Purpose This meta‐analysis compared the results of kinematic alignment (KA) and mechanical alignment (MA) applied in total knee arthroplasty (TKA). Methods Randomized controlled trials and cohort studies comparing functional, radiological, and perioperative results and complications in TKA with KA and MA were collected from databases and included in the analysis. Results Nine trials were included. KA showed a better performance in terms of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (mean difference [MD] =  − 9.06, 95% confidence interval [CI] − 14.69, − 3.42) and Oxford knee score (OKS) (MD = 4.72, 95% CI 0.24, 9.21); however, the Knee Society score (KSS), knee injury and osteoarthritis outcome score (KOOS), EuroQoL 5‐dimension questionnaire (ED‐5D), range of motion, and complications were similar for KA and MA (n.s.). KA resulted in slightly more varus alignment in the tibia [mechanical medial proximal tibial angle (mMPTA) MD = − 2.45, 95% CI − 2.89, − 2.01) and more valgus alignment in the femur (mLDFA MD = − 2.06, 95% CI − 2.48, − 1.65) than MA (P < 0.05), but showed similar results in terms of the joint line orientation angle (JLOA) (MD = 0.54, 95% CI − 2.59, 3.66), hip–knee–ankle angle (HKA), anatomical knee angle (AKA), femoral flexion–extension angle (FFA), and tibial slope (TS). The preoperative results, including the incision length, hospital stay, and changes in hemoglobin, were also similar. Conclusion KA achieved functional, radiological, and perioperative results similar to those of MA and did not increase the complication rate. KA is an acceptable and satisfactory method for application in TKA. Level of evidence III.

Background Local infiltration analgesia (LIA) and adductor canal block (ACB) provide postoperative analgesia for total knee arthroplasty (TKA). ACB blocks the saphenous nerve and has smaller impacts on quadriceps muscle weakness. ACB theoretically does not have enough analgesic effects on posterior sensory nerves. LIA may increase its analgesic effects on the posterolateral knee. The purpose of this study was to evaluate whether ACB combined with a LIA cocktail of ropivacaine, morphine, and betamethasone has superior analgesic effect than LIA for TKA. Methods A total of 86 patients were assessed for eligibility from February 2019 to May 2019. 26 of those were excluded, and 60 patients were divided into 2 groups by computer-generated random number. Group A (LIA group) received LIA cocktail of ropivacaine, morphine and betamethasone. Group B (LIA+ ACB group) received ultrasound-guided ACB and LIA cocktail of ropivacaine, morphine and betamethasone. Postoperative visual analogue scale (VAS) resting or active pain scores, opioid consumption, range of motion (ROM), functional tests, complications and satisfaction rates were measured. The longest follow-up was 2 years. Results Two groups have no differences in terms of characteristics, preoperative pain or function (P > 0.05). ACB combined with LIA had significantly lower resting and active VAS pain scores, better ROM, better sleeping quality and higher satisfaction rates than LIA alone within 72 h postoperatively (P < 0.05). Complications, or adverse events and HSS score, SF-12 score were observed no significant differences within 2 years postoperatively. Conclusions Adductor canal block combined with Local infiltration analgesia provide better early pain control. Although the small statistical benefit may not result in minimal clinically important difference, Adductor canal block combined with Local infiltration analgesia also reduce opioid requirements, improve sleeping quality, and do not increase the complication rate. Therefore, Adductor canal block combined with Local infiltration analgesia still have good application prospects as an effective pain management for total knee arthroplasty. Trial registration Chinese Clinical Trial Registry, ChiCTR1900021385, 18/02/2019.

Objective This study aimed to observe the analgesic effect of the cocktail formulation with diprospan during total hip arthroplasty (THA). Methods From September 2018 to April 2019, 120 patients undergoing primary unilateral THA were included in this prospective, randomized, observer‐blinded study. Patients were randomized into three groups, according to the different local infiltration analgesia (LIA) strategies: LIA with ropivacaine (the ropivacaine group, n = 40), LIA with a new cocktail containing ropivacaine, diprospan, and morphine (the cocktail group, n = 40), and the control group ( n = 40). The primary outcomes included postoperative pain scores. The resting visual analogue scale (VAS) scores were measured at 2, 6, and 12 h after the surgery (a.m. and p.m.) on postoperative day (POD) 1, POD2, and the day of discharge. Movement VAS scores were assessed at 6 h, 12 h after the operation (a.m. and p.m.) on POD1, POD2, and the day of discharge. The secondary outcomes included opioid consumption, postoperative hospital stay, range of motion of the hip at discharge, patient satisfaction, and the results of the follow‐up. Results After the screening, 120 patients were randomized into three groups (40 patients in each group). All of the patients completed the trial. The resting VAS scores in the ropivacaine group and cocktail group at 2 h were lower than those in the control group ( P < 0.001 and P < 0.001, respectively, F = 17.054), and the same trend was also postoperatively found at 6 h ( p = 0.005 and P = 0.002, F = 6.212). Twelve hours after the operation, the pain score in the cocktail group was lower than that in the other two groups, but only the difference between the cocktail group and the control group was statistically significant ( P = 0.018, F = 3.144). From the morning of the first postoperative day to the a.m. on POD 2, the VAS scores in the cocktail group were significantly lower than those in the ropivacaine group and the control group. Furthermore, the movement VAS scores in the ropivacaine group and the cocktail group were better than those in the control group at 6 and 12 h post‐operation ( P < 0.05). The per capita opioid consumption in the cocktail group was less than that in the ropivacaine group and the control group within 24 h post‐operation. There were no significant differences in the comparison of additional indicators among the three groups. Conclusion The new cocktail with diprospan had a better result and longer duration time for early postoperative pain control in primary THA via the posterolateral approac...

Background Single-radius (SR) prostheses and multi-radius (MR) prostheses have different theoretical advantages; however, there has been a paucity of evaluations comparing the two. This study was designed to compare the 10-year clinical, radiological, and survival outcomes of SR and MR posterior-stabilized prostheses in total knee arthroplasty (TKA). Methods In this retrospective cohort study, 220 consecutive patients undergoing TKA between October 2006 and October 2007 were divided into the SR group (106 patients, Stryker Scorpio NRG) and the MR group (114 patients, DePuy Sigma PFC), with a minimum follow-up of 10 years. Clinical, functional, and radiological outcomes, as well as satisfaction rates and survival results, were evaluated. Results Hospital for Special Surgery and Short Form-12 health survey scores were all significantly improved in both groups at the final follow-up ( P < 0.05), but the groups did not differ. The SR group had significantly less anterior knee pain (AKP) and painless crepitation ( P < 0.05). Radiological results in terms of radiolucent lines and component position angle showed no differences between groups. The Kaplan-Meier survival curve estimates at 10 years were not significantly different between the groups ( P = 0.4172). Conclusion Both SR and MR posterior-stabilized prostheses can lead to satisfactory outcomes. The SR prosthesis design gave less anterior knee pain than did the MR prostheses. Two prostheses showed no differences in terms of clinical scales, radiological results, satisfaction rates, and survival results at a long-term follow-up. More accurate measurements are required.