Seung-Baik Kang

Background/Objectives: Opening-wedge high tibial osteotomy (OWHTO) may alter patellar position and patellofemoral (PF) loading, raising concerns about postoperative PF deterioration. This study evaluated compartment-specific changes in SPECT/CT bone tracer uptake (BTU), a marker of subchondral osteoblastic activity, and factors associated with increased PF BTU. Methods: This retrospective study included 35 knees in 34 patients. SPECT/CT was obtained preoperatively and 12–24 months postoperatively. An exploratory 20% relative-change threshold was used to classify BTU responses. Clinical and radiographic variables were compared between PF BTU-increased and non-increased groups. Exploratory multivariable binary logistic regression was used to assess factors associated with a >20% increase in PF BTU, coded as 1, versus no such increase, coded as 0. Results: Mean medial BTU decreased (4.61 ± 2.46 to 3.38 ± 1.50; p = 0.005), whereas mean lateral and PF BTU did not change significantly. PF BTU increased by >20% in 12 knees (34%), decreased by >20% in 16 knees (46%), and remained within ±20% in 7 knees (20%). The increased group had a greater posterior tibial slope angle (PTSA) increase (2.87 ± 1.79° vs. 0.73 ± 2.93°; p = 0.029). In exploratory multivariable logistic regression, greater PTSA change was associated with higher odds of a >20% increase in PF BTU (adjusted OR = 1.5275; 95% CI, 1.0003–2.3325; p = 0.04985). International Knee Documentation Committee (IKDC) and anterior knee pain (AKP) scores did not differ significantly between groups. Conclusions: An exploratory association between PF BTU increase and PTSA change was observed, but it was sensitive to the analysis conditions. No significant between-group differences in short-term clinical scores were detected. These findings do not establish cartilage degeneration, causation, or a preventive benefit from controlling PTSA. Longer-term metabolic, structural, and clinical validation is needed.

Background: Osteoarthritis (OA) is a prevalent degenerative joint disease lacking approved disease-modifying therapies. A key pathogenic driver is a senescence-induced microRNA, miR-204-5p, which suppresses glycosaminoglycan-rich proteoglycan anabolism in chondrocytes, thereby driving chondrocytes toward a catabolic state that progressively degrades cartilage. This study aimed to evaluate LF-ASO-001, a chemically optimized antisense oligonucleotide designed to potently degrade miR-204-5p, as a potential disease-modifying therapy for OA. Methods: The structural mechanism of LF-ASO-001 was characterized through molecular docking and molecular dynamics simulations of the Argonaute2 (AGO2)-miR-204-5p complex. To validate its functional activity, we utilized primary murine chondrocytes under stress-induced senescence and miR-204-overexpressing human chondrocytes to assess the restoration of anabolic homeostasis. In vivo pharmacokinetics and safety were profiled via fluorescence-based biodistribution assays and comprehensive toxicity studies. Therapeutic efficacy was evaluated in the murine destabilization of the medial meniscus model. The study design included both an early intervention strategy to assess the prevention of disease progression and a delayed treatment regimen to evaluate the modulation of established pathology following intra-articular administration. Results: Molecular dynamics simulations revealed that LF-ASO-001 displaces the 3’ end of miR-204-5p from the AGO2 PAZ (Piwi-Argonaute-Zwille) domain, destabilizing the miRNA-loaded complex. LF-ASO-001 suppressed senescence-associated inflammatory and matrix-remodeling phenotypes while restoring anabolic gene expression in senescent chondrocytes. A single intra-articular injection achieved durable cartilage retention and robust efficacy in a post-traumatic OA model in mice. LF-ASO-001 not only prevented joint degeneration but also mitigated established disease in a delayed-treatment model, restoring weight-bearing function. In comparative efficacy studies, LF-ASO-001 provided more robust structural protection than a clinical-stage small-molecule candidate and matched the analgesic benefit of dexamethasone. LF-ASO-001 demonstrated a favorable safety profile, showing no local joint toxicity, adverse effects on serum clinical biochemistry, or alterations in subchondral bone architecture. Conclusions: LF-ASO-001 is a promising disease-modifying OA drug candidate that couples durable single-dose pharmacology with joint preservation and symptomatic relief through targeted degradation of miR-204-5p via AGO2 complex destabilization.

Background/Objectives: Thrombocytopenia increases bleeding tendency and may complicate perioperative management in total knee arthroplasty (TKA), yet data on both in-hospital burden and post-discharge adverse events are limited. This study evaluated the association between preoperative platelet count and outcomes after primary TKA. Methods: In total, 3474 primary TKAs performed for osteoarthritis at a single institution (2008–2023) were retrospectively reviewed. Patients were classified as Normal, Mild, Moderate, or Severe by preoperative platelet count; the Severe group (N = 6) was excluded from comparative analyses and reported descriptively. Inverse probability of treatment weighting (IPTW) balanced baseline covariates. In-hospital outcomes were red blood cell (RBC) transfusion, intensive care unit (ICU) admission, and length of stay; follow-up outcomes were 30-day readmission, 1-year periprosthetic joint infection (PJI), and 1-year mortality. Results: After IPTW, the RBC transfusion rate rose with lower platelet count (Normal, 14.0%; Mild, 27.0%; Moderate, 32.5%; p < 0.001), and transfusion volume peaked in the Moderate group. ICU admission was more frequent (Moderate, 6.0%; Normal, 0.7%; Mild, 0.4%; p = 0.002), and length of stay increased with severity (p = 0.008). Readmission, 1-year PJI, and mortality were comparable across groups. In multivariable analysis, moderate thrombocytopenia was independently associated with RBC transfusion (adjusted odds ratio [aOR], 3.26; 95% confidence interval [CI], 1.51–6.59; p < 0.001) and ICU admission (aOR, 5.46; 95% CI, 1.37–17.41; p = 0.008), but not PJI or mortality. Conclusions: Preoperative thrombocytopenia—particularly in the mild-to-moderate range evaluated in this study—increased perioperative burden after TKA, with higher RBC transfusion and ICU utilization, but was not associated with a significant increase in major postoperative adverse events during 1-year follow-up. Even if not causally responsible, a low preoperative platelet count is a routinely available marker that may flag patients requiring closer perioperative attention. As the associated burden appears largely limited to the hospitalization period, such attentive in-hospital management may allow these patients to achieve favorable outcomes.

Background: Perioperative corticosteroids, particularly dexamethasone, have become a widely adopted component of multimodal pain management in total knee arthroplasty (TKA). While clinical practice guidelines strongly recommend their use, detailed guidance on optimal dosing, frequency, and safety in special populations, especially patients with diabetes mellitus, is still limited. Main text: This narrative review synthesizes the current evidence on systemic perioperative dexamethasone use in TKA, focusing on clinical questions: agent and route selection, dose optimization, dosing frequency, and safety, including considerations for patients with diabetes. A literature search of PubMed, EMBASE, and the Cochrane Library was conducted for studies published between January 2015 and April 2026. Randomized controlled trials, systematic reviews, meta-analyses, clinical practice guidelines, and observational studies addressing systemic corticosteroid use in primary TKA were included. Recent evidence supports intravenous (IV) dexamethasone as the most commonly studied and clinically practical systemic agent. A 16 mg dose provides greater early analgesic and antiemetic benefit than lower doses, and repeat dosing through postoperative day (POD) 1 is supported, with extension to POD 2 emerging but not yet definitive. Perioperative dexamethasone has not been associated with increased infection or wound complications. In patients with well-controlled diabetes, it appears safe with appropriate glycemic monitoring, although safety data are largely limited to doses of 8–10 mg. Conclusions: Current evidence supports IV dexamethasone as an effective component of multimodal analgesia after TKA. In the general TKA population, 16 mg appears more effective than lower doses for early postoperative pain, opioid consumption, and postoperative nausea and vomiting (PONV)-related outcomes. Repeat dosing through POD 1 is supported by available evidence, whereas extension to POD 2 remains promising but requires further validation. In patients with well-controlled diabetes, perioperative dexamethasone appears safe with appropriate glycemic monitoring, although safety data are largely limited to doses of 8–10 mg, and the safety of the 16 mg dose in this population remains insufficiently defined.

Background: Effective perioperative blood glucose control is crucial for reducing postoperative complications in patients with diabetes mellitus (DM) who are undergoing total knee arthroplasty (TKA). The aim of this study was to assess the impact of intravenous (IV) dexamethasone on blood glucose levels, insulin requirements, postoperative pain, and postoperative nausea and vomiting (PONV) in patients with well-controlled type-2 DM. Methods: A total of 83 Asian patients with well-controlled type-2 DM (defined as a preoperative glycated hemoglobin level of ≤7.0%) undergoing primary TKA were randomized to receive either IV dexamethasone or normal saline solution. Blood glucose and insulin requirements were monitored postoperatively up to day 5, and pain and PONV were assessed using a numeric rating scale. Results: Compared with the control, IV dexamethasone transiently elevated blood glucose levels on the day of surgery and on postoperative day 1, with the levels returning to baseline by day 3. Insulin requirements were higher in the intervention group on postoperative day 1 (p = 0.004). While IV dexamethasone did not significantly reduce PONV, it effectively alleviated postoperative pain up to day 3. Conclusions: In patients with DM who underwent TKA, IV dexamethasone administration transiently increased blood glucose on the day of surgery and on postoperative day 1 and elevated insulin requirements on postoperative day 1. Despite having no impact on PONV, IV dexamethasone provided clinical benefits by reducing early postoperative pain. These findings suggest the potential benefits of IV dexamethasone in enhancing perioperative management strategies for patients with DM who are undergoing TKA. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

The purpose of this study was to evaluate whether intravenous (IV) dexamethasone, within the current multimodal pain management protocol, (1) could maintain postoperative pain at a comparable level without IV patient-controlled analgesia (PCA), (2) could reduce opioids-related side effects, and (3) whether an additional dose of dexamethasone on postoperative day (POD) 2 would offer further pain-relieving effect without increasing the risk of complications. A total of 178 patients (182 knees) who underwent total knee arthroplasty for osteoarthritis were included in the study. The patients were divided into Dexa 2 & PCA and Dexa 3 & NoPCA groups. From operative day to POD 5, pain visual analogue score (VAS), rescue opioids consumption, episodes of postoperative nausea and vomiting (PONV), antiemetics usage, and side effects of opioids such as postoperative urinary retention (POUR) and constipation were checked. For safety, wound complication and infection were checked. There was no difference in pain VAS between the two groups during all six perioperative days. Rescue opioids consumption was lower in Dexa 2 & PCA group. Total dosage of used opioids for six perioperative days was lower in Dexa 3 & NoPCA group. Dexa 3 & NoPCA group had less PONV and POUR. There was a marked increase in pain VAS and the use of rescue opioids from POD 1 to POD 2 in the Dexa 2 & PCA. There were no wound problems or infections in either group. Under the current multimodal pain management protocol, comparable level of postoperative pain could be achieved by dexamethasone without the need of IV PCA. By not using IV PCA, overall opioid usage was reduced, which could lead to a lower frequency of PONV and POUR. While there is still room for further research on the duration and frequency of administering dexamethasone, additional administration on POD 2 is believed to provide additional pain management benefits compared with administering only until POD 1.

Choi YS, et al. Clin Orthop Surg. 2025 Aug;17(4):631-638. https://doi.org/10.4055/cios24253

Park J, et al. Clin Orthop Surg. 2025 Jun;17(3):408-416. https://doi.org/10.4055/cios24250

Purpose: This study aimed to determine whether the repair of a medial meniscus posterior root tear (MMPRT) is effective for MMPRT healing, cartilage regeneration, and clinical outcomes in opening wedge high tibial osteotomy (OWHTO).Methods: This retrospective study included 80 patients who underwent OWHTO and subsequent second‐look arthroscopy. The patients were divided into OWHTO‐with‐MMPRT‐repair (n = 40) and OWHTO alone (n = 40) groups, and the healing rates (complete/partial/failure) were compared. Each group was further divided into over‐ and under‐corrected subgroups to compare healing rates. The International Cartilage Repair Society (ICRS) grade, cartilage defect size, Koshino stage, ICRS cartilage repair assessment score of the medial femoral condyle (MFC), and International Knee Documentation Committee (IKDC) scores between the OWHTO‐with‐MMPRT‐repair and OWHTO alone groups were compared according to whether microfracture was performed on the MFC.Results: The overall healing rate of the MMPRT was higher in the OWHTO‐with‐MMPRT‐repair group than that in the OWHTO alone group (P < 0.001). In addition, in the subgroup analysis, no difference in the MMPRT healing rate between the over‐correction and under‐correction groups when MMPRT repair was performed (n.s). In contrast, without MMPRT repair, the healing rate was lower in the under‐correction group than that in the over‐correction group (P = 0.03). Cartilage regeneration of the OWHTO‐with‐MMPRT‐repair group was superior to that of the OWHTO alone group (P < 0.05). The IKDC subjective scores of the OWHTO‐with‐MMPRT‐repair and OWHTO alone groups were 34.5 and 33.1 before surgery (n.s) and 50 and 47.2 at one year after surgery, respectively (n.s). These differences between the two groups for cartilage regeneration and IKDC subjective scores showed the same pattern regardless of microfractures.Conclusions: MMPRT repair during OWHTO might improve MMPRT healing, even with under‐correction, and cartilage regeneration of MFC, regardless of microfracture. However, OWHTO with MMPRT repair might not improve short‐term clinical outcomes compared to OWHTO alone. Further randomized clinical trials are necessary.Level of evidence: III, Retrospective cohort study.