Introduction: Total knee arthroplasty (TKA) is a good treatment for end-stage knee osteoarthritis (KOA). Approximately 60% of the patients are females, and 40% are males. This study analyzed pre- and postoperative angle differences in the range of motion (ROM), and the occurrence of complications with traditional posterior stabilization versus kinematic TKA in relation to gender. Methods: Data from 434 patients with primary cemented total knee arthroplasty from 2018 to 2021 were collected. Alpha and beta angles were determined pre- and postsurgery. The ROM was collected pre- and postoperatively and during follow-up. Additionally, perioperative complications, revision rate, and blood transfusion management were investigated. Results: The pre- and postoperative alpha-angle between men and women was significantly different, as was the level of alpha-angle correction between men and women (p = 0.001; p = 0.003). Same-gender differences in pre- to postoperative alpha-angles between traditional and kinematic TKA were shown (women (w): p = 0.001; men (m); p = 0.042). High postoperative alpha angles led to less ROM in traditional TKA for women (p = 0.008). No significant gender differences in ROM, perioperative complications, or revision surgery and transfusion rates were found. Conclusion: Despite high gender differences in pre- and postoperative angles, only female patients with traditional arthroplasty and high postoperative alpha angles showed less ROM in the follow-up. This leads to the assumption that gender-related pre- and postoperative angle differences, and the degree of angle correction, do not influence the ROM or perioperative occurrence of complications. Both designs present safe procedures for both genders with a wide spectrum of axis deformities.

Introduction: Total hip (THA) and knee arthroplasty (TKA) are surgical interventions for patients with primary and posttraumatic osteoarthritis. The present clinical investigation compared gender differences in THA and TKA. Methods: Data from 419 patients following primary THA and TKA were collected. The occurrence of systemic and surgery-related complications, the units of blood transfused, and the change in Hb were investigated. Hb was collected preoperatively and at 1, 2, 4 and 7 days postoperatively. Statistical analysis was performed using the software IBM SPSS 28. Results: There was no significant difference in surgery-related and general complications in men between THA and TKA. A significant difference between THA and TKA in systemic complications in women was observed. No significant difference between THA and TKA in related to surgery-related complications was evidenced. In men, no difference in Hb progression was observed. In women, a significant Hb drop was evidenced (p = 0.03). The rate of blood transfusion units in women was significantly greater in TKA than in THA (p = 0.001). No statistically significant difference was observed in men in the rate of transfusion between THA and TKA. Conclusion: Perioperative care should be organized differently for women and men. Furthermore, a differentiation between the procedures for each sex could prevent the occurrence of perioperative complicated courses.

The most common spinal disorder in elderly is lumbar spinal stenosis (LSS), resulting partly from ligamentum flavum (LF) hypertrophy. Its pathophysiology is not completely understood. The present study wants to elucidate the role of estrogen receptor α (ER α) in fibroblasts of hypertrophied LF. LF samples of 38 patients with LSS were obtained during spinal decompression. Twelve LF samples from patients with disk herniation served as controls. Hematoxylin & Eosin (H&E) and Elastica stains and immunohistochemistry for ER α were performed. The proportions of fibrosis, loss and/or degeneration of elastic fibers and proliferation of collagen fibers were assessed according to the scores of Sairyo and Okuda. Group differences in the ER α and Sairyo and Okuda scores between patients and controls, male and female sex and absence and presence of additional orthopedic diagnoses were assessed with the Mann–Whitney U test. There was a tendency towards higher expression of ER α in LF fibroblasts in the hypertrophy group (p = 0.065). The Sairyo and Okuda scores were more severe for the hypertrophy group but, in general, not statistically relevant. There was no statistically relevant correlation between the expression of ER α and sex (p = 0.326). ER α expression was higher in patients with osteochondrosis but not statistically significant (p = 0.113). In patients with scoliosis, ER α expression was significantly lower (p = 0.044). LF hypertrophy may be accompanied by a higher expression of ER α in fibroblasts. No difference in ER α expression was observed regarding sex. Further studies are needed to clarify the biological and clinical significance of these findings.

Introduction: Total lower limb arthroplasties are standard orthopedic surgeries that are steadily increasing in modern civilization. In proportion, the number of revision arthroplasties and the corresponding financial burden for healthcare systems will increase. The present clinical investigation analyzed morbidities after aseptic revision knee arthroplasty. Methods: Data from 122 patients following aseptic revision TKA (total knee arthroplasty) were collected. The study collected information on systemic and surgical complications during hospitalization and follow-up, blood transfusion units, and changes in Hb and CRP levels. Hb and CRP were measured preoperatively and on postoperative days 1, 2, and 4. Statistical analyses were performed using IBM SPSS version 29. Results: Significant differences were observed in systemic, surgery-related and blood transfusion rates and reasons for knee replacement changes based on age and gender. Of the patients, 38.5% received a full component change, 11.5% received a partial component replacement (either femoral or tibial), 30.3% had an isolated inlay change, and 19.7% underwent debridement only. Femoral and tibial loosening were more frequent in patients over 75 years and those with longer intervals between the initial operation and re-presentation (p = 0.001). Patients with movement deficits and malposition presented earlier for consultation (p = 0.02). Prolonged high CRP levels were significantly correlated with systemic complications, longer hospital stays, and extended operative times. Conclusions: Aseptic knee revision arthroplasty is a complex procedure with perioperative morbidities that can significantly impact outcomes. Age and gender are crucial factors in managing complications during hospitalization and follow-up. Elderly patients, particularly those over 75 years, are more prone to aseptic loosening and require tailored preoperative preparation. The study underscores the importance of individualized patient care strategies to mitigate risks and improve outcomes in aseptic knee revision arthroplasty. Trial registration: Not applicable.

BackgroundThe principle of acetabular total hip revision (THR) is based on acetabular reconstruction and restoration of the center of rotation. The use of augmentation in high cranial acetabular defects combined with a cementless revision shell was studied sufficiently. This study aimed to report a case with the use of an augment inside a cementless revision shell as a reverse augmentation technique.MethodsWe describe the case of an 86-year-old female patient with a massive acetabular defect during second revision for total hip arthroplasty (THA). Two problems occurred: (1) a fixed cemented stem with a nonmodular head size of 33mm and (2) a high acetabular defect with an elevated rotation center.ResultsWith the distraction technique, allograft filling was used to reconstruct the acetabular defect. A cementless revision shell (REDAPT, Smith and Nephew) with a size of 78mm was used to stabilize the defect. Locking screws placed cranially and distally were used to stabilize the cup for secondary osseointegration. An augment was placed inside the cup to reconstruct the rotation center. A customized polyethylene liner (outer diameter, 54mm/inner diameter, 33mm) was positioned below the augment in the revision cup to reconstruct the center of rotation. An 18-month postoperative X-ray analysis showed a stable construct with full secondary osseointegration.ConclusionThis is the first report of an augment used for a reverse technique inside a cementless shell to restore the center of rotation with the use of a customized polyethylene liner. This might be a reliable option for reconstruction of the center of rotation in large cementless revision cups in acetabular Paprosky type III defects. This technical note shows the possibility of using an augment as a reverse technique in a cementless revision cup.

Introduction: Preoperative digital templating is a standard procedure that should help the operating surgeon to perform an accurate intraoperative procedure. To date, a detailed view considering gender differences in templating total knee arthroplasty (TKA), stage of arthrosis, and the surgeons’ experience altogether has not been conducted. Methods: A series of 521 patients who underwent bicondylar total knee arthroplasty was analyzed retrospectively for the planning adherence of digital templating in relation to sex, surgeon experience, and stage of arthrosis. Pre- and postoperative X-rays were comparably investigated for planned and implanted total knee arthroplasties. Digital templating was carried out through mediCAD version 6.5.06 (Hectec GmbH, 84032 Altdorf, Germany). For statistical analyses, IBM SPSS version 28 (IBM, 10504 Armonk, NY, US) was used. Results: The general planning adherence was 46.3% for the femur and 41.8% for the tibia. The Mann–Whitney U test revealed a gender difference for templating the femur (z = −5.486; p ≤ 0.001) and tibia (z = −3.139; p = 0.002). The surgeon’s experience did not show a significant difference through the Kruskal–Wallis test in the femur (K–W H = 4.123; p = 0.127) and the tibia (K–W H = 2.455; p = 0.293). The stage of arthrosis only revealed a significant difference in the planning of the femur (K–L-score (K–W H = 6.516; p = 0.038) alone. Discussion/Conclusion: Digital templating for total knee arthroplasty brought up gender differences, with oversized implants for women and undersized implants for men. A high stage of femoral arthrosis can lead to the under and oversized planning of the surgeon. Since the surgeon’s experience in planning did not show an effect on the adherence to templating, the beneficial effect of digital templating before surgery should be discussed.