This study examined the differences in total blood loss, the need for blood transfusions, length of hospital stay, wound grading scores, incidence of venous thromboembolism (VTE), and reoperation rates between conventional and limited tourniquet use during unilateral primary total knee arthroplasty (TKA). This double-blind, randomized controlled trial included 90 patients undergoing unilateral primary TKA. Forty-five patients were allocated to the limited tourniquet use group (LIM-TKA), and 45 to the conventional tourniquet use group (CON-TKA). The study analyzed differences in total blood loss, the need for blood transfusions, wound grading scores, incidence of VTE, length of hospital stay, and reoperation rates. The mean total blood loss in the LIM-TKA group was 589.55 ± 238.2 ml, significantly lower than the 692.31 ± 276.15 ml observed in the CON-TKA group (P = 0.031). Significantly poorer wound grades were seen in the CON-TKA group compared to the LIM-TKA group, with 23 vs. 34, 15 vs. 11, 5 vs. 0, 1 vs. 0 and 1 vs. 0 patients, respectively, having grade 1, 2 A, 2B, 2 C and 3 A wounds according to the Southampton Scoring System (P = 0.032). Patients in the LIM-TKA group also had a shorter hospital stay versus the CON-TKA group (5.6 ± 1.28 vs. 7.2 ± 4.06 days, P = 0.006). The rates of blood transfusion, VTE complications, and reoperation were similar between both groups. LIM-TKA results in significantly lower total blood loss and improved wound grading scores, as well as a decreased length of hospital stay compared to CON-TKA. LIM-TKA could be a suitable option for surgeons aiming to minimize tourniquet-related adverse outcomes while maintaining a dry bone surface during TKA cementation. This study was retrospectively registered at Thai Clinical Trials Registry (thaiclinicaltrials.org) on July 28, 2024. Clinical trial number: TCTR20240728002.

BACKGROUND Total knee arthroplasty (TKA) using implants with a high level of constraint has generally been recommended for patients with osteoarthritis (OA) who have valgus alignment. However, studies have reported favorable outcomes even with cruciate-retaining (CR) implants. AIM To evaluate the coronal plane stability of CR-TKA in patients with valgus OA at the mid-term follow-up. METHODS Patients with primary valgus OA of the knee who underwent TKA from January 2014 to January 2021 were evaluated through stress radiography using a digital stress device with 100 N of force on both the medial and lateral side. Gap openings and degrees of angulation change were determined. Descriptive statistical analysis was performed for both continuous and categorical variables. Inter-rater reliability of the radiographic measurements was evaluated using Cronbach’s alpha. RESULTS This study included 25 patients (28 knees) with a mean preoperative mechanical valgus axis of 11.3 (3.6-27.3) degrees. The mean follow-up duration was 3.4 (1.04-7.4) years. Stress radiographs showed a median varus and valgus gap opening of 1.6 (IQR 0.6-3.0) mm and 1.7 (IQR 1.3-2.3) mm and varus and valgus angulation changes of 2.5 (IQR 1.3-4.8) degrees and 2.3 (IQR 2.0-3.6) degrees, respectively. No clinical signs of instability, implant loosening, or revision due to instability were observed throughout this case series. CONCLUSION The present study demonstrated that using CR-TKA for patients with valgus OA of the knee promoted excellent coronal plane stability.

Objectives: This study aimed to determine the proportion of patients who exhibited a change in their coronal plane alignment of the knee (CPAK) classification after mechanically aligned (MA) total knee arthroplasty (TKA) and compare postoperative clinical outcomes between patients who restored their preoperative CPAK classification and those who did not.Materials and Methods: This was a retrospective cohort study including 194 knees from 143 patients who underwent MA TKA between December 2021 and June 2024. Radiographic parameters, including pre- and postoperative lateral distal femoral angle and medial proximal tibial angle, were measured using long-leg standing radiographs to determine the CPAK classification. Postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, range of motion (ROM), and surgical complications were recorded.Results: The most common preoperative CPAK classification was type I (40.7%), followed by type II (22.7%) and type IV (14.9%). Furthermore, 36 (18.6%) knees were restored to their preoperative CPAK classification. No significant differences in postoperative ROM (flexion: 115° vs. 110°, p = 0.445; extension: 5° vs. 5°, p = 0.770) and WOMAC scores (13.56 ± 9.58 vs. 18.12 ± 10.64, p = 0.251) were observed between the restored and non-restored groups. The surgical complication rates were 2.7% and 5.7% in the restored and non-restored groups, respectively.Conclusion: A fixed MA TKA target may alter patients’ CPAK classification postoperatively, with only a limited proportion achieving restoration of their preoperative CPAK classification. Restoration of the preoperative CPAK classification did not significantly influence clinical outcomes.

The anterolateral approach has been widely adopted in total hip arthroplasty (THA), with numerous modifications described since its original introduction. Among these, the minimally invasive anterolateral (MIS-AL) approach, also referred to as the anterior-based muscle-sparing approach, has been developed to minimize soft-tissue damage by preserving the integrity of the gluteus medius muscle. This narrative review describes the surgical technique of the MIS-AL approach for primary THA performed in the supine position and provides a summary of clinical outcomes. When performed in the supine position, the MIS-AL approach offers several advantages beyond its muscle-sparing nature. It does not require a specialized operating table, allows for a simplified operating room setup, facilitates the use of intraoperative fluoroscopy, and enables simultaneous bilateral THA without the need for re-draping. In addition, available evidence suggests that this approach is associated with faster postoperative recovery and a reduced risk of postoperative dislocation, supporting the MIS-AL approach as a reliable and muscle-sparing option for primary THA.

Background/Objectives: Cycling-related acetabular fractures have not been well described. We aimed to determine the proportion of acetabular fractures associated with bicycle accidents and to compare their fracture patterns with those caused by other mechanisms. Findings related to clipless pedal use were considered exploratory. Methods: Patients treated for an acetabular fracture between January 2010 and December 2023 were identified by ICD-10 codes from a university hospital network Clinical Data Warehouse. After exclusions, 378 patients with 385 fractures were classified according to the Judet–Letournel system. Fracture-pattern proportions were compared using Fisher’s exact test, and the association with anterior column involvement was examined with logistic regression adjusted for age and sex. Cleat-shoe status, obtained from medical records or telephone interviews, was analyzed descriptively. Results: Bicycle accidents were the mechanism of injury in 26 of 378 patients (6.9%). Compared with fractures caused by other mechanisms, bicycle-related fractures showed a higher proportion of pure anterior column fractures (38.5% versus 16.7%, p = 0.014) and anterior column involvement (65.4% versus 38.2%, p = 0.011). The association with anterior column involvement remained after adjustment for age and sex (adjusted odds ratio 3.02, 95% CI 1.31–6.98). Among 12 confirmed cleat-shoe users, 7 (58.3%) had a pure anterior column fracture, 10 (83.3%) had anterior column involvement, and 8 (66.7%) had extension into the acetabular roof. Conclusions: Bicycle-related acetabular fractures were associated with a higher proportion of anterior column involvement, and the association remained after adjustment for age and sex. Because bone quality and injury energy could not be adjusted for, this association should not be interpreted as causal. The anterior-dominant pattern among confirmed cleat-shoe users is exploratory and should not be interpreted causally.