Robotic-assisted total knee arthroplasty reduces soft-tissue releases which improves functional outcomes: A retrospective study.

Background: There is increasing use of Robotic-Assisted (RA) and personalized alignment techniques in total knee arthroplasty (TKA). The hypothesis of this study was that RA TKA would result in fewer soft-tissue releases, and that fewer soft-tissue releases would be associated with improved clinical outcomes.

Methods: A retrospective review of an internal company registry was conducted for all primary TKAs performed from Jan 1, 2014, through a database extract date of Nov 4, 2022.

Four-Year Outcomes of Cementless Versus Cemented Fixation of a Newly Introduced Total Knee Arthroplasty Design.

Background: Aseptic loosening continues to be a major cause of failure of total knee arthroplasty (TKA). Although cemented fixation remains the gold standard, there is renewed interest in cementless fixation as a means of decreasing this risk via biologic fixation. The purpose of this study was to evaluate the clinical outcomes of cemented and cementless versions of a newly introduced TKA design at an average of 4 years postoperatively.

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.

The natural history of radiolucencies following cemented unicompartmental knee arthroplasty at 7 years.

Introduction: Radiolucent lines (RLLs) following unicompartmental knee arthroplasty (UKA) can be concerning as aseptic loosening remains a cause of failure in UKA. The aim of our study was to report on the history of RLLs surrounding the components in a cemented medial compartment fixed-bearing UKA as well as the long-term functional outcomes in this group of patients.

Material And Methods: In this retrospective consecutive case-series, twenty-eight patients (37 knees) were treated with medial, fixed-bearing cemented unicompartmental knee arthroplasty.

A Short-Term Multicenter Analysis of Radiolucent Lines in a Single Uncemented Rotating Platform Implant for Total Knee Arthroplasty.

Background: Uncemented total knee arthroplasty is increasing as a potential solution for aseptic loosening via biologic fixation and to increase operative efficiency. However, postoperative radiolucent lines (RLLs) remain a concern for some clinicians. We report on a multicenter analysis of these RLLs over a 2-year period to identify their incidence, progression, and clinical significance.

Poor Patient Follow-up After Metal-on-Metal Total Hip Arthroplasty.

Routine follow-up approximately every 2 to 5 years after total hip arthroplasty (THA) is a common practice. However, although patients are informed of the importance of follow-up, our mean follow-up rate for patients after standard non-metal-on-metal (MOM) THA is only 19%. The US Food and Drug Administration has released several statements on the importance of follow-up every 2 years after MOM THA.

Average narcotic usage in a group of TKA patients following a modern TKA protocol.

Introduction: The optimal dosing of post-operative total knee arthroplasty (TKA) narcotics is unclear. We report on the average narcotic usage in a group of patients treated with an identical multimodal pain protocol following TKA.

Materials And Methods: 49 patients undergoing TKA participated in the survey.

Modern full-component aseptic revision total knee arthroplasties have similar recoveries compared with primary total knee arthroplasty patients when applying an enhanced recovery anaesthetic and analgesic protocol.

Aims: Enhanced perioperative protocols have significantly improved patient recovery following primary total knee arthroplasty (TKA). Little has been investigated the effectiveness of these protocols for revision TKA (RTKA). We report on a matched group of aseptic revision and primary TKA patients treated with an identical pain and rehabilitation programmes.

The Natural History of Radiolucencies Following Uncemented Total Knee Arthroplasty at 9 Years.

Background: Aseptic loosening remains a common cause of failure in total knee arthroplasty (TKA). There is an increased interest in using uncemented TKA to reduce this complication. Radiolucencies (RLs) following uncemented TKA can be concerning.

What publicly available quality metrics do hip and knee arthroplasty patients care about most when selecting a hospital in Maryland: a discrete choice experiment.

Objective: To quantify which publicly reported hospital quality metrics have the greatest impact on a patient's simulated hospital selection for hip or knee arthroplasty.

Design: Discrete choice experiment.

Setting: Two university-affiliated orthopaedic clinics in the greater Baltimore area, Maryland, USA.

Ignore the Patella in Revision Total Knee Surgery: A Minimum 5-Year Follow-Up With Patella Component Retention.

Background: In the setting of aseptic revision, a common question is: what should be done with the previously resurfaced patella? We report on a series of aseptic revision total knee arthroplasties (RTKA) where one or both components were revised and the patella was not.

Methods: The study group was 147 consecutive RTKA in 137 patients with a mean age of 70.1 ± 9.

Incidence of Patella Baja Before and After Primary Total Knee Arthroplasty Based on Body Mass Index.

In the setting of total knee arthroplasty, patella baja has been associated with decreased range of motion and increased risk of certain extensor mechanism complications. The goal of this study was to determine whether obese patients had an increased prevalence of patella baja before and/or after primary total knee arthroplasty. A multicenter retrospective review of 5089 unilateral total knee arthroplasties performed between 1998 and 2012 for osteoarthritis was conducted.

Higher offset cross-linked polyethylene acetabular liners: is wear a significant clinical concern?

Introduction: Total hip arthroplasty (THA) is the 2nd most common total joint replacement surgery in the United States. However, not all THA devices perform well and need revised for several reasons including dislocation. Higher offset acetabular liners reduce this problem by creating a more anatomically/biomechanically natural hip joint, increasing soft-tissue tension, and accommodating larger femoral heads in smaller acetabular cups via increased polyethylene thickness.

Right TKR Patients Treated with Enhanced Pain and Rehabilitation Protocols Can Drive at 2 Weeks.

An important milestone in the recovery following total knee replacement (TKR) is the ability to return to driving. With advances in pain control and the widespread introduction of rapid rehab programs, we hypothesized that the ability to drive would also return sooner than had been traditionally observed. In our group of consecutive right TKR patients, using a driving simulator, we showed that at the 2-week mark, 36 of the 40 patients tested had returned to their preoperative driving capabilities and the other 4 had reached baseline at 3 weeks.

Oral Multimodal Analgesia for Total Joint Arthroplasty.

Background: Oral multimodal analgesia for hip and knee arthroplasty is increasingly used as part of enhanced recovery protocols designed to minimize early postoperative pain and to facilitate early discharge, while minimizing undesirable side effects related to single-agent opioid administration.

Methods: This article is a review of previously published data evaluating the use of various oral medications in the management of postoperative pain after lower extremity arthroplasty and was presented as part of a symposium at the November 2016 AAHKS Annual Meeting.

Results: Multimodal analgesia has been shown to reduce opioid consumption and side effects, with a positive effect on both early and longer term outcomes for hip and knee arthroplasty patients.

The use of metaphyseal sleeves in revision total knee arthroplasty.

Background: Bone loss in revision total knee arthroplasty is common. Various reconstruction options are available. The purpose of our study is to report on one such reconstruction option, titanium metaphyseal sleeves.

The "midsulcus line" as a landmark for tibial resection during total knee arthroplasty.

Background: Proper tibial alignment is an important goal of total knee arthroplasty. Most surgeons agree that tibial coronal alignment should be within three degrees of neutral mechanical alignment. The "midsulcus line" is a line drawn along the sulcus of the tibial spines, and then the line is continued in the sagittal plane and extended onto the anterior tibia where it intersects the tibial tubercle approximately 3 to 4mm lateral to the tubercle's medial border.

Consensus Statement on Indications and Contraindications for Medial Unicompartmental Knee Arthroplasty.

Previous work, now nearly 30 years dated, is frequently cited as the "gold standard" for the indications and contraindications for medial unicompartmental knee arthroplasty (UKA). The purpose of this article is to review current literature on the indications and contraindications to UKA and develop a consensus statement based on those data. Six surgeons with a combined experience of performing more than 8,000 partial knee arthroplasties were surveyed.

A state-of-the-art pain protocol for total knee replacement.

Total knee replacement is acknowledged as a successful and durable operation, but recovery from this surgery is often lengthy and painful. A great deal of attention has recently been directed at enhancing this recovery, most of which has focused on improvements in perioperative pain control. Various protocols have been suggested.

Is there an association between whole-body pain with osteoarthritis-related knee pain, pain catastrophizing, and mental health?

Background: Greater levels of self-reported pain, pain catastrophizing, and depression have been shown to be associated with persistent pain and functional limitation after surgeries such as TKA. It would be useful for clinicians to be able to measure these factors efficiently.

Questions/purposes: We asked: (1) What is the association of whole-body pain with osteoarthritis (OA)-related knee pain, function, pain catastrophizing, and mental health? (2) What is the sensitivity and specificity for different cutoffs for body pain diagram region categories in relation to pain catastrophizing?

Methods: Patients (n = 267) with knee OA undergoing elective TKA at one academic center and two community orthopaedic centers were enrolled before surgery in a prospective cohort study.

Improving patient outcomes through advanced pain management techniques in total hip and knee arthroplasty.

Pain following orthopedic surgery is common and often suboptimally managed, with many patients reporting acute moderate to severe pain following surgery. Opioids are often used to manage this pain, yet this can result in significant side effects and complications, including constipation, nausea, vomiting, respiratory distress, and other central nervous system issues. Multimodal therapy that includes surgical site infiltration with extended release local anesthetic has been seen as a new way to minimize this pain for patients, which can result in improved quality of life and shorter length of hospital stay.

Periarticular Injection Technique to Enhance Pain Relief After Knee Arthroplasty.

Introduction: Currently, a popular form of pain control following total knee arthroplasty is the use of periarticular injections; how the medications are injected is a critical step in the efficacy of this modality.

Step 1 Setup: The setup includes the injection fluid and two control syringes with a 22-gauge needle.

Step 2 Inject The Lateral Femoral Periosteum: Inject around the femur before placing the implants.

A systematic review of clinical outcomes and survivorship after total knee arthroplasty with a contemporary modular knee system.

A systematic review appraising the clinical performance and safety of the primary SIGMA modular knee system (DePuy-Synthes, Warsaw, Ind.) found 5 registry reports and 53 journal publications reporting survivorship or postoperative increase in Knee Society scores on 241632 primary SIGMA knee arthroplasties. Pooled data from national joint registries and clinical studies on primary SIGMA knee survivorship were comparable.