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Knee Arthroplasty: Current State of the Art in Clinical Application...
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Knee Arthroplasty: Current State of the Art in Clinical Application and Basic Research

A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Biomedical Engineering".

Deadline for manuscript submissions: closed (31 October 2023) | Viewed by 5529

Special Issue Editors

Dr. Vicente J. León-Muñoz

E-Mail Website
Guest Editor
Department of Orthopaedic Surgery, Hospital Universitario Reina Sofia, Murcia, Spain
Interests: knee surgery; knee arthroplasty; innovation
Prof. Dr. Fernando Santonja-Medina

E-Mail Website
Guest Editor
Department of Orthopedic Surgery, Hospital Clínico Virgen de la Arrixaca, Murcia, Spain
Interests: orthopedic treatment of scoliosis; knee arthroplasty; knee surgery; foot surgery

Special Issue Information

Dear Colleagues,

We can affirm that we are at a turning point in knee arthroplasty surgery. For almost fifty years, there have been few changes in this type of surgery compared to the present time, but innovations have occurred with the development of more sophisticated techniques and implants. Initial efforts were primarily concerned with reducing serious complications and ensuring the longevity of implants through developing firm bearing surfaces, more biological fixations, more-precise instrumentation systems and developing less-invasive techniques. Nevertheless, it is also true that there has been a uniform, uncritical, systematic and almost dogmatic approach based on principles that today require more evidence.

The fundamental change taking place is the application of concepts from personalised medicine to knee arthroplasty. Clinicians and researchers are now presenting different philosophies of component alignment and biomechanics of knee prostheses. These philosophies recognise each joint as unique and propose a customised approach for each patient. The goal is to improve arthroplasty survival and function, each patient's health-related quality of life and patient satisfaction, and to achieve a sense of normality in the operated knee. The aim is for the patient to forget that he or she has been operated on.

All these changes are producing a wealth of data and information. This Special Issue aims to be an open forum for publishing these innovations and contributions to knowledge.

Topics:

  • New alignment concepts
  • Technology in knee arthroplasty
  • Incorporating bioengineering
  • Customised surgery
  • Extended reality and immersive technologies
  • Defining limits and future challenges

Dr. Vicente J. León-Muñoz
Prof. Dr. Fernando Santonja-Medina
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Applied Sciences is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • alignment
  • technology
  • stability
  • efficiency
  • robotics
  • accuracy

Published Papers (4 papers)

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Research

11 pages, 1625 KiB  
Article
Evaluation of Sit-to-Stand Movement Focusing on Kinematics, Kinetics, and Muscle Activity after Modern Total Knee Arthroplasty
by Kojiro Hyodo, Akihiro Kanamori, Hideki Kadone, Masaya Kajiwara, Kosuke Okuno, Naoya Kikuchi and Masashi Yamazaki
Appl. Sci. 2024, 14(1), 360; https://doi.org/10.3390/app14010360 - 30 Dec 2023
Viewed by 878
Abstract
The sit-to-stand (STS) movement is important in improving satisfaction after total knee arthroplasty (TKA). Reports on motion analysis using a combination of motion capture systems, force plates, and surface electromyography after TKA are limited. We aimed to compare the STS movement of patients [...] Read more.
The sit-to-stand (STS) movement is important in improving satisfaction after total knee arthroplasty (TKA). Reports on motion analysis using a combination of motion capture systems, force plates, and surface electromyography after TKA are limited. We aimed to compare the STS movement of patients aged over 60 who underwent modern and conventional TKA with more than 6 months of postoperative follow-up. Ten patients underwent surgery with a modern implant (Group I: Smith and Nephew JOURNEY II, Memphis, TN, USA), and ten with a conventional implant (Group II: Smith and Nephew LEGION, Memphis, TN, USA). STS movement kinematics and kinetic data were measured by synchronising a motion capture system with a force plate. Surface electromyography was used to measure the muscle activity. STS time was shorter in Group I than in Group II. Maximum knee-extension angular velocity and maximum knee-extension moment were greater in Group I than in Group II. Electromyography revealed that Group I tended to have less activity in the quadriceps femoris than Group II. Group II had a greater hip-extension moment and vertical ground reaction force, and the hip joint seemed to compensate for knee function. Group I possibly used the quadriceps muscle more effectively, due to the implant shape. Full article
(This article belongs to the Special Issue Knee Arthroplasty: Current State of the Art in Clinical Application and Basic Research)
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11 pages, 2782 KiB  
Article
Ergonomic Evaluation of Different Surgeon Positions for Total Knee Arthroplasty Surgery
by Marina Sánchez-Robles, Francisco J. Díaz-Martínez, Vicente J. León-Muñoz, Carmelo Marín-Martínez, Antonio Murcia-Asensio, Matilde Moreno-Cascales and Francisco Lajara-Marco
Appl. Sci. 2023, 13(21), 11842; https://doi.org/10.3390/app132111842 - 30 Oct 2023
Viewed by 1030
Abstract
Ergonomics and risk factors for work-related musculoskeletal disorders have been studied extensively in various industry fields. However, only a few decades ago, these issues became a concern in the healthcare sector. Total knee arthroplasty (TKA) is one of the most common procedures performed [...] Read more.
Ergonomics and risk factors for work-related musculoskeletal disorders have been studied extensively in various industry fields. However, only a few decades ago, these issues became a concern in the healthcare sector. Total knee arthroplasty (TKA) is one of the most common procedures performed by orthopaedic surgeons, and it would be desirable to perform it with an ergonomically safer technique. This study evaluated the ergonomic risk of different surgeon positions when performing contralateral TKA using the dominant hand. After the authors defined the four possible surgeon positions according to the most common positions used by surgeons in our environment (position A, on the opposite side of the knee to be operated on; position B, on the same side as the knee to be operated on; position C, with the patient’s legs separated and the surgeon standing between them; and position D, facing the knee to be operated on, at the patient’s feet), we performed an ergonomic analysis using the Rapid Entire Body Assessment (REBA) method. The overall REBA scores (lower score values indicate better ergonomics than higher) were between 7 and 6.5 for position A, between 6.17 and 5.5 for position B, between 5.92 and 5.5 for position C, and between 3.75 and 3.42 for position D. The test–retest and inter-rater reliability values ranged from substantial agreement to almost perfect agreement. Based on the results, we can conclude that the most ergonomic position for a right-handed surgeon to perform a left TKA is facing the left knee, at the patient’s feet (position D). Full article
(This article belongs to the Special Issue Knee Arthroplasty: Current State of the Art in Clinical Application and Basic Research)
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12 pages, 2001 KiB  
Article
Antibacterial Effect of Topically Administered Tranexamic Acid in Large Joint Arthroplasty
by Urban Slokar, Simon Kovač, Andrej Cör and Katja Šuster
Appl. Sci. 2023, 13(16), 9050; https://doi.org/10.3390/app13169050 - 8 Aug 2023
Viewed by 795
Abstract
Tranexamic acid (TXA) is a synthetic derivative of the amino acid lysine and is commonly used as an antifibrinolytic agent in large joint surgery, such as knee arthroplasty, to minimize blood loss and its associated complications. Some studies have suggested that perioperative intravenous [...] Read more.
Tranexamic acid (TXA) is a synthetic derivative of the amino acid lysine and is commonly used as an antifibrinolytic agent in large joint surgery, such as knee arthroplasty, to minimize blood loss and its associated complications. Some studies have suggested that perioperative intravenous TXA application lowers the incidence of postoperative infections after hip and knee arthroplasty. While its effects on bacteria are not its primary purpose, more research is needed further to elucidate the extent of TXA’s impact on bacterial inhibition and its clinical relevance. In order to determine possible inhibitory effects, 22 clinically relevant bacterial strains were exposed to different TXA concentrations. Two different assays were performed: a microdilution assay with traditional endpoint measurements and a kinetic growth assay for a time-dependent susceptibility assessment. With the microdilution technique, a growth inhibitory effect became evident at higher TXA concentrations (50 and 100 mg/mL) on eight tested bacterial strains, of which four demonstrated absence of growth at 100 mg/mL, suggesting minimal inhibitory concentration. However, the kinetic growth assay revealed more specific TXA-induced dynamic changes in the bacterial growth of all tested bacterial strains. This study showed that TXA affects the growth dynamics of bacteria by altering their lag phase duration, exponential growth rate, and population density and may contribute to the prevention of implant-associated infections. Full article
(This article belongs to the Special Issue Knee Arthroplasty: Current State of the Art in Clinical Application and Basic Research)
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9 pages, 459 KiB  
Article
Bone Cut Accuracy in Total Knee Arthroplasty: Do Conventional Cutting Guides Stay True to the Planned Coronal Orientation of the Components?
by Joan Leal-Blanquet, Pedro Hinarejos, Elisenda Gimenez-Valero, Raul Torres-Claramunt, Juan Sánchez-Soler, Juan Erquicia, Sergi Gil-González, Angela Zumel-Marne and Juan Carlos Monllau
Appl. Sci. 2023, 13(6), 4000; https://doi.org/10.3390/app13064000 - 21 Mar 2023
Viewed by 2262
Abstract
Background: Total knee arthroplasty (TKA) has become the gold standard for the definitive treatment of knee osteoarthritis. One crucial aspect in the implantation of a TKA is the precise orientation of the femoral and tibial components. The main purpose of the present [...] Read more.
Background: Total knee arthroplasty (TKA) has become the gold standard for the definitive treatment of knee osteoarthritis. One crucial aspect in the implantation of a TKA is the precise orientation of the femoral and tibial components. The main purpose of the present study is to assess, in patients undergoing total knee replacement, whether the difference between the planned angulation in the distal femoral cut and the angulation obtained in the postoperative radiological control is low enough to consider the conventional bone-cutting guides reliable. Methods: A retrospective study was designed with a consecutive series of patients who had undergone primary total knee arthroplasty using conventional instrumentation over one year. The authors analysed the main variable (bone cuts) while considering different variables (age, gender, surgeon, prosthesis, laterality, constraint, body mass index and alignment) to identify different patient patterns that justify the results in the main variable. Descriptive variables were analysed using the Mann–Whitney U and Kruskal–Wallis tests. Additionally, the correlation between continuous variables was explored in accordance with the Spearman correlation. Results: A total of 340 patients with a mean age of 75 ± 9.16 years were finally included in the present study. The mean absolute error of the main variable for the femoral coronal bone cut was 1.89° (SD 1.53). For the tibial coronal bone cut, it was 1.31° (SD 2.54). These values correspond to what remains after subtracting the radiological angulation obtained in the postoperative period from the planned intraoperative angulation of the distal femoral cut. No associations were observed between the main variable (the angulation of the proximal tibial cut and distal femoral cut) and the rest of variables for either the femur or tibia. Conclusion: A discrepancy between the planned angulation and the final radiological measure on the coronal plane of the femur and tibia using conventional cutting guides has been demonstrated. The degree of deviation is low enough that it probably does not affect clinical outcomes. Therefore, the use of conventional cutting guides will continue to be an appropriate tool to perform bone cuts in knee replacement surgery. Full article
(This article belongs to the Special Issue Knee Arthroplasty: Current State of the Art in Clinical Application and Basic Research)
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