BACKGROUND:The superiority of medial unicompartmental knee arthroplasty (mUKA) versus total knee arthroplasty (TKA) for isolated anteromedial knee osteoarthritis (AMOA) remains a subject of ongoing debate. We present the 2-year results of a multicenter, randomized trial comparing the patient-reported and clinical outcomes of these 2 implant types in the treatment of AMOA. METHODS:This double-blinded superiority trial recruited patients with severe AMOA at 10 arthroplasty centers and randomized them to undergo either mUKA or TKA. The primary outcome was the average improvement in the Oxford Knee Score (OKS) over 2 years, analyzed by intention-to-treat. A range of patient-reported outcomes served as secondary outcomes. Death, revision, and other reoperations were analyzed as serious adverse events (SAEs). RESULTS:Between September 2017 and March 2021, 350 patients were randomized: 177 (79 female, 98 male; mean age, 67.7 ± 7.5 years) to mUKA and 173 (84 female, 89 male; mean age, 66.7 ± 7.8 years) to TKA. The average 2-year OKS improvement differed by 3.5 points (95% CI, 2.3 to 4.7; p < 0.001) in favor of mUKA, although this difference was below the generally accepted minimal clinically important difference (MCID) of 4 to 5 points. Ten of the 12 secondary outcomes favored mUKA, while the remaining 2 were nonsignificant. The differences in the Forgotten Joint Score (FJS) (14.1; 95% CI, 9.5 to 18.6), range of motion during the first 2 years (7.0°; 95% CI, 5.3° to 8.7°) and at 2 years (5.5°; 95% CI, 3.6° to 7.4°), Knee injury and Osteoarthritis Outcome Score (KOOS) symptoms score (10.3; 95% CI, 7.8 to 12.8), and Short Form-36 (SF-36) bodily pain score (7.6; 95% CI, 4.1 to 11.1) all favored mUKA and reached the MCID. Non-revision reoperations were performed in 4 patients (2.3%) after mUKA and in 12 patients (6.9%) after TKA (9 of the 12 underwent manipulation under anesthesia); the difference was 4.7% (95% CI, 0.2% to 9.8%). There were no differences in the rates of revision or death between the groups. CONCLUSIONS:Averaged over the 2-year follow-up, mUKA demonstrated minor advantages that did not achieve clear clinical superiority on the basis of the OKS difference. However, the FJS, range of motion, KOOS symptoms score, and SF-36 bodily pain score all demonstrated differences in favor of mUKA that were clinically meaningful. The overall findings suggest that mUKA and TKA yield similarly favorable short-term results, with small advantages for mUKA. LEVEL OF EVIDENCE:Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Background: The superiority of medial unicompartmental knee arthroplasty (mUKA) versus total knee arthroplasty (TKA) for isolated anteromedial knee osteoarthritis (AMOA) remains a subject of ongoing debate. We present the 2-year results of a multicenter, randomized trial comparing the patient-reported and clinical outcomes of these 2 implant types in the treatment of AMOA. Methods: This double-blinded superiority trial recruited patients with severe AMOA at 10 arthroplasty centers and randomized them to undergo either mUKA or TKA. The primary outcome was the average improvement in the Oxford Knee Score (OKS) over 2 years, analyzed by intention-to-treat. A range of patient-reported outcomes served as secondary outcomes. Death, revision, and other reoperations were analyzed as serious adverse events (SAEs). Results: Between September 2017 and March 2021, 350 patients were randomized: 177 (79 female, 98 male; mean age, 67.7 ± 7.5 years) to mUKA and 173 (84 female, 89 male; mean age, 66.7 ± 7.8 years) to TKA. The average 2-year OKS improvement differed by 3.5 points (95% CI, 2.3 to 4.7; p < 0.001) in favor of mUKA, although this difference was below the generally accepted minimal clinically important difference (MCID) of 4 to 5 points. Ten of the 12 secondary outcomes favored mUKA, while the remaining 2 were nonsignificant. The differences in the Forgotten Joint Score (FJS) (14.1; 95% CI, 9.5 to 18.6), range of motion during the first 2 years (7.0°; 95% CI, 5.3° to 8.7°) and at 2 years (5.5°; 95% CI, 3.6° to 7.4°), Knee injury and Osteoarthritis Outcome Score (KOOS) symptoms score (10.3; 95% CI, 7.8 to 12.8), and Short Form-36 (SF-36) bodily pain score (7.6; 95% CI, 4.1 to 11.1) all favored mUKA and reached the MCID. Non-revision reoperations were performed in 4 patients (2.3%) after mUKA and in 12 patients (6.9%) after TKA (9 of the 12 underwent manipulation under anesthesia); the difference was 4.7% (95% CI, 0.2% to 9.8%). There were no differences in the rates of revision or death between the groups. Conclusions: Averaged over the 2-year follow-up, mUKA demonstrated minor advantages that did not achieve clear clinical superiority on the basis of the OKS difference. However, the FJS, range of motion, KOOS symptoms score, and SF-36 bodily pain score all demonstrated differences in favor of mUKA that were clinically meaningful. The overall findings suggest that mUKA and TKA yield similarly favorable short-term results, with small advantages for mUKA. Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

BACKGROUND:Chronic postoperative pain after total knee replacement (TKR) is a major clinical problem. It is still unclear if specific inflammatory mediators are associated with long-term postoperative pain complications. The current exploratory study aimed to (1) evaluate a multiplex of inflammatory mediators 5 years after TKR surgery in patients with different degrees of postoperative pain intensities and (2) study any association of the markers with clinical pain intensity, cognitive and functional outcomes. METHODS:Plasma samples were collected 5 years after TKR surgery from 76 knee patients (43 females; 33 males) and analysed for 44 inflammatory markers. Pain (using visual analogue scale, VAS), the pain catastrophizing scale (PCS) and the Oxford knee score (OKS) were evaluated. Patients were categorized as high or low groups based on VAS, PCS and OKS scores. Associations between inflammatory markers, VAS, PCS and OKS were analysed and the marker expressions were compared between groups. RESULTS:Pearson's correlations found 12 biomarkers associated with VAS (p < 0.05), 4 biomarkers with PCS and 3 biomarkers with OKS (p < 0.05). Four markers were altered in patients suffering from high compared to low chronic postoperative pain, three markers were altered in high compared to low catastrophizers and three markers were altered in patients with poor functional scores (p < 0.05). CONCLUSIONS:The present exploratory study suggests that low-grade inflammation might be present in a subset of patients with high pain, high catastrophizing and low function 5 years after TKR. These exploratory results provide insights into some of the long-term postoperative complications after TKR surgery. SIGNIFICANCE STATEMENT:This exploratory study evaluated a subset of inflammatory markers and the association to clinical pain intensity, knee function and pain catastrophizing in patients 5 years after total knee replacement surgery. Our results provide insights into the understanding of the underlying mechanisms that may drive the long experience of pain after TKR surgery.

This study aims to evaluate and compare extremity-MRi with specialized radiography by measuring articular cartilage height in patients with knee osteoarthritis. A prospective study, including sixty patients. Measurements on MRi images, Rosenberg view, and coronal stress radiographs were performed. MRI was compared to specialized radiography. Measurements in the medial compartment showed negligible/weak correlation between MRi and Rosenber/varus stress. In the lateral compartment, MRi and the Rosenberg/valgus stress view were strongly correlated. We conclude that MRi cannot replace radiographs for the measurement of articular cartilage thickness. MRi should, however, be reserved for more unusual cases of atypical clinical findings.

In treatment of isolated medial unicondylar osteoarthritis of the knee, it is possible to choose between medial unicondylar knee arthroplasty (mUKA), or a total knee prosthesis (TKA). The demand for a blinded multicenter RCT with the comparison of mUKA and TKA has been increasing in recent years, to determine which prosthesis is better. Supporters of TKA suggest this treatment gives a more predictable and better result, whereas supporters of UKA suggest it is unnecessary to remove functional cartilage in other compartments. If the mUKA is worn or loosens, revision surgery will be relatively easy, whereas revision-surgery after a TKA can be more problematic. A double-blinded multicenter Randomized Clinical Trial setup is the aim of the study. 6 hospitals throughout all 5 municipal regions of Denmark will be participating in the study. 350 patients will be included prospectively. Follow-up will be with PROM-questionnaires and clinical controls up to 20 years. Results will be assessed in terms of 1) PROM-questionnaires, 2) Clinical assessment of knee condition, 3) cost analysis. To avoid bias, all participants except the theatre-staff will be blinded. OKS, KOOS, SF36, Forgotten Joint Score, EQ5D, UCLA activity scale, Copenhagen Knee ROM scale, and Anchor questions. Publications are planned at 2, 5 and 10 years after inclusion of the last patient. The development of variables over time will be analyzed by calculating the area under the curve (AUC) for the variable relative to the initial value, and comparisons of the between-group differences will be based on parametric statistics. In this study, we feel that we have designed a study that will address these concerns with a well-designed double-blinded multicentre RCT. ClinicalTrials.gov ID: NCT03396640 . Initial Release: 09/19/2017. Date of enrolment of first participant: 10/11/17.

ABSTRACTNon‐steroidal anti‐inflammatory drugs (NSAIDs) may delay bone healing. [Therefore, it is important to establish whether NSAID preparations delay bone healing and what correlations, if any, exist between different bone studies—DEXA—scanning, bone markers, roentgenology controls, and histological examination of newly formed bone]. The purpose of this prospective controlled study was to investigate whether ibuprofen affects bone mineral density, turnover biomarkers, and histomorphometric characteristics of the callus after a Colles' fracture. This study was a single‐center, triple‐blinded, randomized clinical trial. Ninety‐five patients (80 females) with displaced Colles' fracture, median age 65 (range 40–85) years were included in the study and operated on by external fixation from June 2012 through to June 2015. Eighty‐nine patients received interventional medicine and 83 completed the 1‐year follow‐up. The 7‐day ibuprofen group received 600 mg of ibuprofen three times a day (N = 29), the 3‐day ibuprofen group received ibuprofen for 3 days (N = 30) and a placebo for the following 4 days, and finally, the placebo group received a placebo for 7 days (N = 30). The primary outcome was the difference in bone mineral density between the ultra‐distal region of the injured and non‐injured radius at 3 months after surgery. The histomorphometric outcomes included the assessment of callus tissue volume and surface fractions at 6 weeks postoperatively. The biomarkers Osteocalcin and CrossLaps were measured at baseline, 1 week, 2 weeks, 6 weeks, 3 months, and 1 year. We included the results of the dropped‐out patients in the intention to treat analysis. There was no difference between treatment groups in bone mineral density, histomorphometric estimations, and changes in bone biomarkers. These findings may offer an indication of ibuprofen as a bone‐safe analgesic treatment in an acute fracture‐phase. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:545–554, 2020

Aims The aim of this study was to investigate the incidence of knee arthroplasty and arthroscopy following patellar fractures, and to compare this with an age- and gender-matched group without a prior patellar fracture. Patients and Methods A national matched cohort study based on the Danish National Patient Register including all citizens of Denmark (approximately 5.3 million) was undertaken. A total of 6096 patients who sustained a patellar fracture in Denmark between 1 January 1996 and 31 December 2000 were included. The median age of these patients was 50.6 years (interquartile range (IQR) 28.5 to 68.9); 49.1% were women. Patients were followed-up until 31 December 2015, with regard to treatment with knee arthroplasty and/or knee arthroscopy. Results Patients with a patellar fracture had an increased risk of knee arthroplasty (hazard ratio (HR) 1.83, 95% confidence interval (CI) 1.57 to 2.13) compared with citizens without a patellar fracture, and the effect was strongest during the first five years (HR 3.02, 95% CI 2.26 to 4.03). Patients with a patellar fracture also had a higher risk of knee arthroscopy (HR 3.94, 95% CI 3.49 to 4.46), and the effect was highest during the first five years after the fracture (HR 7.40, 95% CI 6.32 to 8.66). Conclusion Patellar fractures are associated with an increased risk of knee arthroplasty and knee arthroscopy. The consequences of a patellar fracture may be more severe than previously considered, and patients must expect a lifelong increased risk of knee arthroplasty. Cite this article: Bone Joint J 2018;100-B:1477–81.

Study Design. A comparative study of radiation dose measured in anthropomorphic phantoms. Objectives. The aim of this study was to first report the first organ dose and effective dose measurements in anthropomorphic phantoms using the new EOS imaging micro-dose protocol in full-spine examinations, and to compare these measurements of radiation dose to measurements in the EOS standard-dose protocol and conventional digital radiology (CR). Summary of Background Data. Few studies evaluating organ dose and effective dose for the EOS low-dose scanner exist, and mainly for the standard-dose protocol. To the best of our knowledge, no studies of effective dose based on anthropomorphic phantom measurements exist for the new micro-dose protocol. Methods. Two anthropomorphic phantoms, representing a 5-year-old (pediatric) and a 15-year-old (adolescent). The phantoms were exposed to EOS micro-dose and standard-dose protocols during full-spine imaging. Additionally, CR in scoliosis settings was performed. For all modalities, organ doses were measured and effective doses were calculated using thermoluminescent dosimeters. Results. We found a 17-fold reduction (94%) of effective dose in micro-dose protocol compared with our CR system in the adolescent phantom. Micro-dose versus standard-dose protocol, showed a 6-fold reduction (83%), and for standard-dose versus our CR system a 2.8-fold reduction (64%) reduction of effective dose was observed. For the pediatric phantom, a 5-fold reduction (81%) of effective dose in micro-dose protocol compared to our CR system was observed. Micro-dose versus standard-dose protocol, showed a seven-fold (86%) reduction. However, we observed an increase in absorbed dose of 38% when comparing the EOS standard-dose protocol with our CR system. Conclusion. The EOS imaging micro-dose option exposes patients to lower radiation doses than any currently available modality for full-spine examination. Expected reduction of dose was established for the adolescent phantom when comparing CR and standard-dose protocol. However, no reduction of effective dose with EOS standard-dose protocol compared to our reference CR system was observed in the pediatric phantom. Level of Evidence: N/A

Study tibial plateau fractures associated with an increased risk of early knee arthroplasty? A matched cohort study of X0001 tibial plateau fractures with an average of XX1 years follow-up

The objective of this study was to evaluate the functional and radiological outcome after lateral tibial plateau fractures (Müller AO classification (AO) 41-B1, B2 and B3) treated with minimal invasive bone tamp reduction and percutaneous screw fixation.

Although epidemiologic studies of tibial plateau fractures have been conducted, none have included geographically defined populations or a validated fracture classification based on computed tomography (CT). The goals of this study were to provide up-to-date information on the incidence and basic epidemiology of tibial plateau fractures in a large unselected patient population and to report the mechanisms of injury involved and the distribution of fractures according to a validated CT-based fracture classification. The authors conducted a population-based epidemiologic study of all patients treated for tibial plateau fracture over a 6-year period from 2005 to 2010. The study was based on an average background population of 576,364 citizens. A retrospective review of hospital records was performed. During this time, a total of 355 patients were treated for tibial plateau fracture. This group included 166 men and 189 women, and mean age was 52.6 years (SD, 18.3). The most common fracture type was AO type 41-B3, representing 35% of all tibial plateau fractures. The second most common fracture type was AO type 41-C3, representing 17% of all tibial plateau fractures. The incidence of tibial plateau fractures was 10.3 per 100,000 annually. Compared with women, men younger than 50 years had a higher incidence of fractures. The incidence of fractures increased markedly in women older than 50 years but decreased in men older than 50 years. In both sexes, the highest frequency was between the ages of 40 and 60 years.

To follow a prospective cohort of consecutive patients with MRI-verified meniscal lesions to identify pre-treatment prognostic factors for long-term results following arthroscopic or conservative treatment.