Body Mass Index Improvement Reduces Total Knee Arthroplasty Complications Among Patients Who Have Extreme, but Not Severe, Obesity.

Background: While morbid obesity has been associated with increased complication risk in primary total knee arthroplasty (TKA), limited evidence is available to attribute decreased surgical complication rates with body mass index (BMI) reduction.

Methods: We retrospectively assessed 464 unilateral TKAs performed in morbidly obese patients, including 158 extremely obese (BMI ≥ 45) and 306 severely obese patients (BMI 40 to 44.9).

Obesity Severity Predicts Patient Dissatisfaction After Total Knee Arthroplasty.

Background: Patient dissatisfaction has been reported in 15 to 20% of traditional total knee arthroplasty (TKA) procedures. While contemporary improvements may have positive effects on patient satisfaction, these may be offset by increasing obesity prevalence among patients who have knee osteoarthritis. We performed this study to determine whether obesity severity impacts patient-reported TKA satisfaction.

Outcomes of Total Knee Arthroplasty Revisions in Obese and Morbidly Obese Patient Populations.

Background: The obese population is at higher risk for complications following primary total knee arthroplasty (TKA), but little data is available regarding revision outcomes. This study aimed to investigate the role of body mass index (BMI) in the cause for revision TKA and whether BMI classification is predictive of outcomes.

Methods: A multi-institutional database was generated, including revision TKAs from 2012 to 2019.

Conversion Total Knee Arthroplasty After Failed Osteochondral Allograft Reconstruction: Similar Functional Performance With Lower Patient Satisfaction.

Background: This study presents surgical techniques used in conversion total knee arthroplasty (cTKA) following early failure of large osteochondral allograft joint replacement and compares postoperative patient reported outcomes measures (PROMs) and satisfaction scores with a contemporary primary total knee arthroplasty (pTKA) cohort.

Methods: We retrospectively evaluated 25 consecutive cTKA patients (26 procedures) to define the utilized surgical techniques, radiographic disease severity, preoperative and postoperative PROMs (visual analog scale [VAS] pain, knee injury and osteoarthritis outcome score for joint replacement [KOOS-JR], University of California Los Angeles Activity), expected improvement and postoperative satisfaction (5-point Likert), and reoperations in comparison with an age and body mass index propensity matched cohort of 50 pTKA performed for osteoarthritis (52 procedures).

Results: Revision components were used in 12 cTKA cases (46.

Blood Transfusion can be Avoided in Single-Anesthetic Bilateral Total Knee Arthroplasty.

Background: Female gender and surgical drain use have been associated with an increased transfusion risk following single-anesthetic bilateral total knee arthroplasty (SBTKA). This study evaluated allogenic blood transfusion rates among female and male patients undergoing SBTKA with intraoperative tourniquet, tranexamic acid and contemporary blood transfusion thresholds but without surgical drain use.

Methods: We performed a retrospective electronic medical record review for 125 consecutive patients undergoing SBTKA (250 knees) between May 1, 2015 and July 10, 2021.

Cemented Patellar Implant Malposition: A Non-Issue for the Painful Total Knee Arthroplasty.

Background: Non-optimal patellofemoral relationships may influence treatment decisions during revision total knee arthroplasty (TKA). We performed this study to determine whether patellar implant malposition or patellar tilt is associated with inferior patient-reported outcome scores or patient satisfaction after primary TKA.

Methods: We identified 396 TKA patients (439 knees) from an institutional registry who had undergone patellar resurfacing, with preoperative and 6-week postoperative radiographs available, and patient-reported outcome measures (PROMs) completed at least 1 year after surgery (mean 505 days).

Tibial Bone Quality in Former Bariatric Surgery Patients with Osteoarthritis.

Unlabelled: Downstream effects of bariatric weight-loss surgery have been associated with bone resorption, potentially jeopardizing total knee arthroplasty (TKA) implant fixation/ingrowth.

Purpose: This case-control study sought to determine if TKA patients with history of bariatric surgery exhibit altered microanatomy of subchondral bone quality in the tibial plateau compared to controls.

Materials And Methods: With IRB approval, 41 bone samples were evaluated from 12 former bariatric surgery patients and 10 sex-, age-, weight-, height-, and BMI-matched controls.

Bacterial DNA screening to characterize surgical site infection risk in orthopaedic patients.

Purpose: To provide an initial characterization of relevant bacterial DNA profiles for patients undergoing closed-fracture fixation or total joint arthroplasties.

Patients And Methods: Swabs were collected and analyzed using Polymerase Chain Reaction from adult patients undergoing closed-fracture fixation or total shoulder, knee, or hip arthroplasties.

Results: Bacterial DNA profiles varied across the different orthopaedic patient populations, and produced uncharacteristic profile shifts with direct relevance to each clinical infection.

Tobacco Use Is Associated with More Severe Adverse Outcomes Than Morbid Obesity after Aseptic Revision TKA.

The association of morbid obesity with increased revision total knee arthroplasty (rTKA) complications is potentially confounded by concurrent risk factors. This study was performed to evaluate whether morbid obesity was more strongly associated with adverse aseptic rTKA outcomes than diabetes or tobacco use history-when present as a solitary major risk factor. Demographic characteristics, surgical indications, and adverse outcomes (reoperation, revision, infection, and amputation) were compared between 270 index aseptic rTKA performed for patients with morbid obesity ( = 73), diabetes ( = 72), or tobacco use ( = 125) and 239 "healthy" controls without these risk factors at a mean 75.

Revision TKA for Instability: Poorer Outcomes after a Previous Aseptic Revision.

Instability is a common indication for early revision total knee arthroplasty (rTKA). The comparative performance of instability rTKA performed after primary TKA and instability rerevision TKA (rrTKA) performed after a previous rTKA performed for any aseptic indication have not been defined. This study was performed to determine the rate of adverse outcomes for patients undergoing aseptic instability TKA revision following a primary TKA or a previous aseptic any-cause rTKA.

TKA is More Durable Than UKA for Morbidly Obese Patients: A Two-Year Minimum Follow-Up Study.

Background: Unicompartmental knee arthroplasty (UKA) indications have expanded during the past two decades to include some morbidly obese patients (body mass index (BMI) > 40 kg/m). Few published studies have compared UKA and total knee arthroplasty (TKA) in this unique patient subgroup with conflicting observations.

Methods: We retrospectively compared 89 mobile bearing UKA (71 patients) and 201 TKA (175 patients) performed at a single institution with a minimum 2-year follow-up (mean 3.

Dual Antibiotic Prophylaxis in Primary Total Knee Arthroplasty-No Benefit for Extremely Obese Patients.

We performed this study to assess the effectiveness of multimodal total knee arthroplasty prosthetic joint infection (TKA-PJI) prophylaxis including "on-time" dual-antibiotic prophylaxis, and the influence of body mass index (BMI) on prophylaxis effectiveness. After obtaining Institutional Review Board approval, we assessed 1,802 primary TKAs (1,496 patients) who received cefazolin alone or cefazolin combined with vancomycin for TKA-PJI prophylaxis. A detailed chart review was performed to determine patient demographic features (age, gender, BMI, American Society of Anesthesiologists Score), antibiotic selection, vancomycin administration timing, and 1-year PJI rates.

Isolated Liner Revision for Total Knee Arthroplasty Instability: A Road That Should Remain Less Taken.

Isolated polyethylene liner exchange (IPLE) is infrequently selected as a treatment approach for patients with primary total knee arthroplasty (TKA) prosthetic joint instability. Potential advantages of less immediate surgical morbidity, faster recovery, and lower procedural cost need to be measured against reoperation and re-revision risk. Few published studies have directly compared IPLE with combined tibial and femoral component revision to treat patients with primary TKA instability.

Revision Total Knee Arthroplasty in Young Patients: Higher Early Reoperation and Rerevision.

Background: Revision total knee arthroplasty (rTKA) rates are increasing in younger patients. Few studies have assessed outcomes of initial aseptic rTKA performed for younger patients compared with traditional-aged patients.

Methods: A detailed medical record review was performed to identify patient demographics, medical comorbidities, surgical rTKA indications, timing from index TKA to rTKA, subsequent reoperation rates, component rerevision rates, and salvage procedures for 147 young patients (158 knees) aged 55 years and younger and for a traditional older cohort of 276 patients (300 knees) between 60 and 75 years.

Characterizing correlations among disease severity measures in osteochondral tissues from osteoarthritic knees.

Osteoarthritis (OA) is a complex disease with biologic, biomechanical, and clinical heterogeneity among patients. Relationships among OA tissue metabolism, histopathology, and extracellular matrix (ECM) composition have not been well characterized. It was hypothesized that moderate (r = .

The Past, Present, and Future of Orthopedic Education: Lessons Learned From the COVID-19 Pandemic.

The COVID-19 global pandemic has upended nearly every medical discipline, dramatically impacted patient care and has had far-reaching effects on surgeon education. In many areas of the country, elective orthopedic surgery has completely stopped to ensure that resources are available for the critically ill and to minimize the spread of disease. COVID-19 is forcing many around the world to re-evaluate existing processes and organizations and adapt to carry out business, of which medicine and education are not immune.

Higher Component Malposition Rates with Patient-Specific Cruciate Retaining TKA than Contemporary Posterior Stabilized TKA.

Customized individually manufactured total knee arthroplasty (CIM-TKA) was developed to improve kinematic total knee arthroplasty (TKA) performance. Component placement accuracy may influence the success of CIM-TKA designs. We performed this study to compare radiographic component alignment and revision rates of a cruciate retaining (CR) CIM-TKA and a contemporary posterior stabilized TKA (PS-TKA).

High Failure Rates for Unicompartmental Knee Arthroplasty in Morbidly Obese Patients: A Two-Year Minimum Follow-Up Study.

Background: Several recent studies have recommended offering unicompartmental knee arthroplasty (UKA) to all patients regardless of body mass index (BMI). The aim of this investigation was to evaluate the proposition that UKA can indeed be offered to the morbidly-obese and super-obese (morbidly-obese, BMI ≥ 40 kg/m) without compromising results or survivorship.

Methods: We retrospectively reviewed mobile-bearing medial UKA procedures performed at our facility from January 2012 to May 2015 with a minimum of 2-year follow-up.

Femoral Component Malrotation Produces Quadriceps Weakness and Impaired Ambulatory Function following Total Knee Arthroplasty: Results of a Forward-Dynamic Computer Model.

Proper placement of the prosthetic components is believed to be an important factor in successful total knee arthroplasty (TKA). Implant positioning errors have been associated with postoperative pain, suboptimal function, and inferior patient-reported outcome measures. The purpose of this study was to investigate the biomechanical effects of femoral component malrotation on quadriceps function and normal ambulation.