ObjectiveTo determine the quantity and quality of articles in the field of knee arthroplasty worldwide and elucidate the characteristics of global scientific production.MethodsWeb of Science was used to identify articles in the field of knee arthroplasty from 2011 to 2015. The total number of papers, number of papers per capita, total number of citations, and mean number of citations were collected.ResultsIn total, 11,590 papers were identified. The number of publications significantly increased from 2011 to 2015. Most originated from North America, East Asia, and West Europe. Most (88.51%) were from high-income countries, 11.48% were from middle-income countries, and only 0.01% were from lower-income countries. The United States had the most articles and total citations. Sweden had the highest mean citations, followed by Denmark and Canada. However, when adjusted by population size, Denmark had the most articles per million population, followed by Switzerland and the Netherlands.ConclusionsThe number of knee arthroplasty publications has rapidly increased in recent years. The United States is the most prolific, but some European countries are more productive relative to their population.

Background: The overall satisfaction of patients after total knee arthroplasty (TKA) is approximately 80%, and current studies have demonstrated that patients with depression may have lower patient satisfaction. The purpose of this study was to determine whether perioperative psychological intervention in patients with depression improves the clinical outcomes and patient satisfaction in patients undergoing TKA. Methods: Six hundred patients who underwent primary TKA from May 2016 to January 2018 were prospectively screened for eligibility. A preoperative psychological evaluation was conducted by a psychiatrist to evaluate each patient’s psychological status. Patients who were diagnosed with depression were randomly divided into 2 groups: the intervention group (patients received psychological interventions that were administered by a psychiatrist at the first visit before surgery and from then on) and the control group (patients received routine TKA care without psychological interventions). The primary outcome was patient satisfaction at 6 months postoperatively. The secondary outcomes were patient satisfaction at 2 years postoperatively as well as the Hospital for Special Surgery (HSS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and range of motion at 6 months and 2 years postoperatively. Results: Fifty-three patients with depression were identified. Fifty-one patients were enrolled in the randomized controlled trial. Two patients were lost to follow-up at 6 months after surgery. Therefore, 49 patients (25 in the intervention group and 24 in the control group) remained in the final analysis. At 6 months postoperatively, statistical differences in patient satisfaction were identified between the 2 groups (88.0% in the intervention group compared with 62.5% in the control group; odds ratio = 4.40; 95% confidence interval, 1.02 to 18.99). There was a significant improvement in the Self-Rating Depression Scale (SDS) score (the reduction rate was 51.97% in the intervention group compared with 17.35% in the control group) and the Symptom Checklist 90 Revised (SCL-90-R) subscore for depression (the reduction rate was 44.66% in the intervention group compared with 15.73% in the control group). The clinical outcomes, including the WOMAC scores, the HSS scores, and maximal range of motion, in the intervention group had improved significantly more compared with those in the control group. Conclusions: Psychological interventions during the perioperative period can improve patient satisfaction in patients with depression who undergo TKA. Therefore, psychological intervention and management may be beneficial for patients with depression who are planning to undergo TKA. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Background:Total knee arthroplasty (TKA) is the most frequently performed procedure in treating advanced knee osteoarthritis. Excessive perioperative blood loss can sometimes lead to postoperative anemia. Tranexamic acid (TXA) is a potent fibrinolysis inhibitor which has been extensively used at the surgical incision and closure to lower overall blood loss in adult reconstruction surgery. Our previous study suggested that about two-thirds of the total blood loss (TBL) came from hidden blood loss (HBL) on postoperative days 1 and 2. The role of reducing HBL with TXA administration in postoperative TKA patients is unknown. The current study was designed to evaluate the efficiency and safety of supplemental intravenous (IV) TXA in further reducing HBL after primary TKA.Methods:A prospective pilot study was conducted at a single institution on 43 consecutive patients who underwent unilateral TKA from September 2014 to February 2015. All patients were given 1 g of IV TXA 10–15 min before operation and another 1 g of IV TXA at the time of wound closure on the day of surgery. On postoperative days 1 and 2, the supplemental group (n = 21) was given additional 1 g of TXA intravenously twice a day, whereas the control group (n = 22) received an equal volume of saline. Drain output, hemoglobin (Hb), and hematocrit (HCT) were recorded preoperatively and 5 consecutive days postoperatively in both groups. HBL was calculated with the Gross formula. Pre- and post-operative lower extremity Doppler venous ultrasound was performed in all patients to detect deep vein thrombosis (DVT). The indexes were compared using the Mann-Whitney test, whereas the results of Hb and HCT were analyzed by repeated-measures analysis of variance. The difference was considered statistically significant if P < 0.05.Results:The demographics and surgical characteristics of the two groups were comparable. Supplemental group had higher Hb level on postoperative days 1–5 compared to the control; however, the difference was not significant (F = 2.732, P = 0.106). The HCT of the supplemental group was significantly higher than that of the control group on postoperative day 5 (F = 5.254, P = 0.027). No significant difference was found in drainage volume and TBL, but the HBL was reduced in the supplemental group (supplemental 133.1 [71.8, 287.3] ml and control 296.0 [185.3, 421.4] ml, Z = 2.478, P = 0.013, median [interquartile range]). There was one DVT in the control group and none in the supplemental group. All patients were followed at 1 year after surgery, and no further complications were reported.Conclusion:Based on the current study, additional doses of IV TXA could potentially further reduce HBL after primary TKA without increasing the risk of venous thromboembolism.

Nighttime vitality has garnered attention in recent years as an important indicator reflecting urban economy and quality of life. However, it is difficult to characterize this intangible issue. As a response, this study employed a data-driven approach to measure nighttime vitality and explored its relationships with urban spatial structure. Specifically, the data from Meituan.com—the largest Chinese shopping platform for local consumer products and retail services—were used to measure nighttime vitality based on a hierarchical weighting method. Multidimensional characteristics of the urban spatial structure were evaluated. Spatial regression models were conducted on the effect analysis of urban spatial structure on nighttime vitality. Relationship estimations were statistically significant with indicators, such as block functions, building density, interaction density, enclosure of locals, and the age structure of the main population. Our findings provide a more complete understanding of nighttime vitality, which is often overlooked in urban vitality studies. Insights derived from this study could help formulate spatial strategies to enhance nighttime vitality and quality of life.

Background:A good postoperative alignment in total knee arthroplasty (TKA) is the key to achieving satisfactory results. We assessed the effect of femoral and tibial resection on the overall alignment after conventional TKA.Methods:We conducted a retrospective analysis of 212 primary TKAs in 188 patients. Intramedullary (IM)-guided resection was applied on the femoral side while extramedullary (EM)-guided resection was used on the tibial side. Using full-length X-ray, the preoperative femoral valgus angle and lower extremity alignment, as well as 2-week postoperative femoral and tibial prosthetic coronal alignment and overall lower extremity alignment, were measured.Results:Postoperatively, good prosthetic alignment was achieved in 191 cases (90.1%) on the tibial side and in 144 cases (67.9%) on the femoral side (χ2 = 5.441, P = 0.02). Multiple linear regression analysis was used to assess the effect of different alignment sides on the overall alignment in the coronal plane. Data were divided into five subgroups based on the valgus or varus status of the prostheses. The standardized regression coefficients of the femoral and tibial prosthetic alignment on the overall alignment were 0.666 and 0.414, respectively; in varus on both sides were 0.658 and 0.377, respectively; in valgus, 0.555 and 0.030; femoral side varus and tibial side valgus, 0.702 and 0.211; femoral side valgus and tibial side varus, −0.416 and 0.287. The study showed that the overall low extremity alignment was statistically influenced by the prosthetic alignment, except for the tibial prosthetic alignment when femoral prosthesis was in valgus (P = 0.153).Conclusions:In conventional TKA, tibial side EM-guided resection may offer satisfactory postoperative alignment, and femoral resection relying on IM guide may lead to more undesirable results. Postoperative coronal alignment is mainly affected by the femoral resection. Therefore, femoral side operation should receive adequate attention from the surgeons.