Background: Early diagnosis of knee osteoarthritis (OA) remains a diagnostic challenge. Urinary C-terminal crosslinked telopeptide of type II collagen (urinary CTX-II) is one of the potential OA biomarkers. However, conclusive evidence regarding the use of this biomarker as a tool for early diagnosis is still lacking. The purposes of this study were to compare urinary CTX-II levels in patients with knee OA and in healthy controls, to evaluate the correlation between urinary CTX-II levels, radiographic severity of OA, and patient-reported outcomes and to evaluate the effect of age and gender on urinary CTX-II levels in the Asian populations. Methods: Two groups were studied. The OA group included 78 patients with knee OA aged > 40 years who met the diagnostic criteria for knee OA described by the American College of Rheumatology (ACR). The control group consisted of 51 healthy participants age > 40 years without clinical or radiographic evidence of knee OA. Bilateral knee radiographs were taken and classified according to the Kellgren and Lawrence (KL) grading system. Urinary CTX-II was measured using a competitive ELISA test and Western Ontario and Mcmaster Universities Arthritis Index (WOMAC) was also recorded in all participants. Results: Urinary CTX-II was significantly higher in the OA group than in the control group (p < 0.001). The severe knee OA group (KL grade 3 and 4) had higher urinary CTX-II levels than mild knee OA group (KL grade 2) but the difference did not reach statistical significance (p = 0.2). There was a moderate correlation between urinary CTX-II levels and KL grades (r = 0.405, p < 0.001) and a weak correlation between urinary CTX-II levels and WOMAC index scores (r = 0.367, p < 0.001). Multiple regression analysis showed that urinary CTX-II was independently associated with KL grades. Whereas age, gender, and WOMAC index had no statistically significant influence on the urinary CTX-II levels.Conclusions: Patients with knee OA had higher urinary CTX-II levels than healthy controls. Moreover, levels of urinary CTX-II were independently correlated with radiographic severity of knee OA. Age, gender, and patient-reported outcomes exerted no effect on the urinary CTX-II levels.Level of evidence: Diagnostic Level III.

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Background: Navio Surgical System, a newer-generation robotic technology, is an image-free roboticassisted total knee arthroplasty (TKA) offering several advantages over older versions, including CT scan, the potential to dynamically assess soft tissue over a range of motion and the ability to use haptic control in bone preparation. Objective: The study aimed to compare the accuracy of component alignment between image-free robotic-assisted and conventional TKA. Methods: Forty patients were randomly assigned to two groups, 20 image-free robotic-assisted and 20 conventional TKA. The primary outcome was prosthetic alignment including mechanical axis alignment, epicondylar axis alignment and posterior tibial slope. The secondary outcomes included postoperative blood loss and operative time. Results: Significant difference were found in the postoperative mechanical axis between the image-free robotic group and the conventional group (1.15°±1° vs. 1.88°±1.19° deviated from neutral mechanical alignment, p = 0.043). There was significant difference in femoral rotational alignment between groups (1.00°±0.75° vs. 2.33°±0.96° deviated from the epicondylar axis, p<0.001). The mean posterior tibial slope did not significantly differ (3.89°±1.66° vs. 4.12°±1.37°, p=0.639). The operative time in the image-free robotic group was significantly longer than that of the conventional group (102.80 ± 11.18 min vs. 62.90 ± 3.28 min, p <0.001). Total blood loss in the image-free robotic group was significantly higher than conventional group (2.24±0.49 g/dl vs. 1.64±0.68 g/dl, p = 0.001). Conclusion: Image-free robotic-assisted TKA constituted a surgical procedure which could provide better accuracy in prosthetic alignment in both mechanical axis and rotational axis compared with conventional TKA. However, the image-free robotic assisted TKA involved higher blood loss and longer operative time.

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