The available literature provides limited and inadequate data regarding the association between intraoperative knee kinematics, long-term clinical outcomes and survivorship after total knee arthroplasty (TKA). This study aimed to examine the potential relationship between specific intraoperative kinematics laxity assessment, acquired with a computer navigation system, and the long-term clinical outcomes and survivorship in patients undergoing TKA. This study consists of a retrospective cohort analysis of consecutive TKA procedures, in which a surgical navigation system was utilized to intra-operatively assess bone resections, implant positioning and gap balancing. The intraoperative kinematic parameters included varus-valgus laxity at 0° (VV 0) and 30° of flexion (VV 30), anterior–posterior displacement at 90° of flexion (AP 90), and passive range of motion (ROM). Different prosthesis designs were used, with a predominance of the posterior stabilized (PS)-type implant. The Knee Injury and Osteo-arthritis Outcome Score (KOOS) was used to investigate patients’ clinical and functional status. Survival was analyzed with the Kaplan–Meier method. Between-group comparisons were performed using the Mann–Whitney U test. A univariate logistic regression analysis was conducted to identify factors associated with clinical failure. Of 165 eligible patients, 120 were included in the final analysis, with a mean follow-up of 7.7 ± 2.8 years. Revision surgery was required in seven cases, representing surgical failure and an overall survival rate of 94.2%, with survival probabilities of 98.8%, 97.4%, and 93.6% at 6, 8, and 10 years, respectively. Clinical failure (KOOS < 70 in three domains) occurred in 23 patients. No intra-operative surgical parameters, including Hip-Knee-Ankle angle, Preoperative KL grade, prostheses design, VV 0, VV 30, AP 90 and ROM, or demographic variables, were found to be statistically correlated with clinical failure at follow-up. Although, in this navigated TKA cohort, survivorship was acceptable and consistent with previously reported benchmarks, it was not possible to reliably predict survival probability based solely on the intra-operative laxity parameters measured. Nevertheless, the use of surgical navigation can help surgeons accurately assess bone resections and the balance of prosthetic components.

Background: Managing large posttraumatic tibial defects presents significant challenges. External fixation is effective for distraction osteogenesis but has drawbacks, including prolonged treatment time and complications. Intramedullary lengthening nails improve patient comfort but have limitations in large bone transport. While combined techniques have been explored, to our knowledge a fully sequential approach where an external fixator is first used for distraction and then replaced by a motorized intramedullary lengthening nail continuing the lengthening has not been clearly described in the literature. This study presents a novel staged technique and a review of existing literature on limb lengthening strategies. Methods: We report the case of a 29‐year‐old male with a 16‐cm posttraumatic tibial defect, treated with 10 cm of bone transport using an external fixator, followed by 6 cm of additional lengthening with a motorized intramedullary nail. Additionally, a literature search was conducted in PubMed, Scopus, and Embase using keywords related to limb lengthening, external fixation, and intramedullary nailing. The technique and outcomes were compared with existing literature. Discussion: The review did not identify any studies on fully sequential limb lengthening. Most studies focus on pediatric cases or hybrid techniques where external fixation and intramedullary nailing are used simultaneously. Our sequential approach allowed for controlled distraction and successfully addressed a 16‐cm bone defect. Conclusions: This case highlights a previously undescribed staged limb lengthening approach. Sequential conversion from external fixation to a motorized intramedullary lengthening nail may offer advantages in reducing EFI, protecting neurovascular structures, and enhancing mechanical stability. Further research is needed to evaluate long‐term outcomes.

Purpose: Contralateral hinge fracture is one of the most common complications of medial opening wedge high tibial osteotomy (HTO), however, this complication has been poorly investigated after closing‐wedge HTO (CW‐HTO). The primary aim of this study was to describe the incidence and characteristics and propose a classification system of medial hinge fracture (MHF) after CW‐HTO. The secondary aim was to identify demographic and surgical factors that predispose to MHF. Methods: Consecutive patients who underwent CW‐HTO for varus malalignment performed at a single institution were retrospectively screened for eligibility. Preoperative data were retrieved from medical charts, while incidence and type of MHF were evaluated on postoperative X‐rays. To determine risk factors for MHF, a series of univariate logistic regression were performed using demographic and radiological data as independent variables, using a generalised linear mixed model (GLMM). Variables that demonstrated a significant difference ( p < 0.1) in univariate analyses were defined as independent variables and were used as covariates in a multivariate analysis with the same dependent variables Results: A total of 137 knees were included in the study. The incidence MHF fractures was 57% and three distinct types of fractures were identified. The most common fracture type was the two fragment one, with its subtypes “linear” (31%), “distal” (9%) and “proximal” (8%). A “third fragment” MHF was identified in 7% of cases, while “intra‐articular” pattern was observed in 2%. Multivariate analysis showed that increased distance between the end of the osteotomy line up until the medial tibial plateau and decreased length of the osteotomy line were significantly associated with higher probability of MHF: respectively OR (odds ratio) 2.8 [1.20–6.78] ( p = 0.018) for the former and OR of 0.35 [0.16–0.77] ( p = 0.009) for the latter. Conclusion: MHF is a common complication after CW‐HTO, and all the risk factors appear to be related to the osteotomy line: higher MHF incidence was associated with an increased distance from the medial plateau and reduced depth of the cut. Both these parameters are clinically relevant as they are modifiable. Level of Evidence: Level IV.