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Current and Emerging Treatment Options in Shoulder, Hip and Knee Arthroplasty

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 7012

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Dr. Nahum Rosenberg

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Department of Orthopedic Surgery, Rambam Health Care Campus, P.O. Box 9602, Haifa, Israel
Interests: joint biomechanics; outcomes of orthopaedic surgery; arthroplasty; tissue regeneration
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Special Issue Information

Dear Colleagues,

This Special Issue aims to explore the current and emerging treatment options for shoulder, hip, and knee arthroplasty. With the increasing prevalence of musculoskeletal disorders and the growing demand for joint replacement surgeries, it is crucial to stay updated on the latest advancements in this field. This Special Issue provides a platform for researchers, clinicians, and experts to share their insights, experiences, and research findings related to innovative treatment approaches in arthroplasty. We invite original research articles, systematic reviews, and meta-analyses that focus on various aspects of shoulder, hip, and knee arthroplasty. The scope of this Special Issue includes, but is not limited to:

Surgical techniques and approaches in joint replacement;
Implant design and materials;
Rehabilitation and post-operative care;
Patient outcomes and satisfaction;
Complications and their management.

We encourage submissions that present novel ideas, evidence-based practices, and clinical studies that contribute to the advancement of arthroplasty. However, please note that we will not be accepting mini reviews or case reports for this Special Issue.

By bringing together diverse perspectives and cutting-edge research, this Special Issue aims to enhance our understanding of the current and emerging treatment options in shoulder, hip, and knee arthroplasty. We hope that this collection of articles will serve as a valuable resource for healthcare professionals, researchers, and policymakers involved in the field of orthopedics. Thank you for considering submitting your work to this Special Issue.

Dr. Nahum Rosenberg
Guest Editor

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. Journal of Clinical Medicine 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 2600 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

joint replacement surgery
arthroplasty techniques
implant selection
prosthetic materials
revision arthroplasty
pain management strategies

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Published Papers (6 papers)

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14 pages, 7655 KiB

Open AccessArticle

Retrospective Evaluation of Cryopreserved Human Umbilical Cord Tissue Allografts in the Supplementation of Cartilage Defects Associated with Hip Osteoarthritis

by Albert Lai, Conrad Tamea, John Shou, Anthony Okafor, Jay Sparks, Renee Dodd, Naomi Lambert, Crislyn Woods, Orion Schulte, Sarah Kovar and Tyler Barrett

J. Clin. Med. 2024, 13(14), 4040; https://doi.org/10.3390/jcm13144040 - 10 Jul 2024

Viewed by 648

Abstract

Background: Osteoarthritis is a chronic disorder that affects the synovial joints by the progressive loss of articular cartilage. In the hip, the largest weight-bearing joint, the deterioration of articular cartilage and acetabular labrum can cause pain, diminishing the quality of life for patients. This study presents changes in reported pain scales from patients who received Wharton’s jelly applications to cartilage deterioration in the hip from the observational retrospective repository at Regenative Labs. Methods: Sixty-nine patients were selected based on inclusion criteria with patient-reported pain scales, including the Numeric Pain Rating Scale and the Western Ontario and McMaster University Osteoarthritis Index, collected at the initial application, 30, and 90-day follow-up visits. Thirteen patients received a second allograft application and had additional follow-up visits at 120 and 180 days. Results: Five of the six scales used showed a statistically significant improvement in average scores across the cohort. The greatest improvements were observed in the NPRS with a 31.36% improvement after 90 days and a 44.64% improvement for patients with two applications after 180 days. The minimal clinically important difference (MCID) was also calculated to determine the perceived value of care for each patient with 44.9% of patients exceeding the MCID and 78.3% reporting at least one level of improvement. Conclusions: The positive outcomes for the patients in this cohort suggest WJ to be a promising alternative care option for patients with structural tissue degeneration in the hip refractory to the current standard of care. Full article

(This article belongs to the Special Issue Current and Emerging Treatment Options in Shoulder, Hip and Knee Arthroplasty)

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12 pages, 932 KiB

Open AccessArticle

Short-Term Outcomes of Total Knee Arthroplasty Using a Conventional, Computer-Assisted, and Robotic Technique: A Pilot Clinical Trial

by Alexey Vladimirovich Lychagin, Andrey Anatolyevich Gritsyuk, Mikhail Pavlovich Elizarov, Yaroslav Alekseevich Rukin, Andrey Andreevich Gritsyuk, Maxim Yaroslavovich Gavlovsky, Pavel Mihailovich Elizarov, Murat Berdiyev, Eugene Borisovich Kalinsky, Ivan Antonovich Vyazankin and Nahum Rosenberg

J. Clin. Med. 2024, 13(11), 3125; https://doi.org/10.3390/jcm13113125 - 26 May 2024

Viewed by 808

Abstract

Background: Total Knee Arthroplasty (TKA) is a prevalent surgical procedure for treating severe knee arthritis, aiming to alleviate pain and restore function. Recent advancements have introduced computer-assisted (CAS) and robot-assisted (RA-TKA) surgical techniques as alternatives to conventional methods, promising improved accuracy and patient outcomes. However, comprehensive comparative studies evaluating the short-term outcomes and prostheses survivorship among these techniques are limited. We hypothesized that the outcome of RA-TKA and/or CAS- TKA is advantageous in function and prosthesis survivorship compared to manually implanted prostheses. Methods: This prospective controlled study compared the short-term outcomes and prostheses survivorship following TKA using conventional, CAS, and RA-TKA techniques. One hundred seventy-eight patients requiring TKA were randomly assigned to one of the three surgical groups. The primary outcomes were knee function (KSS knee score) and functional recovery (KSS function score), which were assessed before surgery three years postoperatively. Secondary outcomes included prosthesis alignment, knee range of movements, and complication rates. Survivorship analysis was conducted using Kaplan–Meier curves, with revision surgery as the endpoint. Results: While all three groups showed significant improvements in knee function postoperatively (p < 0.001), the CAS and RA-TKA groups demonstrated superior prosthetic alignment and higher survivorship rates than the conventional group (100%, 97%, and 96%, respectively). However, although the RA-TKA group had a maximal 100% survivorship rate, its knee score was significantly lower than following CAS and conventional techniques (mean 91 ± 3SD vs. mean 93 ± 3SD, p = 0.011). Conclusion: The RA-TKA technique offers advantages over conventional and CAS methods regarding alignment accuracy and short-term survivorship of TKA prostheses. Since short-term prosthesis survivorship indicates the foreseen rates of mid- and long-term survivorship, the current data have a promising indication of the improved TKA prosthesis’s long-term survivorship by implementing RA-TKA. According to the presented data, although the survival rates were 100%, 97%, and 96% in the three study groups, no clinical difference in the functional outcome was found despite the better mechanical alignment and higher survivorship in the group of patients treated by the RA-TKA. Full article

(This article belongs to the Special Issue Current and Emerging Treatment Options in Shoulder, Hip and Knee Arthroplasty)

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11 pages, 291 KiB

Open AccessArticle

Evaluation of Neuropathic Pain after Total Knee Arthroplasty: Do Yellow Flags Matter?

by Danijel Colovic, Alexander Draschl, Patrick Reinbacher, Andrzej Hecker, Gregor Schittek, Stefan Franz Fischerauer, Andreas Leithner, Sebastian Martin Klim, Amir Koutp, Ulrike Wittig, Kevin Brunnader, Andreas Sandner-Kiesling and Patrick Sadoghi

J. Clin. Med. 2023, 12(24), 7708; https://doi.org/10.3390/jcm12247708 - 15 Dec 2023

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Up to 20% of total knee arthroplasty (TKA) patients continue to experience chronic postsurgical pain. Various factors have been identified as potential contributors, including so-called “yellow flags”, encompassing symptoms of depression, anxiety, and catastrophizing, which were examined in this study to assess their predictive value concerning functional outcomes after TKA. Methods: Fifty TKA patients were categorized into high-risk and low-risk groups based on clinical assessment, demographic data, medication, and patient-reported outcome measures (DN4, SF-36, WOMAC, NRS, Fibromyalgia Survey Questionnaire, Pain Catastrophizing Scale, and Hospital Anxiety and Depression Scale). Postoperative outcomes within six months after TKA were then compared. Results: Both groups exhibited significant (p < 0.001) improvements in all WOMAC and NRS subscales, as well as in the physical function, role physical, pain, and energy/fatigue subdomains of the SF-36 after six months, while the high-risk group showed lower WOMAC scores regarding stiffness (19.0 ± 18.3 vs. 27.2 ± 20.7, p < 0.001) and pain (13.5 ± 13.3 vs. 15.1 ± 16.3, p = 0.029). The high-risk group showed significantly worse preoperative DN4 scores (1.8 ± 1.3 vs. 3.0 ± 1.1, p = 0.002) than the low-risk group, which persisted for one day (2.3 ± 1.2 vs. 3.5 ± 1.5, p = 0.005) and six weeks (2.2 ± 1.9 vs. 3.6 ± 2.3, p = 0.041) postoperatively. Conclusions: Our results indicate that pre-existing yellow flags contribute to a more challenging early postoperative phase, underscoring the importance of considering individual patient characteristics and psychological factors to optimize TKA outcomes. Full article

(This article belongs to the Special Issue Current and Emerging Treatment Options in Shoulder, Hip and Knee Arthroplasty)

14 pages, 2640 KiB

Open AccessArticle

Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty—A Prospective, Randomised, Double-Blinded Clinical Trial

by Malgorzata Domagalska, Tomasz Reysner, Grzegorz Kowalski, Przemysław Daroszewski, Aleksander Mularski and Katarzyna Wieczorowska-Tobis

J. Clin. Med. 2023, 12(22), 7088; https://doi.org/10.3390/jcm12227088 - 14 Nov 2023

Cited by 2 | Viewed by 1112

Abstract

Introduction: This study aimed to investigate pain management, functional recovery, and stress response expressed by the neutrophile-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) after the popliteal artery and posterior knee capsule infiltration (iPACK) block combined with adductor canal block (ACB) in total knee arthroplasty (TKA). Patients and Methods: This was a prospective, double-blinded, randomised, controlled trial in a tertiary referral hospital. Three hundred and sixty-six patients were randomly allocated into the sham block group and iPACK combined with the ACB group. The primary outcome was postoperative pain scores. The secondary outcomes were opioid consumption, functional recovery expressed by a range of motion, and quadriceps strength. Also, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated. Results: There were significant differences between the sham block and iPACK + ACB group in pain scores p < 0.0001 at all time points. Therefore, there was a significant difference in opioid consumption (p < 0.0001) and functional recovery (p < 0.0001). Also, NLR and PLR levels 12 h (p < 0.0001) and 24 h (24 h) after surgery (p < 0.0001) were much lower in the iPACK + ACB group. Conclusion: After total knee arthroplasty, the iPACK combined with ACB block group improved pain management, functional recovery, and stress response. Therefore, we strongly recommend this technique as a part of a multimodal analgesia protocol in knee surgery. Full article

(This article belongs to the Special Issue Current and Emerging Treatment Options in Shoulder, Hip and Knee Arthroplasty)

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11 pages, 1158 KiB

Open AccessArticle

Postoperative Hemodynamics of Total Knee Arthroplasty Unaffected by Cementless Approach under Contemporary Patient Blood Management Protocol: A Propensity Score-Matched Study

by Keun Young Choi, Yong Deok Kim, Nicole Cho, Man Soo Kim, Yong In, Hwang Yong You and In Jun Koh

J. Clin. Med. 2023, 12(22), 6980; https://doi.org/10.3390/jcm12226980 - 8 Nov 2023

Cited by 1 | Viewed by 789

Abstract

(1) Background: A cementless total knee arthroplasty (TKA) is a recent and an increasingly popular innovation that enhances porous fixation surfaces. However, the lack of cemented sealing of an exposed resected bone has raised concerns about the potential for greater blood loss. The goals of this study were to determine if a cementless approach impacts post-TKA hemodynamics and to identify risk factors for blood loss in instances of cementless (vs. cemented) TKAs under a contemporary patient blood management (PBM) protocol. (2) Methods: We recruited 153 consecutive patients undergoing unilateral TKAs between 2019 and 2023. All enrollees received cementless or cemented prostheses of the same design (cementless, 87; cemented, 66). After propensity score matching for demographics, there were 46 patients in each group. We then compared blood loss metrics (total [TBL] and estimated [EBL]), drainage volumes, hemoglobin (Hb) levels, and transfusion rates by group. (3) Results: Post-TKA hemodynamics (i.e., TBL, EBL, drainage, Hb level, and transfusion rate) of cementless (n = 46) and cemented (n = 46) TKA groups did not differ significantly. In addition, the proportions of patients with Hb drops > 3.0 g/dL were similar for the two groups. A logistic regression analysis revealed that only preoperative Hb and EBL during the early postoperative period were predictive of a substantial fall in Hb levels. The fixation method was not associated with Hb decline > 3.0 g/dL by postoperative Day 3. (4) Conclusion: The cementless TKA has no impact on customary post-TKA hemodynamics and is not associated with greater TKA-related blood loss when implementing a contemporary PBM protocol. Full article

(This article belongs to the Special Issue Current and Emerging Treatment Options in Shoulder, Hip and Knee Arthroplasty)

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11 pages, 4643 KiB

Open AccessSystematic Review

Anterior Referencing versus Posterior Referencing in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

by Filippo Familiari, Michele Mercurio, Francesco Napoleone, Olimpio Galasso, Ermes Giuzio, Roberto Simonetta, Michelangelo Palco, Nicholas N. DePhillipo and Giorgio Gasparini

J. Clin. Med. 2023, 12(23), 7453; https://doi.org/10.3390/jcm12237453 - 1 Dec 2023

Cited by 1 | Viewed by 2058

Abstract

(1) Background: The purpose of this study was to perform a systematic review and meta-analysis of studies comparing clinical and radiographic outcomes between anterior referencing (AR) and posterior referencing (PR) systems in total knee arthroplasty (TKA). (2) Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, MEDLINE, Scopus, and Cochrane Central databases were searched in August 2022. Data extracted for quantitative analysis included the Knee Society Score (KSS), the Western Ontario and McMaster University (WOMAC) index, knee ROM, posterior condylar offset (PCO), and the posterior condylar offset ratio (PCOR). The methodological quality of the included studies was assessed using the Modified Newcastle–Ottawa Quality Assessment. Randomized controlled trials were assessed with version 2 of the risk of bias tool (RoB2), recommended by the Cochrane Collaboration. (3) Results: For the meta-analysis, five comparative studies met the eligibility criteria. There were 584 patients in all, 294 of whom had AR TKA and 290 of whom had PR TKA. Three studies with 181 and 179 cases in the AR and PR groups, respectively, had reported preoperative KSS. A statistically significant difference was found favoring the PR group. (p = 0.01). The same cases’ postoperative range of motion was documented, and a statistically significant difference was discovered in favor of the AR group. Postoperative PCO was described in four studies in 243 and 241 cases in the AR and PR TKA groups, respectively, and a statistically significant difference was found with a higher postoperative PCO in the PR group (p = 0.003). Postoperative PCOR was calculated in two studies in the same cases in the AR and PR TKA groups and a statistically significant difference was found with a higher postoperative PCOR in the PR group (p = 0.002). (4) Conclusion: Anterior referencing for TKA may result in improved knee ROM postoperatively, while posterior referencing may produce larger PCO and PCOR on postoperative imaging. However, no significant differences were noted in clinical outcomes between the AR and PR groups at final follow-up. Full article

(This article belongs to the Special Issue Current and Emerging Treatment Options in Shoulder, Hip and Knee Arthroplasty)

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