Purpose: This study focused on analyzing the contact pressure and area on different patellar component designs in total knee arthroplasty (TKA) to evaluate biomechanics related to the patellofemoral (PF) joint. Materials and Methods: The patellar components studied included the dome design, modified dome design, and anatomical design implants. Using finite element analysis and mechanical testing, the pressure and area were evaluated. The first loading condition was simulated at flexion angles of 0°, 15°, 45°, 90°, 120°, and 150°. The second loading condition was simulated for a clinically relevant scenario, involving a 2-mm medial shift at a flexion angle of 45°. Results: For both the modified dome and anatomical designs, the contact area and pressure increased with the flexion angle. The dome design reached its maximum contact area at a flexion angle of 120°. Among the designs, the anatomical design had the largest contact area and a lower contact pressure compared to the dome and modified dome designs. However, when a medial shift of 2 mm was simulated at a 45° flexion angle, which can occur clinically, the anatomical design showed edge contact, leading to higher contact pressure and reduced contact area. In contrast, the modified dome design demonstrated the lowest contact pressure and the greatest contact area under the same shifted conditions. Conclusion These findings suggest that the design of the patellar component significantly affects patellar biomechanics and stability. Specifically, the modified dome design showed improved biomechanical effects in clinically relevant scenarios. Therefore, patellar components with a modified dome design are expected to better manage PF joint pain and reduce complications in TKA.

Purpose: This study focused on analyzing the contact pressure and area on different patellar component designs in total knee arthroplasty (TKA) to evaluate biomechanics related to the patellofemoral (PF) joint. Materials and Methods: The patellar components studied included the dome design, modified dome design, and anatomical design implants. Using finite element analysis and mechanical testing, the pressure and area were evaluated. The first loading condition was simulated at flexion angles of 0°, 15°, 45°, 90°, 120°, and 150°. The second loading condition was simulated for a clinically relevant scenario, involving a 2-mm medial shift at a flexion angle of 45°. Results: For both the modified dome and anatomical designs, the contact area and pressure increased with the flexion angle. The dome design reached its maximum contact area at a flexion angle of 120°. Among the designs, the anatomical design had the largest contact area and a lower contact pressure compared to the dome and modified dome designs. However, when a medial shift of 2 mm was simulated at a 45° flexion angle, which can occur clinically, the anatomical design showed edge contact, leading to higher contact pressure and reduced contact area. In contrast, the modified dome design demonstrated the lowest contact pressure and the greatest contact area under the same shifted conditions. Conclusion These findings suggest that the design of the patellar component significantly affects patellar biomechanics and stability. Specifically, the modified dome design showed improved biomechanical effects in clinically relevant scenarios. Therefore, patellar components with a modified dome design are expected to better manage PF joint pain and reduce complications in TKA.

Purpose: This study focused on analyzing the contact pressure and area on different patellar component designs in total knee arthroplasty (TKA) to evaluate biomechanics related to the patellofemoral (PF) joint. Materials and Methods: The patellar components studied included the dome design, modified dome design, and anatomical design implants. Using finite element analysis and mechanical testing, the pressure and area were evaluated. The first loading condition was simulated at flexion angles of 0°, 15°, 45°, 90°, 120°, and 150°. The second loading condition was simulated for a clinically relevant scenario, involving a 2-mm medial shift at a flexion angle of 45°. Results: For both the modified dome and anatomical designs, the contact area and pressure increased with the flexion angle. The dome design reached its maximum contact area at a flexion angle of 120°. Among the designs, the anatomical design had the largest contact area and a lower contact pressure compared to the dome and modified dome designs. However, when a medial shift of 2 mm was simulated at a 45° flexion angle, which can occur clinically, the anatomical design showed edge contact, leading to higher contact pressure and reduced contact area. In contrast, the modified dome design demonstrated the lowest contact pressure and the greatest contact area under the same shifted conditions. Conclusion These findings suggest that the design of the patellar component significantly affects patellar biomechanics and stability. Specifically, the modified dome design showed improved biomechanical effects in clinically relevant scenarios. Therefore, patellar components with a modified dome design are expected to better manage PF joint pain and reduce complications in TKA.

Purpose: This study focused on analyzing the contact pressure and area on different patellar component designs in total knee arthroplasty (TKA) to evaluate biomechanics related to the patellofemoral (PF) joint. Materials and Methods: The patellar components studied included the dome design, modified dome design, and anatomical design implants. Using finite element analysis and mechanical testing, the pressure and area were evaluated. The first loading condition was simulated at flexion angles of 0°, 15°, 45°, 90°, 120°, and 150°. The second loading condition was simulated for a clinically relevant scenario, involving a 2-mm medial shift at a flexion angle of 45°. Results: For both the modified dome and anatomical designs, the contact area and pressure increased with the flexion angle. The dome design reached its maximum contact area at a flexion angle of 120°. Among the designs, the anatomical design had the largest contact area and a lower contact pressure compared to the dome and modified dome designs. However, when a medial shift of 2 mm was simulated at a 45° flexion angle, which can occur clinically, the anatomical design showed edge contact, leading to higher contact pressure and reduced contact area. In contrast, the modified dome design demonstrated the lowest contact pressure and the greatest contact area under the same shifted conditions. Conclusion These findings suggest that the design of the patellar component significantly affects patellar biomechanics and stability. Specifically, the modified dome design showed improved biomechanical effects in clinically relevant scenarios. Therefore, patellar components with a modified dome design are expected to better manage PF joint pain and reduce complications in TKA.

Purpose: This study focused on analyzing the contact pressure and area on different patellar component designs in total knee arthroplasty (TKA) to evaluate biomechanics related to the patellofemoral (PF) joint. Materials and Methods: The patellar components studied included the dome design, modified dome design, and anatomical design implants. Using finite element analysis and mechanical testing, the pressure and area were evaluated. The first loading condition was simulated at flexion angles of 0°, 15°, 45°, 90°, 120°, and 150°. The second loading condition was simulated for a clinically relevant scenario, involving a 2-mm medial shift at a flexion angle of 45°. Results: For both the modified dome and anatomical designs, the contact area and pressure increased with the flexion angle. The dome design reached its maximum contact area at a flexion angle of 120°. Among the designs, the anatomical design had the largest contact area and a lower contact pressure compared to the dome and modified dome designs. However, when a medial shift of 2 mm was simulated at a 45° flexion angle, which can occur clinically, the anatomical design showed edge contact, leading to higher contact pressure and reduced contact area. In contrast, the modified dome design demonstrated the lowest contact pressure and the greatest contact area under the same shifted conditions. Conclusion These findings suggest that the design of the patellar component significantly affects patellar biomechanics and stability. Specifically, the modified dome design showed improved biomechanical effects in clinically relevant scenarios. Therefore, patellar components with a modified dome design are expected to better manage PF joint pain and reduce complications in TKA.

Background: Inhibitory effects of denosumab on bone remodeling are reversible and disappear once treatment is discontinued. Herein, we examined whether and to what extent delayed denosumab administration is also associated with fracture risk using nation-wide data. Methods: The study cohort included women aged 45 to 89 years who were started on denosumab for osteoporosis between October 2017 and December 2019 using data from the Korean Health Insurance Review and Assessment service. Participants were stratified according to the time of their subsequent denosumab administration from the last denosumab administration, including those with within 30 days early dosing (ED30), within the planned time of 180–210 days (referent), within 30–90 days of delayed dosing (DD90), within 90–180 days of delayed dosing (DD180), and longer than 181 days of delayed dosing (DD181+). The primary outcome was the incidence of all clinical fractures. Results: A total of 149,199 participants included and 2,323 all clinical fractures (including 1,223 vertebral fractures) occurred. The incidence of all fractures was significantly higher in the DD90 compared to reference group (hazard ratio [HR], 1.2; 95% confidence interval [CI], 1.1 to 1.4). The risk of all fracture was even higher in the longer delayed DD180 group (HR, 1.9; 95% CI, 1.6 to 2.3) and DD181+ group (HR, 1.8; 95% CI, 1.5 to 2.2). Increased risks of fractures with delayed dosing were consistently observed for vertebral fractures. Conclusion Delayed denosumab dosing, even by 1 to 3 months, was significantly associated with increased fracture risk. Maintaining the correct dosing schedule should be emphasized when starting denosumab.

Background: Inhibitory effects of denosumab on bone remodeling are reversible and disappear once treatment is discontinued. Herein, we examined whether and to what extent delayed denosumab administration is also associated with fracture risk using nation-wide data. Methods: The study cohort included women aged 45 to 89 years who were started on denosumab for osteoporosis between October 2017 and December 2019 using data from the Korean Health Insurance Review and Assessment service. Participants were stratified according to the time of their subsequent denosumab administration from the last denosumab administration, including those with within 30 days early dosing (ED30), within the planned time of 180–210 days (referent), within 30–90 days of delayed dosing (DD90), within 90–180 days of delayed dosing (DD180), and longer than 181 days of delayed dosing (DD181+). The primary outcome was the incidence of all clinical fractures. Results: A total of 149,199 participants included and 2,323 all clinical fractures (including 1,223 vertebral fractures) occurred. The incidence of all fractures was significantly higher in the DD90 compared to reference group (hazard ratio [HR], 1.2; 95% confidence interval [CI], 1.1 to 1.4). The risk of all fracture was even higher in the longer delayed DD180 group (HR, 1.9; 95% CI, 1.6 to 2.3) and DD181+ group (HR, 1.8; 95% CI, 1.5 to 2.2). Increased risks of fractures with delayed dosing were consistently observed for vertebral fractures. Conclusion Delayed denosumab dosing, even by 1 to 3 months, was significantly associated with increased fracture risk. Maintaining the correct dosing schedule should be emphasized when starting denosumab.

Objective: This study was performed to evaluate the efficacy and safety of lurasidone (160 mg/day) compared to quetiapine XR (QXR; 600 mg/day) in the treatment of acutely psychotic patients with schizophrenia. Methods: Patients were randomly assigned to 6 weeks of double-blind treatment with lurasidone 160 mg/day (n=105) or QXR 600 mg/day (n=105). Primary efficacy measure was the change from baseline to week 6 in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impressions severity (CGI-S) score. Adverse events, body measurements, and laboratory parameters were assessed. Results: Lurasidone demonstrated non-inferiority to QXR on the PANSS total score. Adjusted mean±standard error change at week 6 on the PANSS total score was -26.42±2.02 and -27.33±2.01 in the lurasidone and QXR group, respectively. The mean difference score was -0.91 (95% confidence interval -6.35–4.53). The lurasidone group showed a greater reduction in PANSS total and negative subscale on week 1 and a greater reduction in end-point CGI-S score compared to the QXR group. Body weight, body mass index, and waist circumference in the lurasidone group were reduced, with significantly lower mean change compared to QXR. Endpoint changes in glucose, cholesterol, triglycerides, and low-density lipoprotein levels were also significantly lower. The most common adverse drug reactions with lurasidone were akathisia and nausea. Conclusion Lurasidone 160 mg/day was found to be non-inferior to QXR 600 mg/day in the treatment of schizophrenia with comparable efficacy and tolerability. Adverse effects of lurasidone were generally tolerable, and beneficial effects on metabolic parameters can be expected.

Background/Aims: Optimal risk stratification based on simplified geriatric assessment to predict treatment-related toxicity and survival needs to be clarified in older patients with diffuse large B-cell lymphoma (DLBCL). Methods: This multicenter prospective cohort study enrolled newly diagnosed patients with DLBCL (≥ 65 yr) between September 2015 and April 2018. A simplified geriatric assessment was performed at baseline using Activities of Daily Living (ADL), Instrumental ADL (IADL), and Charlson’s Comorbidity Index (CCI). The primary endpoint was event-free survival (EFS). Results: The study included 249 patients, the median age was 74 years (range, 65-88), and 125 (50.2%) were female. In multivariable Cox analysis, ADL, IADL, CCI, and age were independent factors for EFS; an integrated geriatric score was derived and the patients stratified into three geriatric categories: fit (n = 162, 65.1%), intermediate-fit (n = 25, 10.0%), and frail (n = 62, 24.9%). The established geriatric model was significantly associated with EFS (fit vs. intermediate-fit, HR 2.61, p < 0.001; fit vs. frail, HR 4.61, p < 0.001) and outperformed each covariate alone or in combination. In 87 intermediate-fit or frail patients, the relative doxorubicin dose intensity (RDDI) ≥ 62.4% was significantly associated with worse EFS (HR, 2.15, 95% CI 1.30–3.53, p = 0.002). It was related with a higher incidence of grade ≥ 3 symptomatic non-hematologic toxicities (63.2% vs. 27.8%, p < 0.001) and earlier treatment discontinuation (34.5% vs. 8.0%, p < 0.001) in patients with RDDI ≥ 62.4% than in those with RDDI < 62.4%. Conclusions This model integrating simplified geriatric assessment can risk-stratify older patients with DLBCL and identify those who are highly vulnerable to standard dose-intensity chemoimmunotherapy.