Excellent 2-Year Outcomes of a Midlevel Constrained Liner Used in Stemless Primary TKA.

Introduction: Instability after total knee arthroplasty (TKA) remains a leading cause of revision TKA and can lead to patient dissatisfaction. While many companies have developed midlevel constrained (MLC) polyethylene inserts in primary TKAs, there is little data on their outcomes.

Purpose: We sought to analyze short-term outcomes including survivorship, rates of manipulation under anesthesia (MUA), and improvements in patient-reported outcome measures (PROMs) preoperatively to postoperatively in one design of MLC TKA.

Women in dental education and their desire to lead: A follow-up.

The aim of this study was to provide a follow-up to the 2015 national survey of women in dental education to re-examine factors and perceived barriers to pursuing administrative and leadership roles. At the beginning of 2023, a survey was administered to full-time women faculty in predoctoral dental programs in the United States. The survey instrument employed a structured format along with open-ended questions to capture qualitative data.

Early-Life Exposure to War and Later-Life Physical Functional Health.

Objectives: A growing body of research shows that early-life exposure to war has adverse effects on later-life health. Research has emphasized the importance of exposure timing implicating domain-specific developmental processes and associated critical/sensitive periods. This study looks at the impacts of early childhood war exposure and the repercussions for later-life physical and functional health, with a focus on time of exposure as a source of variability.

The John N. Insall Award: Does Melatonin Improve Subjective Sleep Quality After Total Knee Arthroplasty? A Randomized, Placebo-Controlled Trial.

Background: Sleep disturbance is a common problem following total knee arthroplasty (TKA). The objective of this study was to determine if exogenous melatonin improves sleep quality following primary TKA.

Methods: A randomized, double-blind, placebo-controlled trial was conducted.

In Vivo Weight-Bearing Kinematics for Constrained Versus Traditional Bicruciate Stabilized Total Knee Arthroplasty Cohorts Compared to the Normal Knee.

Background: Constrained inserts in total knee arthroplasty (TKA) may offer additional stability, but can this insert type allow unrestricted movements or will the extra conformity cause kinematic conflict with the cam-post mechanism in deeper flexion? The objective of this study was to evaluate the weight-bearing kinematics of both traditional and constrained bicruciate stabilized (BCS) TKA inserts to determine if the rollback induced by the cam-post mechanism will work in unison with the constrained polyethylene insert.

Methods: This study used previously published 3-dimensional model fitting techniques to compare weight-bearing flexion and femoro-tibial condylar motion patterns for 20 patients who had a traditional insert, 20 patients who had a constrained insert, and 10 previously published nonimplanted knees, all performing a deep knee bend activity while under fluoroscopic surveillance.

Results: The results from this study indicate that subjects having a bicruciate stabilized TKA experienced similar postoperative kinematics for both constrained and unconstrained insert options, comparable to normal knees.

Referencing the center of the femoral head during robotic or computer-navigated primary total knee arthroplasty results in less femoral component flexion than the traditional intramedullary axis.

Background: During robotic and computer-navigated primary total knee arthroplasty (TKA), the center of the femoral head is utilized as the proximal reference point for femoral component position rather than the intramedullary axis. We sought to analyze the effect on femoral component flexion-extension position between these two reference points.

Methods: We obtained CT 3D-reconstructions of 50 cadaveric intact femurs.

Windows of Vulnerability: Consequences of Exposure Timing during the Dutch Hunger Winter.

Prior research on early-life exposures to famine has established in utero development as a critical period of vulnerability to malnutrition. Yet, previous research tends to focus narrowly on this stage, at the expense of a more comprehensive examination of childhood. As a result, the literature has yet to compare the severity of the consequences of exposure to malnutrition across developmentally salient periods.

Significantly Worse Fixation of Cemented Patellar Components on Multiacquisition Variable-Resonance Image Combination Magnetic Resonance Imaging Compared to Femoral and Tibial Components: A Cause for Concern?

Background: The etiology of anterior knee pain after total knee arthroplasty (TKA) remains unclear. Few studies have examined patellar fixation quality. The purpose of the present study was to evaluate the patellar cement-bone interface after TKA on magnetic resonance imaging (MRI) and to correlate the patella fixation grade with the incidence of anterior knee pain.

Re-initiation of elective total knee arthroplasty with an adapted pathway during the 2020 COVID-19 pandemic was safe and effective.

Introduction: In June 2020 when elective total knee arthroplasty (TKA) resumed after the initial COVID-19 surge, we adapted our TKA pathway focusing on a shorter hospitalization, increased home discharge, and use of post-discharge telemedicine and telerehabilitation. The purpose of this study was to evaluate if changes in postoperative care affected early TKA outcomes.

Materials And Methods: Five hundred and fifty-four patients who underwent elective primary unilateral TKA for primary osteoarthritis between June and August 2020 (study group) were matched 1:1 for age, sex, body mass index, and Charlson comorbidity index with control patients who underwent surgery between August and November 2019.

Comparison of clinical outcomes of VISIONAIRE patient-specific instrumentation with conventional instrumentation in total knee arthroplasty: a systematic literature review and meta-analysis.

Introduction: Malalignment and resulting complications are major challenges in total knee arthroplasty (TKA) which patient-specific instrumentation (PSI) is proposed to alleviate. Previous PSI meta-analyses of TKA outcomes typically do not differentiate between PSI systems and assess relatively few outcomes, so the value of their findings is limited. VISIONAIRE cutting guides (Smith + Nephew Inc.

Do obese patients benefit from a kinematic, appropriately designed total knee prosthesis?

Introduction: Modern total knee arthroplasty (TKA) using the Journey 2 implant utilizes a bicruciate stabilized (BCS) technique. However, whether bicruciate stabilized TKA is equally effective across weight classes is unknown.

Methods: We identified patients who underwent primary bicruciate stabilized TKA during 2016 and 2017, at a single institution.

Cohort Trends in the Burden of Multiple Chronic Conditions Among Aging U.S. Adults.

Objectives: Multimorbidity, also referred to as multiple chronic conditions (MCCs), is the concurrent presence of 2 or more chronic health conditions. Increasing multimorbidity represents a substantial threat to the health of aging populations. Recent trends suggest greater risk of poor health and mortality among later-born cohorts, yet we are unaware of work examining cohort differences in multimorbidity among aging U.

COVID-19 disruptions to elective postoperative care did not adversely affect early complications or patient reported outcomes of primary TKA.

Introduction: Elective orthopedic care, including in-person office visits and physical therapy (PT), was halted on March 16, 2020, at a large, urban hospital at the onset of the local COVID-19 surge. Post-discharge care was provided predominantly through a virtual format. The purpose of this study was to assess the impact of postoperative care disruptions on early total knee arthroplasty (TKA) outcomes, specifically 90-day complications, 120-day rate of manipulation under anesthesia (MUA) and 1-year patient-reported outcome measures (PROMs).

Posterior Tibial Slope in Computer-Navigated Total Knee Arthroplasty: The Transmalleolar Sagittal Axis Underestimates Slope Compared to Traditional Intramedullary Axis.

Background: Tibial slope in total knee arthroplasty (TKA) impacts knee flexion, balance, and ligament strain. Implants were initially designed with tibial slope recommendations based on the intramedullary axis. However, technology-assisted TKA, such as robotics or navigation, determines slope from the ankle-knee axis connecting the center of the transmalleolar line to the proximal exit point of the tibial shaft axis.

Immersive technologies for total knee arthroplasty surgical education.

The need to adapt surgical curricula to meet the demands of an increasingly restrictive training environment is rising. Modern constraints of surgical trainees including work-hour restrictions and concerns surrounding patient safety have created an opportunity to supplement traditional teaching methods with developing immersive technologies including virtual and augmented reality. Virtual reality (VR) and augmented reality (AR) have been preliminarily investigated as it relates to total joint arthroplasty.

Telemedicine in an Outpatient Arthroplasty Setting During the COVID-19 Pandemic: Early Lessons from New York City.

The early months of the coronavirus disease 19 (COVID-19) pandemic in New York City led to a rapid transition of non-essential in-person health care, including outpatient arthroplasty visits, to a telemedicine context. Based on our initial experiences with telemedicine in an outpatient arthroplasty setting, we sought to determine early lessons learned that may be applicable to other providers adopting or expanding telemedicine services. A cross-sectional study was performed by surveying all patients undergoing telemedicine visits with 8 arthroplasty surgeons at 1 orthopedic specialty hospital in New York City from April 8 to May 19, 2020.

The Long Arm of Conflict: How Timing Shapes the Impact of Childhood Exposure to War.

This paper examines how the timing of childhood exposure to armed conflict influences both the magnitude of the impact it has on later-life health and the pathways through which those impacts manifest. Utilizing the Survey of Health and Retirement in Europe, we examine cohorts of children during World War II. We find that cohorts born during the war show the largest negative effects of exposure on health in later life.

Polyethylene Components in Primary Total Knee Arthroplasty: A Comprehensive Overview of Fixed Bearing Design Options.

The articular design of a polyethylene insert influences the kinematics and overall function of a total knee arthroplasty (TKA). Standard symmetric posterior-stabilized and cruciate-retaining polyethylene designs have a long track record of high patient satisfaction and longevity in TKA. However, the number and variety of polyethylene inserts and articulations have continued to evolve in an attempt to better replicate native knee kinematics or provide additional constraint.

Modern Internet Search Analytics and Total Joint Arthroplasty: What Are Patients Asking and Reading Online?

Background: Patients considering total joint arthroplasty often search for information online regarding surgery; however, little is known about the specific topics that patients search for and the nature of the information provided. Google compiles frequently asked questions associated with a search term using machine learning and natural language processing. Links to individual websites are provided to answer each question.

Natural Language Processing of Patient-Experience Comments After Primary Total Knee Arthroplasty.

Background: There is interest in improving patient experience after total knee arthroplasty (TKA) due to recent shifts toward value-based medicine. Patient narratives are a valuable but unexplored source of information.

Methods: Records of 319 patients who had undergone primary TKA between August 2016 and August 2019 were linked with vendor-supplied patient satisfaction data, which included patient comments and the Press Ganey satisfaction survey.

Improvement Initiative to Develop and Implement a Tool for Detecting Drug-Drug Interactions During Oncology Clinical Trial Enrollment Eligibility Screening.

Objectives: Screening subjects for drug-drug interactions (DDIs) before enrollment in oncology clinical trials is integral to ensuring safety, but standard procedures or tools are not readily available to screen DDI in this setting. Our objectives were to develop a DDI screening tool for use during oncology clinical trial enrollment and to test usability in single-center and multicenter pilot studies.

Methods: A multistage approach was used for this quality improvement intervention.