BACKGROUND:Total knee arthroplasty (TKA) has moved toward a more personalized approach, but achieving the ideal coronal alignment is still challenging, as most knees naturally change alignment throughout the range of motion. This study introduced the dynamic alignment of the knee (DyAK) classification, based on robotic hip-knee-ankle measurements in extension (rHKA-E) and flexion (rHKA-90F), and evaluated the clinical impact of changes in DyAK type. METHODS:This study analyzed 350 patients who underwent robotic TKA using functional alignment principles. The DyAK classification matrix included nine knee phenotypes, with neutral defined as -3 (varus) to 3° (valgus) in rHKA-E and rHKA-90F, respectively. Initial (precut) and final (postimplantation) DyAK types were compared to assess variations in dynamic coronal alignment and their clinical impact, Knee Society Score knee and function, Forgotten Joint Score-12, and Kujala Anterior Knee Pain Scale. RESULTS:Regarding the initial DyAK, type D1 was the most prevalent (58.3%), followed by type D2 (15.1%) and type D4 (9.2%). After implant placement, in the final DyAK, the distribution shifted, with type D5 becoming the most common (46.0%), while type D1 decreased to 26.9% and type D4 increased to 13.1%. Overall, 56.9% of patients experienced a change in DyAK type following TKA. Among them, 32.9% showed a modification in either rHKA-E or rHKA-90F, while 24.0% exhibited changes in both parameters. A statistically and clinically significant difference in the change in Knee Society Score knee was found, with better outcomes in patients who maintained their DyAK type compared with those who showed modifications in both rHKA-E and rHKA-90F (P = 0.004). CONCLUSIONS:Dynamic alignment of the knee is a clear, practical, and accurate classification. Integrating DyAK into clinical practice could be a step forward in the personalization of TKA, helping to optimize functional outcomes and improve the understanding of the dynamic nature of the joint. LEVEL OF EVIDENCE:Level III.
Implant-associated infections (IAIs) remain a major challenge in orthopaedic surgery, causing substantial morbidity, mortality, and healthcare costs. Antimicrobial implant coatings have emerged as a promising preventive strategy, but their comparative clinical benefit remains unclear. This study aimed to evaluate the effectiveness of antimicrobial coatings in preventing IAIs and to compare their clinical performance to uncoated implants. A systematic review and network meta-analysis was conducted in accordance with PRISMA guidelines. Medline, Embase, Scopus, and Web of Science were systematically searched for comparative studies evaluating antimicrobial implant coatings for the prevention of orthopaedic IAIs. The primary outcome was the incidence of postoperative IAIs, while secondary outcomes included complications, site-specific infections, causative organisms, use of antibiotic prophylaxis, operative time, time to infection, and implant survival. Random-effects network meta-analysis, subgroup analyses, and assessment of publication bias were performed to synthesize and compare treatment effects across coating types. Twenty-six studies encompassing 3,592 patients were included, of whom 1,576 received coated and 2,016 uncoated implants. Coating technologies included Defensive Antibacterial Coating (DAC) hydrogel, gentamicin, iodine, silver, antibiotic-loaded calcium sulfate, and gold-silver-palladium alloy. Overall, infection rates were lower in coated implants (26.9
Direct visual internal urethrotomy (DVIU) for short anterior urethral strictures is associated with a high rate of stricture recurrence. Optilume™ drug-coated balloon (ODCB) has recently emerged as a minimally invasive treatment alternative. However, comparative data between ODCB and DVIU are limited. This multicenter study aims to compare the two procedures in terms of functional outcomes and stricture-free survival (SFS) in patients with anterior urethral strictures. This multicenter retrospective study included 140 patients treated for anterior urethral stricture under 3 cm in length with either ODCB dilatation or internal urethrotomy. Data were collected from five European tertiary referral centers between November 2010 and April 2026. Stricture length was assessed by either cystoscopy, retrograde urethrography, or both. Stricture recurrence during follow-up was defined as symptomatic restenosis requiring reintervention. Multivariable Cox regression analysis was performed to identify predictors of recurrence. SFS was estimated using Kaplan-Meier estimates, with group comparisons assessed using the log-rank test. A total of 68 (48
Acute, traumatic meniscus tears are common and should be repaired whenever possible. However, the biological age of the patient, along with the specific tear morphology, may significantly influence the selection of the repair technique, expected clinical outcomes and the postoperative rehabilitation protocol. Risk factors for failure of meniscus repair, such as ligament laxity, need to be addressed to improve the healing potential of the meniscus. Biologic augmentation strategies, including bone marrow stimulation, platelet-rich plasma, fibrin clot, mesenchymal stem cells or meniscal wrapping, can be used to enhance healing and reduce failure of meniscus repair rates. However, the clinical evidence remains limited and of low quality. As such, the routine use of biologic augmentation in meniscus repair warrants critical evaluation. In patients with post-meniscectomy syndrome, meniscus allograft transplantation (MAT) may be a viable option to reduce pain and joint degeneration and improve knee function. Meniscus implants provide alternatives to traditional MAT; however, their long-term efficacy, chondroprotective effects and integration within the knee joint require further research. Meniscus reconstruction using tendon autografts has been described as an alternative treatment option in patients with meniscus loss. Emerging methods, such as gene therapy and repurposed drugs, demonstrate in vitro potential for advancing meniscal repair, although their clinical applications are still in their infancy. Future research is necessary to optimize meniscal repair techniques, enhance clinical efficacy, and ultimately, improve outcomes in patients. Level of Evidence Level V.
PURPOSE:This study aims to test whether week-long wrist accelerometry combined with deep learning can (i) distinguish healthy individuals from people with knee osteoarthritis (KOA), (ii) separate prodromal KOA from established KOA, and (iii) identify individuals who will receive a KOA diagnosis within 5 years. METHODS:We conducted a retrospective case-control study using the UK Biobank data set. After quality control, 102,120 participants with valid accelerometry were available; KOA was identified via ICD-10 M17.x codes (n = 7262). To reduce adiposity confounding, analyses were restricted to body mass index (BMI) ≥ 29, with controls matched to KOA on age, sex and BMI distributions. We used preprocessed, orientation-independent, hourly mean acceleration over a 24-h cycle and included month, sex, age and weight as covariates. A 1D convolutional neural network modelled daily activity profiles with embeddings for categorical covariates. Fivefold cross-validation assessed accuracy, macro F1, macro sensitivity and AUC. RESULTS:Balanced cohorts were formed for three tasks: healthy versus KOA (n = 3677 per class), prodromal versus diagnosed KOA (n = 1596 vs. 2081), and healthy vs prodromal within 5 years (n = 1369 per class). Daily activity patterns were similar across groups, with slightly lower daytime acceleration in KOA/prodromal participants. Model performance was moderate for healthy versus KOA (accuracy 63.5 ± 1.2%; AUC 0.672 ± 0.017) and healthy vs prodromal within 5 years (64.5 ± 0.5%; AUC 0.675 ± 0.019). Discrimination between prodromal and diagnosed KOA was close to random (54.6% ± 1.5%; AUC 0.552 ± 0.015). CONCLUSIONS:One week of wrist-worn accelerometry contains a reproducible signal associated with KOA and can flag elevated risk up to 5 years before diagnosis. Since existing KOA cannot be distinguished from prodromal KOA, it can be assumed that patients show altered movement patterns years before diagnosis. These findings highlight the clinical relevance of early, unobtrusive movement monitoring and support the potential of wearables as a scalable, low-cost component of population-level KOA screening. LEVEL OF EVIDENCE:Level II, prognostic study-lower-quality prospective cohort. The study uses a large, population-based prospective cohort (UK Biobank) with retrospective analytical methods; follow-up is high, but the study is a secondary analysis rather than a primary prospectively designed prognostic trial.
