Knee replacement methods may need to change

Welcome, readers! At Health Rounds we bring you everything from advancements for treating Earth-bound creaky joints to plans for medical research on the International Space Station. Today we feature a potentially practice changing study on knee replacement surgery and a report from researchers who intend to grow liver tissues in low-Earth orbit as a possible future alternative to organ transplants.

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Knee replacement surgeons may be inadvertently setting patients up for poor outcomes, according to a study that suggests a more personalized approach may be beneficial.

During these operations, surgeons traditionally try to put the hip, knee and ankle in a straight line. This study, published in The Bone and Joint Journal, found that to be a bad idea if those parts of the body were not in a straight line to begin with.

Among 231 patients who underwent knee replacement surgery for osteoarthritis, those whose knee alignment changed afterward reported significantly worse outcomes when questioned an average of more than four years later, the study found.

Those who underwent a change in alignment, as seen on before-and-after X-rays and measured by the Coronal Plane Alignment of the Knee (CPAK) classification system, reported  more knee problems and less ability to forget about their artificial knee during daily activities on questionnaires evaluating how they were faring years later.

Going forward, the researchers advocate incorporating the CPAK classification into pre-surgical planning, setting each patient's native knee alignment as the surgical target using robot-assisted technology.

"In future clinical practice, our findings may guide surgeons in pre-operative planning and execution of total knee arthroplasty," study coauthor Dr. Toshiki Konishi of Kyushu University Hospital in Japan said in a statement.

"Providing a more personalized approach to knee alignment... could become a new standard in orthopedic surgery."

Liver tissue experiments planned for the International Space Station may ultimately provide alternatives to livers for transplantation, researchers reported at the American College of Surgeons Clinical Congress in San Francisco.

Experiments completed thus far indicate that the unique conditions of low Earth orbit, within 1,200 miles from Earth, will help the liver tissues to self-assemble with enhanced functionality, compared to Earth-based methods, they said.

"This represents a critical step toward creating viable liver tissue implants that could serve as an alternative or adjunct to traditional liver transplants," study leader Dr. Tammy Chang of the University of California, San Francisco said in a statement.

The cells in the experiments are created from normal human cells reprogrammed to act like embryonic stem cells, which means they can change into many different types of cells.

Unlike Earth-bound tissue engineering methods, microgravity allows the cells to float freely and organize naturally, resulting in more physiologically accurate tissues, the researchers explained.

They have developed a customized bioreactor, dubbed the "Tissue Orb," to house their experimental tissues, which simulates the natural blood flow process of human tissues.

The researchers are also working on advanced cooling techniques to allow for safe transport of engineered tissues from space to Earth, maintaining them below freezing without damaging them. This technology could extend the shelf life of engineered tissues and potentially be applied to whole organs, they said.

The spaceflight experiment is scheduled for launch in February 2025.

This newsletter was edited by Bill Berkrot; additional reporting by Shawana Alleyne-Morris.

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