Background: Total knee arthroplasty (TKA) has evolved significantly, yet achieving consistently optimal outcomes remains challenging across diverse patient populations. This comprehensive narrative review identifies evidence-based “game changers” that genuinely transform TKA success while distinguishing them from interventions lacking clinical superiority. The analysis organizes findings across three perioperative phases: preoperative optimization, intraoperative techniques, and postoperative management. Preoperative game changers include end-stage bone-on-bone osteoarthritis, preoperative medical optimization of patients performed by dedicated practitioners, cryocompression therapy, and perioperative dexamethasone administration. Intraoperative interventions demonstrating substantial impact encompass reduced surgical time and optimized surgical instrumentation, personalized alignment, medial congruent bearings, cementless implants for high-demanding and high-BMI patients, and perioperative tranexamic acid. Postoperative game changers include early mobilization following surgery, venous thrombo-embolic prophylaxis avoiding high-bleeding-risk pharmaceuticals, and multimodal pain management. The review also identifies those initial promises without established clinical advantages, or “fake game changers”, that consume resources without meaningful benefits. This evidence synthesis demonstrates that TKA optimization requires systematic implementation of validated interventions rather than pursuing technological innovations indiscriminately. The future of TKA lies in evidence-based adoption of proven strategies that translate to genuine patient outcome improvements rather than merely increasing procedural complexity.

Purpose: Medial unicompartmental knee arthroplasty (mUKA) may offer significant advantages for octogenarian patients due to its reduced surgical burden. The purpose of this study was to analyze the clinical and radiological outcomes, including complications and implant survivorship, in octogenarians following robotic‐assisted mUKA compared to patients aged ≤60 years. Methods: We conducted a retrospective analysis of prospectively collected data on robotic‐assisted mUKA performed between 2018 and 2022, with a minimum follow‐up of 24 months. Inclusion criteria were patients aged ≥80 years and patients aged ≤60 years. Participants without consent were excluded. A total of 203 patients were included in the final analysis. Propensity score matching was performed to balance the two cohorts (Young: ≤60 years; Octogenarians: ≥80 years) based on body mass index (BMI), Oxford Knee Score (OKS) and Knee Society Score (KSS). The Mann–Whitney U test was used to compare continuous variables both preoperatively and postoperatively, as well as clinical improvements across cohorts. The Wilcoxon Signed‐Rank Test and the minimally clinically important difference (MCID) were used to evaluate postoperative clinical outcome improvements within each cohort. The Chi‐Square test was used to compare survival and complication rates between groups. Results: No differences were found between groups in any clinical or radiographic parameters, either preoperatively or postoperatively. Both groups showed comparable and clinically meaningful improvements in KSS and OKS scores. In the octogenarian group, there were two cases of intracortical lateral tibial fractures managed conservatively. One case of subpopliteal deep vein thrombosis (DVT) occurred in the younger cohort. No differences in implant survival were observed between the groups. Conclusion: Advanced age alone should not preclude octogenarian patients from undergoing robotic‐assisted mUKA, as they can achieve meaningful functional improvements comparable to those of younger patients. Level of Evidence: Level III.

The medial unicompartmental knee arthroplasty (mUKA) has been recognized as an excellent treatment for medial knee osteoarthritis. The posterior tibial slope (PTS) is measured radiographically with the intramedullary axis (IMA) to the tibial baseplate on the sagittal plane radiograph. However, in most computer-navigated or robotic mUKAs, the PTS is set from a transmalleolar axis (TMA).The PTS difference was evaluatedbetween the sagittal TMA and the sagittal IMA of patients undergoing a CT-based primary robotic-assisted mUKA.We retrospectively reviewed the preoperative computed tomography (CT) scans taken according to the MAKO system protocol (Stryker) of 67 patients undergoing mUKAs. We measured the angular difference between the IMA and the TMA in the sagittal plane.Using the TMA to set the PTS the estimation of the slope of the medial tibial plateau would increase by an average of 1.9 ± 3.2 degreescompared to the IMA. Furthermore, in nineknees, PTS was decreased.Tibial components implanted with the help of a CT scan-based preoperative planning MAKO will show an average of 1.9 degrees more than those measured on sagittal radiographs potentially of concern for knee kinematics. A universal language is needed to standardize the slope calculation and the respective reference axis used.

Article: The interlocking lag screw design nail for pertrochanteric fracture: a systematic review of biomechanical studies using cadaveric specimens - Minerva Orthopedics 2024 October;75(5):354-65 - Minerva Medica - Journals

Introduction: Lateral unicompartmental knee arthroplasty (L-UKA) is typically performed through a lateral parapatellar approach. Few studies of L-UKA performed through a medial approach are published. We aimed to present surgical tips, and mid-term clinical results and survivorships of L-UKA performed through a medial approach. Methods: We retrospectively reviewed single-centre single-surgeon data from L-UKA using medial parapatellar approach between 2016 and 2023. Patients with follow-up < 12 months were excluded. Primary endpoint was implant survivorship (time from index surgery to revision or last follow-up). Secondary endpoints included the rates of patients achieving Patient Acceptable Symptom State (PASS) thresholds: ≥ 67.5 for Knee Society Score-Knee (KSS-K) and ≥ 70.5 for Knee Society Score-Function (KSS-F). Survival analysis was used for implant survivorship. Logistic regression was performed for factors potentially associated with failure to achieve the PASS thresholds. Significance was set at P < 0.05. Results: Among 110 patients initially identified, two died before 12-month follow-up and were excluded from clinical outcome analysis, leaving 108 patients for functional assessment at a mean 47.6 months ± 24.5 of follow-up (range 12–96.7 months). No complications were reported during hospitalization. There were four failures (3.7%) overall: two cases (1.8%) of OA progression, one (0.9%) of aseptic loosening, and one case (0.9%) of periprosthetic fracture of the medial condyle requiring revision surgery. All 110 patients were included in survival analysis, with the 2 patients who died before 12 months included as censored data at time of death. The overall 7-year survivorship was 97.2% (95% CI 94.2–100%), declining to 92.1% at 84 months when the last revision occurred. PASS thresholds were achieved by 99.0% patients for KSS-Knee and by 86.1% for the KSS-F. Patient age was a significant predictor of failure to achieve functional PASS thresholds (OR = 1.3 per year, 95% CI 1.0–1.6, p = 0.036). Conclusions: L-UKA performed through a medial parapatellar approach yielded excellent clinical outcomes and survivorship at mid-term follow-up. Level of evidence: IV (retrospective case series).