Early Aseptic Tibial Loosening Is a Concern With a Modern Two-Peg Cementless Total Knee Arthroplasty Design.

Background: While early generations of cementless total knee arthroplasty (TKA) had inferior outcomes compared to cemented TKA, modern cementless designs have offered excellent clinical results. The purpose of this study was to compare patient-reported outcome measures (PROMs) and early aseptic revision rates of a specific cementless TKA design featuring a two-pegged tibia to that of its cemented counterpart.

Methods: A retrospective case series of all cementless and cemented TKAs utilizing a single design performed at a single, high-volume academic center was performed.

The CCJR® Gerard A. Engh Excellence in Knee Research Award: Remote Monitoring of Sleep Disturbance Following Total Knee Arthroplasty: A Cautionary Note.

Background: Sleep disturbances are common after total knee arthroplasty (TKA). Despite the rising popularity of wearables to track sleep, little evidence exists in the arthroplasty literature regarding their efficacy. We aimed to correlate validated wearable sleep metrics with patient-reported sleep quality following TKA.

Integrating Smartphone Applications and Wearable Devices for Postoperative Rehabilitation in Total Knee Arthroplasty: A Critical Review.

Background: Smartphone and wearable technologies offer innovative methods for monitoring postoperative recovery in total knee arthroplasty (TKA) patients. This review assessed the benefits of these technologies in postoperative care, focusing on (1) smartphone applications, (2) wearable devices, and (3) their combination.

Methods: A systematic search identified studies on smartphone applications and wearables for post-TKA monitoring.

Is Retention of the Acetabular Component at Revision Surgery a Long-Term Solution?

Background: Acetabular retention in revision total hip arthroplasty (THA) may be advantageous, yet long-term survival data is limited. Thus, we investigated long-term survivorship of retained acetabular components in revision THA with analysis of rerevision rate, instability risk, and clinical outcomes.

Methods: We reviewed 98 hips with polyethylene wear and/or osteolysis that were revised with retained acetabular components.

Use of Remote Physiologic and Therapeutic Monitoring Following Total Knee Arthroplasty.

Introduction: Remote physiologic monitoring (RPM), or remote therapeutic monitoring (RTM), has grown exponentially for the management of chronic medical diseases in Medicare patients. More recently, the application of this technology has ventured into the orthopaedic arena, and more specifically, for total joint arthroplasty. Platforms to expedite this monitoring can provide continuous biodata feedback on digital biomarkers to patients and surgeons, which can potentially help improve and create novel patient-specific recovery pathways.

Cementless Versus Cemented Total Knee Arthroplasty: Concise Midterm Results of a Prospective Randomized Controlled Trial.

Background: We previously reported the 2-year results of a prospective randomized controlled trial of cementless versus cemented total knee arthroplasty (TKA) implants of the same design. The purpose of the present study was to provide concise results at intermediate-term follow-up.

Methods: The original study included 141 TKAs (76 performed without cement and 65 performed with cement).

Patients' Perceptions of Remote Monitoring and App-Based Rehabilitation Programs: A Comparison of Total Hip and Knee Arthroplasty.

Background: Remote monitoring rehabilitation programs are new technologies growing in popularity for patients undergoing lower extremity total joint arthroplasty. The purpose of this study was to assess the patients' perceptions of these technologies.

Methods: Patients who underwent total hip arthroplasty (THA), total knee arthroplasty arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA) from September 2020 to February 2022, and participated in a clinical study utilizing remote monitoring and an app-based rehabilitation program were given a questionnaire 3 months postoperatively to assess their perceptions of these technologies.

Chitranjan S. Ranawat Award: Tourniquet Use Does Not Impact Trajectory of Total Knee Arthroplasty Early Recovery: A Prospective, Randomized Controlled Trial.

Background: The impact of tourniquet use on recovery after total knee arthroplasty (TKA) remains controversial. The purpose of this prospective, single blinded, randomized controlled trial was to investigate the effect of tourniquet use on early recovery after TKA using a smartphone app-based patient engagement platform (PEP) with a wrist-based activity monitor to obtain more robust data on early recovery.

Methods: There were 107 patients undergoing primary TKA for osteoarthritis who were enrolled (54 tourniquet [TQ+]; 53 no tourniquet [TQ-]).

Sleep Disturbances Following Total Knee Arthroplasty.

Background: Sleep disturbances are common after total knee arthroplasty (TKA), yet literature examining sleep and postoperative pain remains sparse. With the use of wearable devices, convenient objective remote sleep monitoring is now possible. We aimed to measure patient sleep following TKA using validated questionnaires and wearable devices to compare sleep patterns to pain scores 90 days postoperatively.

Popliteus Avulsion Fracture After Unicompartmental Arthroplasty: A Case Report.

Case: An active 64-year-old patient presented with new-onset lateral knee pain 42 days after an uncomplicated medial unicompartmental knee arthroplasty (UKA). Magnetic resonance imaging and diagnostic injection of local anesthetic identified an avulsion fracture of the popliteus tendon as the source of discomfort. Repair of the tendon to its native footprint was performed with suture anchor fixation.

Hot Topics and Current Controversies in Total Knee Arthroplasty.

Total knee arthroplasty continues to evolve. It is important to review some of the current controversies and hot topics in arthroplasty. Optimal knee alignment strategy is now just a matter of debate.

Mid-Term Performance of the First Mass-Produced Three-Dimensional Printed Cementless Tibia in the United States as Reported in the American Joint Replacement Registry.

Background: Cementless tibial components have shown improvements in clinical performance compared to predicate designs, though evidence supporting mid-term performance and fixation is scarce. The purpose of this study is to determine the mid-term survivorships, revision rates, and reasons why 3-dimensional printed cementless tibial baseplates (3DTKAs) failed compared to other cementless as well as cemented tibial baseplates reported from the American Joint Replacement Registry (AJRR) data.

Methods: All primary total knee arthroplasty (TKA) cases performed in patients 65 years of age or older within the AJRR from January 2, 2012 through June 30, 2020 were queried.

Sleep Disturbances and Disorders in Patients with Knee Osteoarthritis and Total Knee Arthroplasty.

➤: There is increasing evidence that patient-reported outcomes following total knee arthroplasty (TKA) are associated with psychosocial factors and pain catastrophizing. Sleep disturbance, pain, and mental health have a complex interaction, which, if unrecognized, can be associated with impaired patient-reported outcomes and dissatisfaction following TKA.

➤: The gold standard of objective sleep assessment is polysomnography, which is not feasible to use routinely for TKA patients.

James A. Rand Young Investigator's Award: Questioning the "Nickel Free" Total Knee Arthroplasty.

Background: A study was performed to measure metal ions present in the knee joint after performing a total knee arthroplasty (TKA) with standard cobalt chromium (CoCr) components as well as with "nickel-free" oxidized zirconium femoral and titanium tibial (OxZr/Ti) components.

Methods: Knee joint fluid was collected prior to arthrotomy, and on postoperative day one to determine the amount of metal debris generated when performing a TKA with standard instrumentation from consecutive cases with CoCr components (n = 24) and OxZr/Ti components (n = 16).

Results: CoCr implant patients had statistically higher levels of nickel (Ni) (29.

The Impact of Component Design and Fixation on Stress Shielding After Modern Total Knee Arthroplasty.

Background: Total knee arthroplasty (TKA) tibial baseplate thickness, metallurgy, and implant fixation with cement may influence stress shielding. The purpose of the present study is to compare bone mineral density of 2 cemented and press-fit TKA designs with differing tibial baseplate thicknesses and metallurgy over a 2-year period to assess for changes in stress shielding.

Methods: One-hundred one TKAs were performed in this Institutional Review Board-approved, prospective study.

Implant Malalignment may be a Risk Factor for Poor Patient-Reported Outcomes Measures (PROMs) Following Total Knee Arthroplasty (TKA).

Background: Implant malalignment may be a risk factor for poor patient-reported outcomes measures (PROMs) following total knee arthroplasty (TKA).

Methods: Postoperative surveys were administered to assess PROMs regarding satisfaction, pain, and function in 262 patients who underwent surgery at 4 centers in the U.S.

Intra-articular administration of vancomycin and tobramycin during primary cementless total knee arthroplasty : determination of intra-articular and serum elution profiles.

Aims: Intra-articular administration of antibiotics during primary total knee arthroplasty (TKA) may represent a safe, cost-effective strategy to reduce the risk of acute periprosthetic joint infection (PJI). Vancomycin with an aminoglycoside provides antimicrobial cover for most organisms isolated from acute PJI after TKA. However, the intra-articular doses required to achieve sustained therapeutic intra-articular levels while remaining below toxic serum levels is unknown.

Clinical impact of component placement in manually instrumented total knee arthroplasty : a systematic review.

Aims: The goal of the current systematic review was to assess the impact of implant placement accuracy on outcomes following total knee arthroplasty (TKA).

Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Ovid Medline, Embase, Cochrane Central, and Web of Science databases in order to assess the impact of the patient-reported outcomes measures (PROMs) and implant placement accuracy on outcomes following TKA. Studies assessing the impact of implant alignment, rotation, size, overhang, or condylar offset were included.

The Impact of Psychological Factors and Their Treatment on the Results of Total Knee Arthroplasty.

➤: There is a growing body of evidence implicating psychosocial factors, including anxiety, depression, kinesiophobia, central sensitization, and pain catastrophizing, as negative prognostic factors following total knee arthroplasty (TKA).

➤: Symptoms of anxiety and depression likely represent risk factors for negative outcomes in patients undergoing TKA. However, few studies have assessed the impact of preoperative interventions for these conditions on postoperative outcomes.

Modular dual mobility total hip arthroplasty is a viable option for young, active patients : a mid-term follow-up study.

Aims: Dual mobility (DM) implants have been shown to reduce the dislocation rate after total hip arthroplasty (THA), but there remain concerns about the use of cobalt chrome liners inserted into titanium shells. The aim of this study was to assess the clinical outcomes, metal ion levels, and periprosthetic femoral bone mineral density (BMD) at mid-term follow-up in young, active patients receiving a modular DM THA.

Methods: This was a prospective study involving patients aged < 65 years, with a BMI of < 35 kg/m, and University of California, Los Angeles activity score of > 6 who underwent primary THA with a modular cobalt chrome acetabular liner, highly cross-linked polyethylene mobile bearing, and a cementless titanium femoral stem.

Telemedicine for patients undergoing arthroplasty : access, ability, and preference.

Aims: The purpose of this study was to determine the access to and ability to use telemedicine technology in adult patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), and to determine associations with the socioeconomic characteristics of the patients, including age, sex, race, and education. We also sought to understand the patients' perceived benefits, risks, and preferences when dealing with telemedicine.

Methods: We performed a cross-sectional survey involving patients awaiting primary THA and TKA by one of six surgeons at a single academic institution.

Is Apixaban Safe and Effective for Venous Thromboembolism Prophylaxis After Primary Total Hip and Total Knee Arthroplasties?

Background: Venous thromboembolism (VTE) is a serious complication of total hip arthroplasty (THA) and total knee arthroplasty (TKA). Apixaban is approved for VTE prophylaxis. This study seeks to ascertain the risk of VTE and bleeding complications in patients undergoing primary THA and TKA receiving apixaban for postoperative VTE prophylaxis for one of the following indications: high risk for VTE, previously on apixaban, and contraindication to the use of aspirin.

Radiological outcomes following manual and robotic-assisted unicompartmental knee arthroplasty.

Aims: The purpose of this study was to compare the radiological outcomes of manual versus robotic-assisted medial unicompartmental knee arthroplasty (UKA).

Methods: Postoperative radiological outcomes from 86 consecutive robotic-assisted UKAs (RAUKA group) from a single academic centre were retrospectively reviewed and compared to 253 manual UKAs (MUKA group) drawn from a prior study at our institution. Femoral coronal and sagittal angles (FCA, FSA), tibial coronal and sagittal angles (TCA, TSA), and implant overhang were radiologically measured to identify outliers.

Total Hip Arthroplasty in Patients With Osteoarthritis Associated With Legg-Calve-Perthes Disease: Perioperative Complications and Patient-Reported Outcomes.

Background: Complications and patient-reported outcomes (PROs) of total hip arthroplasty (THA) in patients with Legg-Calve-Perthes disease (LCPD) have demonstrated variable results. The purpose of this study was to use a validated grading scheme to analyze complications associated with THA in patients with residual LCPD deformities. Second, we report PROs and intermediate-term survivorship in this patient population.

Suspected Metal Allergy and Femoral Loosening After Total Knee Arthroplasty: A Diagnostic Dilemma.

Metal sensitivity is increasingly prevalent and is associated with negative outcomes after total knee arthroplasty (TKA). Currently, there is no consensus on diagnostic criteria for TKA failure from immune reaction. We present a patient who had pain and aseptic effusion 2 years after TKA.