To describe short-term patient-reported and MRI outcomes after single-stage revision ACL reconstruction using Achilles tendon allografts with calcaneal bone blocks and to explore differences associated with additional InternalBrace augmentation. This prospective randomized exploratory pilot trial included patients undergoing first-time revision ACL reconstruction. Participants were allocated by simple 1:1 randomization to reconstruction with or without InternalBrace augmentation. Thirty participants with final follow-up were analyzed, including 16 in the InternalBrace group and 14 in the non-InternalBrace group. The prespecified primary outcomes were patient-reported outcome measures comprising the IKDC, Lysholm, Tegner Activity Scale, KOOS subscales, and SF-36 Physical and Mental Component Summary scores. Longitudinal patient-reported outcomes were analyzed using baseline-adjusted linear mixed-effects models including treatment group, follow-up visit, and their interaction. P values across the primary patient-reported outcomes were adjusted using the Benjamini–Hochberg procedure. MRI graft appearance, tunnel diameters, range of motion, and clinical stability findings were secondary outcomes. IKDC, Lysholm, all KOOS subscales, and the SF-36 Physical Component Summary score improved from baseline to final follow-up after false-discovery-rate adjustment, whereas Tegner activity did not change significantly and the SF-36 Mental Component Summary score decreased. At 54 weeks, the adjusted IKDC score was 78.9 in the no-InternalBrace group and 77.5 in the InternalBrace group, corresponding to an adjusted between-group difference of − 1.4 points (95% CI, − 10.4 to 7.6; p = 0.754). No patient-reported outcome showed a significant 54-week between-group difference or treatment-by-time interaction after multiplicity adjustment. MRI classified 15 grafts as tight, 10 as elongated, and 5 as insufficient; MRI classification did not differ significantly between groups (simulated Fisher exact p = 0.231). Mean active flexion was 136.5° without InternalBrace and 135.3° with InternalBrace. Patient-reported knee outcomes improved at short-term follow-up, although half of the grafts were classified as elongated or insufficient on MRI. No clear short-term advantage of InternalBrace augmentation was identified in patient-reported outcomes, range of motion, clinical stability, or MRI classification. The small sample, short follow-up, absence of instrumented laxity measurements, and wide confidence intervals preclude conclusions regarding equivalence or definitive treatment effectiveness. Trial registration: ClinicalTrials.gov, NCT07564336. Retrospectively registered on 27/04/2026.

Graft choice in primary anterior cruciate ligament (ACL) reconstruction remains controversial. While hamstring autografts are common, allografts offer advantages such as no donor site morbidity and reduced operation time. This study aimed to compare the clinical, functional and health-related quality of life (HRQOL) outcomes of hamstring allografts vs. autografts in primary ACL reconstruction. In this single-center randomized controlled trial, patients undergoing primary ACL reconstruction were randomized to receive either a hamstring allograft or autograft. Clinical evaluation and patient-reported outcome measures (PROMs), including the International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Short Form (SF)-36 Health survey, were collected preoperatively and at multiple follow-ups to 12 months. Operation time and postoperative magnetic resonance imaging (MRI) scans at 12 months were also analyzed. The final cohort included 25 patients (13 allograft, 12 autograft). At 12 months, no statistically significant differences between groups were detected for any PROM. Mean IKDC scores were 83.0 ± 7.2 in the allograft group and 87.2 ± 5.0 in the autograft group (p = 0.12). Both groups demonstrated improvement in patient-reported functional outcomes; however, objective instrumented laxity testing was not performed. Mean operation time was significantly shorter for the allograft group (61.6 ± 11.4 min) compared to the autograft group (83.0 ± 13.6 min; p < 0.001). In this small pilot randomized cohort of patients aged 27 years and older, no statistically significant short-term differences in PROMs were detected between hamstring allograft and autograft ACL reconstruction at 12 months. Allograft use was associated with significantly shorter operative time. These findings should be interpreted cautiously because the study was not powered to demonstrate equivalence or noninferiority and longer term follow-up with objective laxity testing is required to assess graft durability and stability.

PURPOSE:Graft choice in primary anterior cruciate ligament (ACL) reconstruction remains controversial. While hamstring autografts are common, allografts offer advantages such as no donor site morbidity and reduced operation time. This study aimed to compare the clinical, functional and health-related quality of life (HRQOL) outcomes of hamstring allografts vs. autografts in primary ACL reconstruction. METHODS:In this single-center randomized controlled trial, patients undergoing primary ACL reconstruction were randomized to receive either a hamstring allograft or autograft. Clinical evaluation and patient-reported outcome measures (PROMs), including the International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Short Form (SF)-36 Health survey, were collected preoperatively and at multiple follow-ups to 12 months. Operation time and postoperative magnetic resonance imaging (MRI) scans at 12 months were also analyzed. RESULTS:The final cohort included 25 patients (13 allograft, 12 autograft). At 12 months, no statistically significant differences between groups were detected for any PROM. Mean IKDC scores were 83.0 ± 7.2 in the allograft group and 87.2 ± 5.0 in the autograft group (p = 0.12). Both groups demonstrated improvement in patient-reported functional outcomes; however, objective instrumented laxity testing was not performed. Mean operation time was significantly shorter for the allograft group (61.6 ± 11.4 min) compared to the autograft group (83.0 ± 13.6 min; p < 0.001). CONCLUSION:In this small pilot randomized cohort of patients aged 27 years and older, no statistically significant short-term differences in PROMs were detected between hamstring allograft and autograft ACL reconstruction at 12 months. Allograft use was associated with significantly shorter operative time. These findings should be interpreted cautiously because the study was not powered to demonstrate equivalence or noninferiority and longer term follow-up with objective laxity testing is required to assess graft durability and stability.

This study investigated the association of preoperative 25-hydroxy (25 (OH)) vitamin D levels with postoperative complications in osteoporotic hip fracture patients following surgery. We hypothesized that patients with low concentrations of 25 (OH) vitamin D might have an increased risk of developing adverse outcomes. Between January 2019 and December 2020, a retrospective observational study was conducted, including low-energy fragility fractures at the proximal femur. Regarding preoperative 25 (OH) vitamin D levels, patients were divided into two groups (<30 ng/mL and ≥30 ng/mL). Early and late postoperative complications were assessed and graded according to the Clavien–Dindo classification system. Logistic regression analysis was performed to demonstrate the association between preoperative 25 (OH) vitamin D levels (<30 ng/mL, ≥30 ng/mL) and postoperative complications after adjusting for age and sex. Of 314 patients, 222 patients (70.7%) had a 25 (OH) vitamin D level of <30 ng/mL. The mean serum 25 (OH) vitamin D level was 22.6 ng/mL (SD 13.2). In 116 patients (36.9%), postoperative complications were observed, with the most occurring in the short term (95 patients, 30.2%). Late postoperative complications were present in 21 patients (6.7%), most graded as Clavien I (57.1%). Logistic regression analysis identified a low vitamin D level (<30 ng/mL) as an independent risk factor for early postoperative complications (OR 2.06, 95% CI 1.14–3.73, p = 0.016), while no significant correlation was found in late complications (OR 1.08, 95% CI 0.40–2.95, p = 0.879). In conclusion, preoperative 25 (OH) vitamin D serum level might be an independent predictor for early postoperative complications. However, future studies are warranted to determine risk factors for long-term complications and establish appropriate intervention strategies.

Obesity is strongly associated with mortality and morbidity, but there is a lack of data on its impact on health-related quality of life (HRQoL) across different age groups. Therefore, this study’s objective was to determine the association between body mass index (BMI) and HRQoL in the Austrian adult population based on age groups using the 36-Item Short Form (SF-36) survey. Methods: The SF-36 survey was sent to 500 randomly assigned Austrian adults (response rate: 80.6%). This study assessed HRQoL subscale and component scores based on gender, level of education, smoking status, and alcohol consumption in 403 participants. Results: Increasing BMI is associated with a negative impact on all domains of physical health and social function. The study uncovered substantial variations in the impact of increasing BMI on HRQoL across different age groups, with a pronounced effect observed in the physical components, particularly among individuals aged 65–74. Conclusions: BMI is negatively associated with the physical aspects of HRQoL and social function, affecting various adult age groups differently. Consequently, our results emphasize assessing different age groups and possible influencing factors on HRQoL, such as BMI, for further optimization in designing prevention programs against obesity.

Cellular responses induced by surgical procedure or ischemia-reperfusion injury (IRI) may severely alter transcriptome profiles and complicate molecular diagnostics. To investigate this effect, we characterized such pre-analytical effects in 143 non-malignant liver samples obtained from 30 patients at different time points of ischemia during surgery from two individual cohorts treated either with the Pringle manoeuvre or total vascular exclusion. Transcriptomics profiles were analyzed by Affymetrix microarrays and expression of selected mRNAs was validated by RT-PCR. We found 179 mutually deregulated genes which point to elevated cytokine signaling with NFκB as a dominant pathway in ischemia responses. In contrast to ischemia, reperfusion induced pro-apoptotic and pro-inflammatory cascades involving TNF, NFκB and MAPK pathways. FOS and JUN were down-regulated in steatosis compared to their up-regulation in normal livers. Surprisingly, molecular signatures of underlying primary and secondary cancers were present in non-tumor tissue. The reported inter-patient variability might reflect differences in individual stress responses and impact of underlying disease conditions. Furthermore, we provide a set of 230 pre-analytically highly robust genes identified from histologically normal livers (<2% covariation across both cohorts) that might serve as reference genes and could be particularly suited for future diagnostic applications.

This study assessed the quality of life (QOL) and the functional outcome in daily living in patients with a chronic, treatment-resistant periprosthetic joint infection (PJI) or osteomyelitis, living with a natural or iatrogenic sinus tract.METHODS:A follow-up examination in three national reference centers for septic bone and joint surgery was performed utilizing the Hospital Anxiety and Depression Scale (HADS-D/A), the Visual Analogue Scale (VAS), and the Short Form-36 (SF-36) score, including patients with a chronic sinus tract due to treatment-resistant PJI or osteomyelitis.RESULTS:In total, 48 patients were included, with a mean follow-up time of 43.1 ± 23.9 months. The mean SF-36 Mental Component Summary (MCS) was 50.2 (±12.3) and the Physical Component Summary (PCS) was 33.9 (±11.3). The mean HADS-D was 6.6 (±4.4) and HADS-A was 6.2 (±4.6), and the VAS was 3.4 (±2.6). The SF-36 MCS showed no significant differences between the study group and the standard population (47.0, p = 0.10), as well as the HADS-A. The PCS in the study population was significantly worse (50.0, p < 0.001), as was the HADS-D.CONCLUSIONS:A sinus tract represents a treatment option in selected cases with an acceptable QOL. The treatment should be considered for multimorbid patients with a high perioperative risk or if the bone or soft tissue quality prevents surgery.

Zusammenfassung Ziel Die Punktion großer Gelenke erfolgt einerseits zur Diagnostik und andererseits zur Behandlung von Gelenkspathologien. Mittels Punktion kann eine rasche Schmerzreduktion durch Entlastung von Ergüssen oder intraartikulären Hämatomen erfolgen. Das gewonnene Punktat erlaubt schon bei der Beschau mit dem freien Auge eine erste Einschätzung und in der Folge eine mikroskopisch-zytologische sowie mikrobiologische Befundung im Labor. Indikationen Die Punktion eines großen Gelenkes ist zur Diagnose und/oder Therapie bei entzündlichen, traumatischen oder postoperativen Gelenksveränderungen angezeigt. Diagnostische Punktionen dienen der Punktatgewinnung, der differentialdiagnostischen Schmerzausschaltung oder (selten) der Kontrastmittelapplikation für die Magnetresonanzarthrographie. Therapeutische Punktionen ermöglichen die Injektion von Medikamenten oder plättchenreichem Plasma (PRP) sowie die Entlastung bzw. Drainage von Ergüssen. Kontraindikationen Bei entzündlichen und insbesondere eitrigen Hautveränderungen im Punktionsbereich sind Gelenkpunktionen kontraindiziert. Obwohl keine absolute Kontraindikation, ist bei Einnahme blutgerinnungswirksamer Substanzen Vorsicht geboten. Operationstechnik Besonderes Augenmerk ist auf ein steriles Vorgehen zu legen. Unnötige Schmerzen können durch das sterile Setzen einer Lokalanästhesiequaddel, „sichere“ Punktionspunkte sowie vorsichtiges Hantieren mit den Punktionskanülen vermieden werden. Weiterbehandlung Punktate müssen entsprechend den lokalen, intrahospitalen Richtlinien zeitgerecht aufgearbeitet bzw. entsorgt werden. Die Punktionsstellen werden mit sterilem Pflasterverband abgedeckt, bei Medikamentenapplikation die Gelenke zur Verteilung des Wirkstoffes passiv durchbewegt. Danach erfolgt eine Kompressionsbehandlung mit elastischer Bandage von distal nach proximal bis über die Punktionsstelle zur Vermeidung von Nachblutungen oder sofortiger Ergussneubildung. Fakten Werden sämtliche Maßnahmen der Sterilität bei der Punktion großer Gelenke eingehalten, ist davon auszugehen, dass Infektionen mit 0,04–0,08 % (4 bis 8/10.000 Punktionen) nur sehr selten auftreten. Das Risiko für falsch positive Erregernachweise ist äußerst gering.

Objective Puncture of large joints is performed for diagnostic purposes on the one hand and for the treatment of joint pathologies on the other. Puncture can be used for rapid pain relief by relieving effusions or intra-articular hematomas. The obtained puncture specimen allows immediate visual assessment and subsequent microscopic-cytological and microbiological evaluation in the laboratory.Indications The indication for puncture of a large joint is for diagnosis and/or therapy of inflammatory, traumatic or postoperative joint problems. Diagnostic punctures are used to obtain punctate, to differentiate the location of pain or (rarely) to apply contrast medium for magnetic resonance arthrography. Therapeutic punctures allow the injection of drugs or platelet-rich plasma (PRP) as well as the relief or drainage of effusions.Contraindications If there are inflammatory skin alterations-especially purulent inflammation-joint punctures through these lesions are absolutely contraindicated. Special attention is necessary if the patients are on anticoagulants.Surgical technique Absolute sterile handling is mandatory. Unnecessary pain can be avoided by a sterile skin wheal of local anesthesia, safe puncture points, and careful handling of the cannulas.Postoperative management Joint aspiration material has to be handled according to the local, intrahospital rules in a timely manner. Puncture sites are covered with sterile dressings, and if intra-articular medication is administered, the joints have to be passively moved through the range of motion to distribute the medication. Thereafter, compression therapy from distally to proximally while also covering the puncture site avoids recurrence of swelling or hematoma.Facts If sterile conditions are guaranteed, infections rarely occur (0.04-0.08%, 4-8/10,000 cases). The risk of false-positive detection of microorganisms is extremely low.

Background Despite numerous scientific investigations, the tribological advantages of mobile bearing inserts have not been sustainably confirmed or refuted for modern knee prostheses in clinical studies. The purpose of this study was to compare fixed and mobile bearing inserts in order to draw conclusions regarding clinical benefits. Methods The present prospective single center cohort study of 2 non-randomized stratified groups consisted of 67 patients. All included patients received cemented total knee arthroplasty (Attune®) due to osteoarthritis. 34 patients were treated with a mobile and 33 patients with a fixed insert. The WOMAC score and the Visual Analogue Scale was used for the subjective assessment of success, while the Knee-Society-Score was used considering the Range of Motion for the objective assessment. The subjective and the clinical scores showed improvements for both compared groups postoperatively at 2 years of minimum follow-up. Results The overall postoperative results of the WOMAC score, the Knee-Society-Score and the Visual Analogue Scale presented no statistically difference between the compared groups ( p > 0,05). The postoperative ROM showed a superior improvement of 13.2° ± 18.4° in the mobile-bearing group versus 4.9° ± 18.4° ( p = 0.017) in the fixed-bearing group. The flexion of the knee joint was 114° ± 10.1° for the mobile-bearings and 109.2° ± 7.2° for fixed bearings ( p = 0.012). Conclusion According to the findings, both inserts showed overall promising postoperative results, in terms of objective as well as subjective parameters, without clinically relevant significant differences, except for ROM, which was superior in the mobile bearing group. The present clinical trial has been registered at the ISRCTN registry with the reverence number ISRCTN15117998 on 04/04/2022.

Summary Background Environmental stimuli and well-being are considered to be significant factors in patients’ rehabilitation. The aim of this study was to describe the effect of colors and art in hospital rooms on patients’ recovery after total hip or knee arthroplasty. Methods We performed a prospective randomized, controlled study including 80 patients. The intervention group was randomized to colored patient rooms while the control group received medical care in conventional patient rooms. Data were collected preoperatively and postoperatively (3 and 6 days after operation). We measured mood, anxiety and depression, quality of life (QOL) and pain. Results Significantly better QOL summary scores were measured in the intervention group (6 days postoperative) compared to the control group (physical component summary score 37.1 ± 5.0 vs. 34.1 ± 6.7; p = 0.029 and mental component summary score 51.6 ± 6.6 vs. 47.2 ± 8.4; p = 0.015). Postoperatively, we found decreased total mood scores in both groups showing better results for the intervention group without significant differences (p = 0.353; p = 0.711). Conclusion The use of colors in hospital rooms is an effective intervention to improve well-being and to enhance faster rehabilitation. We could demonstrate a positive effect of colors on patients’ postoperative QOL.

Summary Background Wound healing deficits and subsequent surgical site infections are potential complications after surgical procedures, resulting in increased morbidity and treatment costs. Closed-incision negative-pressure wound therapy (ciNPWT) systems seem to reduce postoperative wound complications by sealing the wound and reducing tensile forces. Materials and methods We conducted a collaborative English literature review in the PubMed database including publications from 2009 to 2020 on ciNPWT use in five surgical subspecialities (orthopaedics and trauma, general surgery, plastic surgery, cardiac surgery and vascular surgery). With literature reviews, case reports and expert opinions excluded, the remaining 59 studies were critically summarized and evaluated with regard to their level of evidence. Results Of nine studies analysed in orthopaedics and trauma, positive results of ciNPWT were reported in 55.6%. In 11 of 13 (84.6%), 13 of 15 (86.7%) and 10 of 10 (100%) of studies analysed in plastic, vascular and general surgery, respectively, a positive effect of ciNPWT was observed. On the contrary, only 4 of 12 studies from cardiac surgery discovered positive effects of ciNPWT (33.3%). Conclusion ciNPWT is a promising treatment modality to improve postoperative wound healing, notably when facing increased tensile forces. To optimise ciNPWT benefits, indications for its use should be based on patient- and procedure-related risk factors.

BACKGROUND:Despite the fact that about one third of patients with primary localized extremity soft tissue sarcoma (eSTS) will develop metastatic disease, abdominal metastases (AM) and retroperitoneal metastases (RM) constitute rare events. There is no clear consensus on how to achieve follow-up on patients with primary localized eSTS following curative resection, especially regarding the surveillance of potential AM/RM.AIM:To systematically analyse incidence, diagnosis, treatment and outcome of AM/RM in eSTS patients.METHODS:In this systematic review, 899 studies available in PubMed and published between 2000 and 2018 were screened, identifying 17 original articles focused on AM or RM in eSTS. Article selection was based on the PRISMA guidelines, using the search terms (abdominal metastasis AND soft tissue sarcoma) and (soft tissue sarcoma metastasis abdomen). All studies published between January 1, 2000 and December 31, 2018 were screened. Further articles were identified by cross-searching article references, with the final search date being February 18, 2019. Due to limited data and the different reporting techniques used, the present review focused on descriptive analysis of the included studies.RESULTS:Of the 17 studies included, six original articles reported on incidence ± diagnosis, therapy and outcome in AM and RM, whilst three original and eight case reports focused on diagnostic pathway, therapeutic procedures or outcomes without allowing conclusions regarding incidence of AM and RM. According to the former six studies, incidence of AM ranged from 0.9%-5.6% in patients with miscellaneous histological subtypes, and up to 12.1% in patients with myxoid liposarcoma. The most common histological subtypes that developed AM or RM were (myxoid) liposarcoma and leiomyosarcoma, but also rare subtypes such as epithelioid sarcoma, myxofibrosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumour had been reported to develop AM/RM. Surgery for AM/RM was performed in five of eight case-reports (62.5%) and in 20.8%-100.0% of original articles. In particular, patients with hepatic metastases undergoing metastasectomy had a survival benefit compared to patients treated with chemotherapy or best supportive care (> 3 years vs < 6 mo).CONCLUSION:Patients with eSTS should undergo surveillance with abdominal ultrasonography/computed tomography, or even whole-body-magnetic resonance imaging to detect AM/RM at an early stage.

Purpose Metaphyseal fixation in revision total knee arthroplasty (RTKA) is a very promising treatment option for extended bone defects. Currently published mid-term results remain limited. The purpose was to analyse the implant durability, the clinical and the radiological mid-term results in RTKA when using metaphyseal sleeves. Methods Clinical and radiological follow-up examinations were performed in 92 patients (93 knees) with RTKA using hybrid fixation technique (cementless sleeves and stem). Radiographic measurements regarding osseointegration at the bone–sleeve interface were performed and the range of motion (ROM), a subjective satisfaction score (SSS), the American Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as well as the SF-36 Health survey were examined. Bone defects were analysed using the Anderson Orthopaedic Research Institute (AORI) classification. Results No knee had to be revised due to aseptic loosening at the time of the follow-up (mean 6.3 years ± 2.3, minimum 2 years). Satisfactory radiographic osseointegration at the sleeve/bone interface was detected in 96.1% of cases. 17 knees (18.2%) had to be re-revised, 15 of them due to a recurrent infection and 2 due to aseptic reasons (mediolateral instability and a periprosthetic fracture). The median of the ROM (96°), SSS (8), KSS (87), WOMAC (9), SF-36 MCS (55) and SF-36 PCS (38) showed very satisfying results. Conclusion No case of aseptic loosening was found in this large series of RTKA with extended bone defects using metaphyseal sleeve fixation. In this large retrospective series, it has been shown that this technique is an excellent treatment option for extended bone defects in RTKA surgery. Level of evidence Retrospective cohort study, level III.

Purpose The purpose of this study was to compare the clinical and functional outcome scores following total knee arthroplasty (TKA) with two different systems. The hypothesis was that there is a difference between patients receiving the newer design than those receiving the predecessor. Methods Two hundred patients who underwent TKA were randomized into two groups: patients received either Attune TKA or PFC Sigma (both DePuy Synthes, Warsaw, IN). Clinically, the Knee Society Knee and Function Scores (KS and FS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Range of Motion (ROM) and Visual Analogue Scale (VAS) were evaluated and compared between the groups 2 years after surgery. 158 patients (80 in the Attune group and 78 in the PFC Sigma group) were available for follow-up. Results Through bivariate analysis using parametric and non-parametric statistical tests, no significant differences in postoperative KS, FS, WOMAC, ROM or VAS between the two groups were detected. Both groups significantly improved regarding all evaluated endpoints 2 years after surgery. Conclusions In the current study population, no difference in clinical outcome between the two systems was found. The expected benefits of design modifications could not be observed in clinical outcome scores 2 years postoperatively. Both designs are effective options for improving pain and function in end-stage osteoarthritis. Level of evidence I.

Introduction The aim of this study was to assess the prevalence of protein energy malnutrition (PEM) and correlation with poor post-operative outcome in the elderly undergoing primary total hip arthroplasty (THA). Hypothesis Patients with PEM would have inferior post-operative outcome after THA. Materials and method We retrospectively evaluated the nutritional status of 220 hospitalized patients undergoing THA, 65 years and older. PEM was assessed using serum albumin and total lymphocyte count (TLC). Studied outcome parameters were length of pre-operative and post-operative stay, complications up to six months after surgery and 12-month mortality. Clinical and demographic data were retrieved from medical records from the hospital database. Results The prevalence of PEM among patients undergoing THA was 12.3% (27/220). Patients with PEM were significantly older (mean age 81.3 ± 7.0, p < 0.001), had a lower BMI (24.7 ± 4.1 kg/m 2, p = 0.022), and showed more comorbid conditions (mean CCI 2.8 ± 2.0, p = 0.002) compared with well-nourished patients (age 75.6 ± 6.2, BMI 26.8 ± 4.3 kg/m 2, CCI: 1.7 ± 1.7). Length of pre-operative stay differed significantly ( p < 0.001) between PEM (median 7, range 1–36 days) and non PEM (median 1, range 1–22 days). In the PEM group, 12 (44.4%) patients had post-operative complications within six months after OP and 15 (7.8%) patients in the non PEM group (HR = 6.3, 95% CI 1.7–23.1). Conclusion We observed a higher post-operative complication rate for malnourished patients undergoing elective THA. These results underline the importance of pre-operative nutritional assessment in the elderly. Therefore, serum albumin and TLC are valuable clinical markers of PEM and the post-operative outcome.

Purpose Our aim was to assess the outcome with respect to cumulative revision rates of unicompartmental knee arthroplasty (UKA) by comparing published literature and arthroplasty registry data. Our hypothesis was that there is a superior outcome of UKA described in dependent clinical studies compared to independent studies or arthroplasty registers. Methods A systematic review of all clinical studies on UKA in the past decade was conducted with the main endpoint revision rate. Revision rate was calculated as "revision per 100 component years (CY)". The respective data were analysed with regard to a potential difference of the percentage of performed revision surgeries as described in dependent and independent clinical studies. Clinical data were further compared to arthroplasty registers in a systematic search algorithm. Results In total, 48 study cohorts fulfilled our inclusion criteria and revealed 1.11 revisions per 100 CY. This corresponds to a revision rate of 11.1% after 10 years. No deviations with regard to revision rates for UKA among dependent and independent clinical literature were detected. Data from four arthroplasty registers showed lower survival rates after 10 years compared to published literature without being significant. Conclusions The outcomes of UKA in dependent and independent clinical studies do not differ significantly and are in line with arthroplasty register datasets. We cannot confirm biased results and the authors recommend the use of UKAs in properly selected patients by experts in their field.