outcomes and improve prosthesis survival. However, due to the limitations of this study, its conclusions should be confirmed by future, better-designed studies (prospective, double-blind, randomized).
Total knee arthroplasty (TKA) effectively alleviates pain and restores joint function in patients with advanced knee osteoarthritis. However, persistent quadriceps muscle weakness often limits early functional recovery, and the contribution of early postoperative changes in muscle strength, edema, and pain to short-term function remains unclear. The aim of the study was to investigate early postoperative changes in quadriceps strength, edema, and pain, and their relationships with functional performance at 6 weeks following unilateral TKA. Twenty-four patients (mean age 68.67 years and body mass index 33.18 kg/m2, 20f, 4m) undergoing primary unilateral TKA were assessed on postoperative day 1, week 2, and week 6. Outcome measures included isometric quadriceps strength, knee edema, pain intensity (VAS), and functional performance (5 Times Sit-to-Stand Test [5T-Stst], 2-Minute Walk Test [2MWt], WOMAC). Correlations and forward stepwise multiple regression analyses evaluated the predictive value of early recovery indicators on functional outcomes. Significant improvements in quadriceps strength and reductions in edema and pain were observed within 6 weeks. Early quadriceps strength gains (day 1 to week 2) were strongly associated with faster 5T-Stst performance at week 6 (r = -0.644, P = 0.001), accounting for 27% of its variance (R² = 0.27, P = 0.005). Edema reduction also correlated with improved sit-to-stand performance (r = 0.528, P = 0.008), whereas early pain reduction showed no significant correlation with functional outcomes. Early postoperative improvements in quadriceps muscle strength and edema resolution are critical predictors of short-term functional recovery after TKA, whereas pain relief alone is insufficient. These findings emphasize the first two postoperative weeks as a pivotal window for rehabilitation interventions focusing on neuromuscular activation and swelling control. Objective assessment of quadriceps strength from the first postoperative day may guide personalized rehabilitation strategies and optimize recovery strategies.
Knee osteoarthritis (KOA) is a prevalent degenerative joint disease among the elderly, leading to severe pain and functional impairment. Methotrexate (MTX), a disease-modifying antirheumatic drug with anti-inflammatory properties, may alleviate pain and stiffness in KOA patients and improve functional status. This meta-analysis aims to evaluate the efficacy of oral MTX in patients with KOA. A comprehensive search was conducted in PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the China National Knowledge Infrastructure (CNKI) databases for literature published up to May 1, 2026, without language restrictions. Randomized controlled trials comparing oral MTX with placebo in adult patients with symptomatic KOA were included. The primary outcome was the change in the WOMAC total score. Secondary outcomes included changes in WOMAC pain, stiffness, and function. Four randomized controlled trials encompassing 366 randomized participants were included. For the primary outcome, data from 343 participants were available for analysis. Secondary outcomes (pain, stiffness, physical function) were based on three trials (281 patients), all showing improvements. MTX moderately reduced the WOMAC total score compared to placebo or control groups (mean difference [MD] = -8.69; 95% confidence interval [CI]: -16.92 to -0.46). Moderate improvements were also observed in WOMAC pain (MD = -2.66; 95% CI: -3.34 to -1.97), stiffness (MD = -0.51; 95% CI: -0.87 to -0.15), and function (MD = -7.10; 95% CI: -13.39 to -0.80). Sensitivity analyses confirmed the robustness of these findings. Oral methotrexate moderately alleviates pain and stiffness in patients with knee osteoarthritis and improves functional status. These preliminary results suggest that methotrexate may have a beneficial effect on pain and function in KOA, providing symptomatic relief without evidence of structural modification. However, the evidence is currently limited and does not support routine clinical use. Further large-scale RCTs are warranted.