Alphabet Soup of Primary Total Knee Arthroplasty Liner Options-Cruciate Retaining, Posterior Stabilized, Medial Congruent, Medial Pivot: Making Sense of the Options and What the Latest Data Show.

The traditional dual-option debate of cruciate-retaining versus posterior-
stabilized knee arthroplasty designs has evolved into a more complex discussion in recent years. The growing interest and rapid adoption of medial conforming and medial pivot designs has made the original debate surrounding cruciate-retaining versus posterior-stabilized designs more interesting. Each liner option has its own advantages and disadvantages.

Preoperative Evaluation, Anesthetic Considerations, and Perioperative Oral and Parenteral Medications in Total Knee Arthroplasty.

Effective pain management protocol is critical to early mobilization, early discharge, and increasing patient satisfaction for hip and knee arthroplasty. Surgeons have tried to minimize dependence on opioids and opioid-related adverse events through multimodal protocols that use periarticular injections as well as oral and parenteral medications. The efficacy, cost, and adverse effects of each of these components need to be considered when formulating an evidence-based multimodal pain protocol.

How Much Hip Motion Is Used in Real-Life Activities? Assessment of Hip Flexion by a Wearable Sensor and Implications After Total Hip Arthroplasty.

Background: Hip range of motion precautions are often considered a requirement for patients after total hip replacement. Few studies have attempted to estimate hip motion during activities of daily living. The purpose of this study is to evaluate hip range of motion and gait during real-life activities in healthy individuals with a novel tracking wearable sensor.

Outpatient Joint Arthroplasty: Practical Guidelines for Success, Effect of COVID--19, and the Roles of Technology and Partnering With Industry.

The COVID-19 pandemic has had a drastic effect on the landscape of outpatient joint arthroplasty. By accelerating the migration to ambulatory surgery centers and hospital outpatient departments, protocols and techniques had to adapt quickly. In addition, the roles of technology and partnering with industry became more appealing in some cases to address specific voids and needs during this transition period.

A Prospective, Randomized Evaluation of the Quality of Wound Closure With Barbed Versus Standard Suture After Total Joint Arthroplasty.

Complications such as joint infection or delayed wound healing can lead to morbidity and elevated health care costs after total joint arthroplasty. The purpose of this study was to compare the quality of running knotless barbed suture vs standard monofilament suture wound closure with respect to wound drainage and healing complications after total joint arthroplasty. For this study, 1000 joint arthroplasty patients were prospectively randomized to have fascial, soft tissue, and skin closure with knotless barbed suture vs standard suture during the period 2016 to 2018.

Economic Impact of Preoperative Meloxicam IV Administration in Total Knee Arthroplasty: A Randomized Trial Sub-Study.

We evaluated the economic impact associated with preoperative meloxicam IV 30 mg vs placebo administration among adult total knee arthroplasty (TKA) recipients enrolled in Phase IIIB NCT03434275 trial. Data on total hospital costs and length of stay (LOS) obtained from the trial were compared between meloxicam IV 30 mg and placebo groups. Patients in the meloxicam IV 30 mg vs placebo group (n = 93 vs 88) incurred an adjusted $2,266 (95% CI: -$1,035, $5,116; p = 0.

Clinical Outcomes and Experience of a Multiyear Consecutive Case Series of Total Knee Arthroplasty Procedures Conducted with a Bipolar Sealer System for Hemostasis.

Maximizing hemostasis during total knee replacement procedures remains a key challenge in current practice. Bipolar sealer technology achieves intraoperative hemostasis through tissue sealing and coagulation with adjustable radio frequency energy and a saline-irrigated tip. Optimal surgical site hemostasis is important to avoid potential complications such as hemarthrosis, wound drainage, increased pain, delayed discharge, and readmissions.

Safety and Efficacy of Perioperative Intravenous Meloxicam for Moderate-to-Severe Pain Management in Total Knee Arthroplasty: A Randomized Clinical Trial.

Objective: To evaluate the effect of perioperative meloxicam IV 30 mg on opioid consumption in primary total knee arthroplasty (TKA).

Design: Multicenter, randomized, double-blind, placebo-controlled trial.

Subjects: In total, 181 adults undergoing elective primary TKA.

HTX-011 Reduced Pain and Opioid Use After Primary Total Knee Arthroplasty: Results of a Randomized Phase 2b Trial.

Background: HTX-011 is an extended-release, dual-acting local anesthetic consisting of bupivacaine and low-dose meloxicam in a novel polymer that is administered by needle-free application during surgery. The active ingredients are released from the polymer by controlled diffusion over 72 hours.

Methods: This phase 2b, double-blind, placebo-controlled and active-controlled trial enrolled patients undergoing primary unilateral total knee arthroplasty under general anesthesia.

Outpatient Joint Replacement: Practical Guidelines for Your Program Based on Evidence, Success, and Failures.

Joint arthroplasty is increasingly being performed in ambulatory surgery centers (ASCs). Enabled by enhanced recovery protocols and multimodal pain management, and incentivized by the implementation of value-based payment models, this trend is projected to continue, with more than half of total joint replacements predicted to be outpatient by 2026. Like any advance in healthcare, this transition offers both new advantages and new challenges.

The Efficacy of Tranexamic Acid in Total Hip Arthroplasty: A Network Meta-analysis.

Background: Tranexamic acid (TXA) is an antifibrinolytic agent commonly used to reduce blood loss in total hip arthroplasty (THA). The purpose of our study was to evaluate the efficacy of TXA in primary THA to support the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Medicine on the use of TXA in primary total joint arthroplasty.

Methods: A search was performed using Ovid-MEDLINE, Embase, Cochrane Reviews, Scopus, and Web of Science databases to identify all publications before July 2017 on TXA in primary THA.

The Efficacy of Tranexamic Acid in Total Knee Arthroplasty: A Network Meta-Analysis.

Background: A growing body of published research on tranexamic acid (TXA) suggests that it is effective in reducing blood loss and the risk for transfusion in total knee arthroplasty (TKA). The purpose of this network meta-analysis was to evaluate TXA in primary TKA as the basis for the efficacy recommendations of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Medicine on the use of TXA in primary total joint arthroplasty.

Methods: We searched Ovid MEDLINE, Embase, Cochrane Reviews, Scopus, and Web of Science databases for publications before July 2017 on TXA in primary total joint arthroplasty.

The Safety of Tranexamic Acid in Total Joint Arthroplasty: A Direct Meta-Analysis.

Background: Tranexamic acid (TXA) is effective in reducing blood loss in total joint arthroplasty (TJA), but concerns still remain regarding the drug's safety. The purpose of this direct meta-analysis was to evaluate and establish a basis for the safety recommendations of the combined clinical practice guidelines on the use of TXA in primary TJA.

Methods: A search was completed for studies published before July 2017 on TXA in primary TJA.

Is There an Advantage to Knotless Barbed Suture in TKA Wound Closure? A Randomized Trial in Simultaneous Bilateral TKAs.

Background: Effective wound closure is critical to minimizing wound complications and withstanding the forces associated with early knee motion after TKA. Barbed sutures allow for knotless fixation, have been used successfully in other specialties, and may provide for more even distribution of tension along the length of the incision; however, data regarding unidirectional barbed sutures from randomized trials have raised important concerns about their use. Bidirectional barbed sutures offer a potential alternative, but have not been studied extensively in orthopaedic surgery.

Hyponatremia after primary hip and knee arthroplasty: incidence and associated risk factors.

Hyponatremia is the most common electrolyte abnormality in clinical practice. Often overlooked or misdiagnosed, hyponatremia can quickly deteriorate and cause serious and potentially life-threatening complications. In the orthopedic patient, hyponatremia can mimic common postoperative sequelae, thereby making diagnosis even more difficult.

Outcomes and complications of unicondylar arthroplasty.

Unicompartmental knee arthroplasty has experienced resurgence in popularity because of the lower morbidity of the procedure and the proposed benefits over total knee replacement in appropriately selected patients. Improved component designs and advanced surgical techniques have promoted excellent results. Expanded indications to include the very young and the elderly have yielded comparable clinical outcomes.

Modified hybrid stem fixation in revision TKA is durable at 2 to 10 years.

Background: Hybrid revision knee component fixation, in which cement is placed in the metaphysis combined with a cementless diaphyseal engaging stem, provides ease of insertion, possibly improved component alignment, and easier removal if required, compared with fully cemented prostheses. The literature suggests the technique has a 2 to 5 year survivorship ranging from 81% to 94%.

Questions/purposes: To confirm the literature we asked whether (1) a modified hybrid fixation technique is durable and reliable at an average 5-year followup, (2) this method of fixation provides clinical improvements as assessed by knee scores, (3) there are radiographic findings unique to this fixation technique, (4) the degree of knee constraint influences clinical performance or radiographic findings, and (5) end-of-stem pain is associated with this fixation method?

Patients And Methods: We retrospectively reviewed all 83 patients who had 88 both-component revision TKAs using our modified hybrid fixation technique.

Incidence of sciatic nerve palsy after revision hip arthroplasty through a posterior approach.

Sciatic nerve palsy after revision hip arthroplasty is rare, but can have substantial impacts. The purpose of this study is to report the safety and reliability of limited sciatic nerve exposure during revision surgery. A retrospective case series of 350 revision hip surgeries performed by a single surgeon underwent sciatic nerve identification.

Traumatic simultaneous asymmetric hip dislocations and motor vehicle accidents.

Hip dislocations are becoming more frequent with increasing numbers of motor vehicle accidents. Bilateral hip dislocations are a rare injury, and simultaneous asymmetric dislocations are even more rare. Of the 20 cases described in the English literature, 16 have been sustained by occupants of motor vehicle accidents.

Interprosthetic fractures of the femur: treatment with a single-locked plate.

Interprosthetic fractures of the femur, those between an ipsilateral hip and knee arthroplasty, are challenging to treat secondary to limited bone available for fixation, osteopenic bone, a compromised intramedullary blood supply, and an often elderly patient population. From 2002 to 2006, 22 consecutive patients with an interprosthetic femur fracture were treated with a single-locking plate. Follow-up averaged 17.