Baldini Andrea, Ardiri Damiano, Benvenuti Lorenzo, Chirico Mattia, Fiorilli Enrico, Singlitico Alessandro, Leggieri Filippo
Orthopaedic Unit, Istituto Fiorentino di Cura e Assistenza (IFCA), 50139 Florence, Italy.
BIOMORF Department of Biomedical, Dental, Morphological and Functional Images, University of Messina, 98100 Messina, Italy.
J Pers Med. 2025 Aug 20;15(8):389. doi: 10.3390/jpm15080389.
: 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.
全膝关节置换术（TKA）已经有了显著发展，但在不同患者群体中始终实现最佳效果仍具有挑战性。这篇全面的叙述性综述确定了基于证据的“变革因素”，这些因素真正改变了TKA的成功率，同时将它们与缺乏临床优势的干预措施区分开来。该分析按照围手术期的三个阶段整理研究结果：术前优化、术中技术和术后管理。术前的变革因素包括终末期骨对骨骨关节炎、由专业医生对患者进行术前医疗优化、冷冻压缩疗法以及围手术期给予地塞米松。显示出重大影响的术中干预措施包括缩短手术时间和优化手术器械、个性化对线、内侧匹配型假体、用于高要求和高体重指数患者的非骨水泥植入物以及围手术期使用氨甲环酸。术后的变革因素包括术后早期活动、避免使用高出血风险药物进行静脉血栓栓塞预防以及多模式疼痛管理。该综述还确定了那些没有既定临床优势的初始承诺，即“虚假变革因素”，它们消耗资源却没有带来有意义的益处。这一证据综合表明，TKA的优化需要系统实施经过验证的干预措施，而不是盲目追求技术创新。TKA的未来在于基于证据采用已证实的策略，这些策略能真正改善患者的治疗效果，而不仅仅是增加手术操作的复杂性。
