This retrospective study compared cement penetration, the radiolucent line (RLL) incidence, and clinical outcomes in total knee arthroplasty (TKA) using high-viscosity cement (HVC) versus low-viscosity cement (LVC) with a minimum follow-up of two years. We hypothesized that LVC would result in superior cement penetration and a reduced RLL incidence compared with HVC without differences in clinical outcomes.A total of 100 patients (50 HVC, 50 LVC) who underwent TKA with the same implant design were included. Cement penetration was assessed in four tibial and two femoral zones. Clinical outcomes including the VAS, WOMAC, KSS, KOOS and FJS were evaluated preoperatively and at the final follow-up visit. Postoperative complications were recorded. LVC demonstrated significantly greater cement penetration in the posterior tibial zone (3.03 mm vs. vs 2.82 mm; p=0.005) and posterior femoral zone (1.76 mm vs.1.39 mm; p<0.000) than HVC, and no differences were observed in other zones. The RLL incidence and rates of complications including aseptic loosening and prosthetic joint infection were comparable between groups. Both groups showed significant postoperative improvements in the WOMAC, KSS, and KOOS, with no intergroup differences preoperatively and postoperatively. LVC demonstrated superior cement penetration in select zones, which may enhance implant fixation. However, there were no differences in the RLL incidence or clinical outcomes between the HVC and LVC groups.Both cements provided satisfactory fixation and clinical results, suggesting that either may be appropriate based on surgical preferences and fixation goals.

This retrospective study compared cement penetration, the radiolucent line (RLL) incidence, and clinical outcomes in total knee arthroplasty (TKA) using high-viscosity cement (HVC) versus low-viscosity cement (LVC) with a minimum follow-up of two years. We hypothesized that LVC would result in superior cement penetration and a reduced RLL incidence compared with HVC without differences in clinical outcomes.A total of 100 patients (50 HVC, 50 LVC) who underwent TKA with the same implant design were included. Cement penetration was assessed in four tibial and two femoral zones. Clinical outcomes including the VAS, WOMAC, KSS, KOOS and FJS were evaluated preoperatively and at the final follow-up visit. Postoperative complications were recorded. LVC demonstrated significantly greater cement penetration in the posterior tibial zone (3.03 mm vs. vs 2.82 mm; p=0.005) and posterior femoral zone (1.76 mm vs.1.39 mm; p<0.000) than HVC, and no differences were observed in other zones. The RLL incidence and rates of complications including aseptic loosening and prosthetic joint infection were comparable between groups. Both groups showed significant postoperative improvements in the WOMAC, KSS, and KOOS, with no intergroup differences preoperatively and postoperatively. LVC demonstrated superior cement penetration in select zones, which may enhance implant fixation. However, there were no differences in the RLL incidence or clinical outcomes between the HVC and LVC groups.Both cements provided satisfactory fixation and clinical results, suggesting that either may be appropriate based on surgical preferences and fixation goals.

This retrospective study compared cement penetration, the radiolucent line (RLL) incidence, and clinical outcomes in total knee arthroplasty (TKA) using high-viscosity cement (HVC) versus low-viscosity cement (LVC) with a minimum follow-up of two years. We hypothesized that LVC would result in superior cement penetration and a reduced RLL incidence compared with HVC without differences in clinical outcomes.A total of 100 patients (50 HVC, 50 LVC) who underwent TKA with the same implant design were included. Cement penetration was assessed in four tibial and two femoral zones. Clinical outcomes including the VAS, WOMAC, KSS, KOOS and FJS were evaluated preoperatively and at the final follow-up visit. Postoperative complications were recorded. LVC demonstrated significantly greater cement penetration in the posterior tibial zone (3.03 mm vs. vs 2.82 mm; p=0.005) and posterior femoral zone (1.76 mm vs.1.39 mm; p<0.000) than HVC, and no differences were observed in other zones. The RLL incidence and rates of complications including aseptic loosening and prosthetic joint infection were comparable between groups. Both groups showed significant postoperative improvements in the WOMAC, KSS, and KOOS, with no intergroup differences preoperatively and postoperatively. LVC demonstrated superior cement penetration in select zones, which may enhance implant fixation. However, there were no differences in the RLL incidence or clinical outcomes between the HVC and LVC groups.Both cements provided satisfactory fixation and clinical results, suggesting that either may be appropriate based on surgical preferences and fixation goals.

Osteoarthritis (OA) is a joint disorder caused by wear and tear of the cartilage that cushions the joints. It is a progressive condition that can cause significant pain and disability. Currently, there is no cure for OA, though there are treatments available to manage symptoms and slow the progression of the disease. A chondral defect is a common and devastating lesion that is challenging to treat due to its avascular and aneural nature. However, there are conventional therapies available, ranging from microfracture to cell-based therapy. Anyhow, its efficiency in cartilage defects is limited due to unclear cell viability. Exosomes have emerged as a potent therapeutic tool for chondral defects because they are a complicated complex containing cargo of proteins, DNA, and RNA as well as the ability to target cells due to their phospholipidic composition and the altering exosomal contents that boost regeneration potential. Exosomes are used in a variety of applications, including tissue healing and anti-inflammatory therapy. As in recent years, biomaterialsbased bio fabrication has gained popularity among the many printable polymer-based hydrogels, tissue-specific decellularized extracellular matrix might boost the effects rather than an extracellular matrix imitating environment, a short note has been discussed. Exosomes are believed to be the greatest alternative option for current cell-based therapy, and future progress in exosome-based therapy could have a greater influence in the field of orthopaedics. The review focuses extensively on the insights of exosome use and scientific breakthroughs centered OA.

Osteoarthritis (OA) is a joint disorder caused by wear and tear of the cartilage that cushions the joints. It is a progressive condition that can cause significant pain and disability. Currently, there is no cure for OA, though there are treatments available to manage symptoms and slow the progression of the disease. A chondral defect is a common and devastating lesion that is challenging to treat due to its avascular and aneural nature. However, there are conventional therapies available, ranging from microfracture to cell-based therapy. Anyhow, its efficiency in cartilage defects is limited due to unclear cell viability. Exosomes have emerged as a potent therapeutic tool for chondral defects because they are a complicated complex containing cargo of proteins, DNA, and RNA as well as the ability to target cells due to their phospholipidic composition and the altering exosomal contents that boost regeneration potential. Exosomes are used in a variety of applications, including tissue healing and anti-inflammatory therapy. As in recent years, biomaterialsbased bio fabrication has gained popularity among the many printable polymer-based hydrogels, tissue-specific decellularized extracellular matrix might boost the effects rather than an extracellular matrix imitating environment, a short note has been discussed. Exosomes are believed to be the greatest alternative option for current cell-based therapy, and future progress in exosome-based therapy could have a greater influence in the field of orthopaedics. The review focuses extensively on the insights of exosome use and scientific breakthroughs centered OA.

Osteoarthritis (OA) is a joint disorder caused by wear and tear of the cartilage that cushions the joints. It is a progressive condition that can cause significant pain and disability. Currently, there is no cure for OA, though there are treatments available to manage symptoms and slow the progression of the disease. A chondral defect is a common and devastating lesion that is challenging to treat due to its avascular and aneural nature. However, there are conventional therapies available, ranging from microfracture to cell-based therapy. Anyhow, its efficiency in cartilage defects is limited due to unclear cell viability. Exosomes have emerged as a potent therapeutic tool for chondral defects because they are a complicated complex containing cargo of proteins, DNA, and RNA as well as the ability to target cells due to their phospholipidic composition and the altering exosomal contents that boost regeneration potential. Exosomes are used in a variety of applications, including tissue healing and anti-inflammatory therapy. As in recent years, biomaterialsbased bio fabrication has gained popularity among the many printable polymer-based hydrogels, tissue-specific decellularized extracellular matrix might boost the effects rather than an extracellular matrix imitating environment, a short note has been discussed. Exosomes are believed to be the greatest alternative option for current cell-based therapy, and future progress in exosome-based therapy could have a greater influence in the field of orthopaedics. The review focuses extensively on the insights of exosome use and scientific breakthroughs centered OA.

Background: The Coronal Plane Alignment of the Knee (CPAK) classification system has been developed as a comprehensive system that describes 9 coronal plane phenotypes based on constitutional limb alignment and joint line obliquity (JLO). Due to the characteristics of Asian populations, which show more varus and wider distribution in lower limb alignment than other populations, modification of the boundaries of the arithmetic hip-knee-ankle angle (aHKA) and JLO should be considered. The purpose of this study was to determine the knee phenotype in a Korean population based on the original CPAK and modified CPAK classification systems. Methods: We reviewed prospectively collected data of 500 healthy and 500 osteoarthritic knees between 2021 and 2023 using radiographic analysis and divided them based on the modified CPAK classification system by widening the neutral boundaries of the aHKA to 0° ± 3° and using the actual JLO as a new variable. Using long-leg standing weight-bearing radiographs, 6 radiographic parameters were measured to evaluate the CPAK type: the mechanical HKA angle, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), aHKA, JLO, and actual JLO. Results: From 2 cohorts of 1,000 knees, the frequency distribution representing all CPAK types was different between the healthy and arthritic groups. The most common categories were type II (38.2%) in the healthy group and type I (53.8%) in the arthritic group based on the original CPAK classification. The left and upward shift in the distribution of knee phenotypes in the original classification was corrected evenly after re-establishing the boundaries of a neutral aHKA and the actual JLO. According to the modified CPAK classification system, the most common categories were type II (35.2%) in the healthy group and type I (38.0%) in the arthritic group. Conclusions Although the modified CPAK classification corrected the uneven distribution seen when applying the original classification system in a Korean population, the most common category was type I in Korean patients with osteoarthritic knees in both classification systems. Furthermore, there were different frequencies of knee phenotypes among healthy and arthritic knees.

Background: Revision total knee arthroplasty (RTKA) is a technically demanding procedure for failed primary TKA. Posterior-stabilized (PS) and constrained condylar knee (CCK) articulations are commonly used for RTKA, but comparison of these articulations in RTKA is scarce. The aim of this study was to compare survival rates and clinical outcomes of RTKAs using PS articulation and CCK articulation. Methods: This study conducted a retrospective analysis of 86 RTKAs (PS, n = 41; CCK, n = 45) with a mean follow-up of 9.15 ± 2.79 years. Clinical outcomes were evaluated using the Hospital for Special Surgery score, Knee Society Score, and The Western Ontario and McMaster Universities Osteoarthritis Index at final follow-up. The survival rate of each group was analyzed by KaplanMeier survival analysis and Cox-hazard progression model. Results: Clinical outcomes were improved in both groups without significant difference. Twelve patients had orthopedic complications (4 in PS group and 8 in CCK group). Eight of them underwent re-RTKA (3 in PS group and 5 in CCK group). The articulation design did not influence the failure. The estimated 10-year survival rate was 92.7% in the PS group and 88.2% in the CCK group with no significant difference (p = 0.60). Also in septic failure, there was no significant difference in survival rate (92.7% in PS group and 92.5% in CCK group, p = 0.87). The hazard ratio in the PS group was not significantly different (p = 0.607). Conclusions In RTKA, both PS and CCK showed similar survival rates and clinical outcomes at a mean follow-up of 9.2 years. Implant articulation did not affect the outcomes when properly indicated

Background: The number of revision total knee arthroplasty (TKA) has been increasing. Although many studies have analyzed the causes of revision TKA in Western countries, a limited number of studies have analyzed changes in causes of or trends in revision TKA in Asia. This study analyzed and determined the frequency and causes of failures after TKA in our hospital. We also analyzed the differences and trends over the past 17 years. Methods: A total of 296 revision TKAs performed in a single institution from 2003 to 2019 were analyzed. During the 17-year study period, patients who had undergone primary TKA between 2003 and 2011 were classified into a past group, while those who had undergone primary TKA from 2012 to 2019 were classified into a recent group. A revision performed within 2 years after primary TKA was defined as early revision. Further, differences in causes of revision TKA according to the interval from primary TKA to revision TKA were determined. The causes of revision TKA were analyzed through a comprehensive analysis of patients’ medical records. Results: Overall, infection was the most common cause of failure (151/296 cases, 51.0%). Compared to the past group, the recent group had a relatively higher proportion of patients undergoing revision TKA for mechanical loosening (past group, 19.1% vs.recent group, 31.9%) and instability (11.2% vs. 13.5%) and a relatively lower proportion of patients undergoing revision TKA for infection (56.2% vs. 48.8%), polyethylene (PE) wear (9.0% vs. 2.9%), osteolysis (2.2% vs. 1.9%), and malalignment (2.2% vs. 1.0%).On comparison according to the interval from primary TKA to revision TKA, the rate of infection relatively decreased, whereas the rate of mechanical loosening and instability relatively increased in the late revision TKA compared to the early revision TKA. Conclusions Infection and aseptic loosening were the most common reasons of revision TKA in both past and recent groups.Compared to the past, revision TKA due to PE wear has decreased significantly and revision TKA due to mechanical loosening has relatively increased recently. Orthopedic surgeons need to be aware of recent trends in mechanisms of failure and should try to recognize and address the probable causes in TKA

Background: Computer-assisted surgery, including robotic and navigational total knee arthroplasty (TKA), has been proposed as a technique used to improve alignment of implants. The purpose of this study was to compare the clinical and radiological outcomes during a minimum follow-up period of 10 years among robotic, navigational, and conventional TKA. Methods: A total of 855 knees (robotic group, 194; conventional group, 270; and navigational group, 391) were available for physical and radiological examinations over a mean follow-up period of 10 years. The survival rate was analyzed using the KaplanMeier method based on the survival endpoint. The Hospital for Special Surgery score, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Society Score, and range of motion were used for clinical evaluation. The hip-knee-ankle (HKA) axis angle, the coronal inclination of femoral and tibial components, and the presence of radiolucent lines were also assessed at the final follow-up. Results: All clinical assessments at the final follow-up revealed improvements in the three groups without any significant difference among the groups (p> 0.05). The cumulative 10-year survival rate was 97.4% in the robotic group, 96.6% in the conventional group, and 98.2% in the navigational group, with no significant difference (p = 0.447). The rates of complication-associated surgery were not significantly different among the groups (p = 0.907). Only the proportion of outliers in the HKA axis angle showed a significant difference (p = 0.001), but other radiological outcomes were not significantly different among the three groups. Conclusions Our study demonstrated satisfactory survival rates for robotic, navigational, and conventional TKAs and similar clinical outcomes during the long-term follow-up. Larger studies with continuous serial data are needed to confirm these findings.