A Restricted Functional Balancing Technique for Total Knee Arthroplasty With a Varus Deformity: Does a Medial Soft-Tissue Release Result in a Worse Outcome?

Background: A functional alignment technique for total knee arthroplasty (TKA) utilizes implant position modifications to balance the soft tissues. There is concern that, in some cases, extreme coronal and tibial component alignment could facilitate early implant failure. To be cautious, a restricted functional alignment may be used.

Metal-Backed Patella Implants in Knee Arthroplasty: Can the Past Predict the Future?

Background: There is a renewed interest in uncemented total knee arthroplasty to potentially provide longer durability, including the use of newer design metal-backed patellae (MBPs). The purpose of this study was to review survivorship with failure mode and time to failure of an earlier version MBP at up to 10-30 years of follow-up that may influence the desirability of using these components today.

Methods: A retrospective review was performed of patients that had uncemented total knee arthroplasty with an uncemented MBP.

Effect of Posterior Osteophytes on Total Knee Arthroplasty Coronal Soft Tissue Balance: Do They Matter?

Background: Achieving coronal plane balance in total knee arthroplasty (TKA) is of paramount importance. There is concern that obtaining balancing before removal of posterior osteophytes may lead to asymmetrical extension balance once removed. We hypothesized that there is a particular posterior osteophyte size and location that does not result in significant change in coronal gap balancing.

Manipulation Under Anesthesia Rates in Technology-Assisted versus Conventional-Instrumentation Total Knee Arthroplasty.

Introduction: Various technological advancements, specifically robotic assistance, have been implemented for total knee arthroplasty (TKA) procedures to attempt to improve patient outcomes and decrease complication rates. Manipulations under anesthesia have been considered a surrogate for knee stiffness, an undesired postoperative outcome that can potentially be avoided. Currently, there is a lack of information regarding the impact that these new technologies have on manipulations under anesthesia (MUA) rates following TKA.

New Technology for Total Knee Arthroplasty Provides Excellent Patient-Reported Outcomes: A Minimum Two-Year Analysis.

Introduction: Robotic-assisted total knee arthroplasty has been demonstrated to help increase various patient-reported, clinical, and surgical outcome metrics (PROMs). However, the current literature is limited regarding PROMs data for longer follow-up periods beyond one year. Therefore, the purpose of this study was to 1) report multicenter patient-reported outcomes with multiple metrics, as well as 2) postoperative surgeon-specific outcomes at a minimum two-year follow-up.

All-Polyethylene Tibial Component Use for Elderly, Low-Demand Total Knee Arthroplasty Patients.

Background: Potential advantages combined with lower cost have prompted a renewed interest in modern all-polyethylene tibial designs.

Methods: A total of 317 Natural Knee total knee arthroplasties with an all-polyethylene tibial component that was performed since 1993 were retrospectively reviewed to confirm that cost savings were not associated with inferior clinical results. They were primarily used in elderly, low-demand patients.

A Targeted Approach to Ligament Balancing Using Kinetic Sensors.

Background: Currently, soft-tissue imbalance contributes to several of the foremost reasons for revision following primary TKA, including instability, stiffness, and aseptic loosening. In order to decrease the incidence of soft-tissue imbalance, intraoperative sensors were developed to provide real-time, quantitative load data within the knee. This study examines the intraoperative data of a group of multicenter patients to determine how targeted ligament releases affect intra-articular loading, and to understand which types of releases are necessary to achieve quantified ligament balance.

Primary TKA Patients with Quantifiably Balanced Soft-Tissue Achieve Significant Clinical Gains Sooner than Unbalanced Patients.

Although total knee arthroplasty has a high success rate, poor outcomes and early revision are associated with ligament imbalance. This multicenter evaluation was performed in order to provide 1-year followup of a previously reported group of patients who had sensor-assisted TKA, comparing the clinical outcomes of quantitatively balanced versus unbalanced patients. At 1 year, the balanced cohort scored 179.

A new method for defining balance: promising short-term clinical outcomes of sensor-guided TKA.

Recently, technological advances have made it possible to quantify pounds of pressure across the bearing surface during TKA. This multicenter evaluation, using intraoperative sensors, was performed for two reasons: 1) to define "balance" 2) to determine if patients with balanced knees exhibit improved short-term clinical outcomes. Outcomes scores were compared between "balanced" and "unbalanced" patients.

Failure analysis of knee arthrodesis with the WichitaFusion Nail.

Arthrodesis is a salvage procedure for failed total knee arthroplasty with the intent to create a stable, pain-free limb on which to ambulate or transfer. For many patients, the alternative to arthrodesis may be an above-knee amputation. Available techniques for knee arthrodesis include compression plating, external fixators, and intramedullary fixation.

Use of jumbo cups for revision of acetabulae with large bony defects.

Several methods of treatment are available for acetabular revision associated with bone loss. Jumbo cups (minimum diameter of 62 mm in women, 66 mm in men, or 10 mm larger than the normal contralateral acetabulum) are often useful for large defects. The purpose of this study is to report a large jumbo cup series with an average 10-year follow-up.

Knee strength retention and analgesia with continuous perineural fentanyl infusion after total knee replacement: randomized controlled trial.

Purpose: Despite providing adequate pain relief, a femoral nerve block can induce postoperative muscle weakness after total knee arthoplasty (TKA). Fentanyl has been shown to have peripheral effects but has not been used as a perineural infusate alone after TKA.

Methods: Sixty patients scheduled for TKA were randomized to one of three blinded groups: a continuous 24 h infusion of either fentanyl 3 μg/ml, ropivacaine 0.

Articulating spacers for the treatment of infected total knee arthroplasty: effect of antibiotic combinations and concentrations.

Performing 2-stage procedures using articulating antibiotic cement spacers to eradicate infection while providing pain relief and maintaining function has become common among many surgeons. Despite the efficacy of antibiotic cement spacers in the treatment of infected total knee arthroplasty, questions remain regarding the dosing of the antibiotic cement. The authors assessed their experience with different antibiotic regimens and concentrations for the eradication of infection.

The Natural-Knee system: 25 years of successful results.

The Natural-Knee (NK) total knee arthroplasty (TKA) system has been in use for 25 years. The unique features of this system include a deep trochlear groove, an asymmetrical tibial baseplate, use of Cancellous-Structured Titanium coating for preferred bone ingrowth, and a bimetal cementless femoral component. So far, 3135 NK total knee replacements have been reviewed.

Surgical nuances to minimize muscle damage during the direct lateral approach in minimally invasive hip replacement.

Compared with total hip replacements performed using a standard incision direct lateral approach, a minimally invasive direct lateral approach can produce less pain and blood loss without increasing the rate of complications. To minimize the potential for limping after detaching the anterior gluteus medius and the gluteus minimus tendons, special handling of the abductors (which is more difficult because of the limited exposure afforded by the smaller incision) is required. Using special retractors, minimizing overzealous retraction, and achieving strong repair has resulted in no increase in the incidence of limping.

Total hip arthroplasty requiring subtrochanteric osteotomy for developmental hip dysplasia: 5- to 14-year results.

This study evaluated total hip arthroplasty in patients with developmental hip dysplasia requiring femoral subtrochanteric shortening derotational osteotomy (SDO). Twenty-three total hip arthroplasties that required SDO were evaluated at an average follow-up of 8 years (range, 5-14 years). Clinical and radiographic data were retrospectively reviewed.

What would you do? Challenges in hip surgery.

The following are 5 case presentations of interesting and challenging patients with hip pathology.

Preoperative planning for revision total knee arthroplasty:avoiding chaos.

Use of preoperative planning is important in avoiding an unstable revision total knee arthroplasty. Physical examination should determine the status of the collateral ligaments so that implants with appropriate constraint are made available. Radiographic examination should determine if bone loss is present and whether primary or revision implants will be needed.

Cemented tibial stems are not requisite in revision.

Tibial stems are necessary in most total knee revisions to share the load and protect the fixation interface of the tibial tray. Successful use of a tibial stem requires independent stability of the stem with or without cement. Some additional geometry on the undersurface of the tibial tray such as peripheral pegs or fins is necessary to provide additional resistance to rotatory stresses if the stem is not cemented.

Jumbo cup or high hip center: is bigger better?

A jumbo cup and a high hip center cup placement are 2 options in the revision of loose acetabular components associated with bone loss. They allow biologic attachment, which is required for long-term fixation. They are easier to use than cages.