Synovial innate immune exhaustion is associated with worse pain in knee osteoarthritis.

Objective: Uncontrolled pain remains a major clinical challenge in the management of knee osteoarthritis (OA), the most common disabling joint disease. Worse pain is associated with synovial innate immune cell infiltration (synovitis), but the role of innate immune regulatory cells in pain is unknown. Our objective was to identify synovial innate immune cell subsets and pathophysiologic mechanisms associated with worse pain in patients with knee OA.

Association between synovial tissue damage and pain in late-stage knee osteoarthritis: A cross-sectional study.

Objective: To identify the presence and distribution of histopathological features of synovial inflammation and tissue damage, and to test their associations with ultrasound (US) imaging measures of synovitis and patient-reported measures of pain in knee osteoarthritis (OA).

Design: In the cross-sectional study of 122 patients undergoing surgery for painful late-stage (Kellgren-Lawrence Grade 3 or 4) knee OA, we compared US measures of synovitis (n = 118) and pain (Knee Injury and Osteoarthritis Outcome Score) to histopathological measures of inflammation vs. synovial tissue damage in synovial tissue biopsies.

Survivorship and Outcomes of 2-Stage Revision for Infected Total Hip Arthroplasty at a Mean of 7-Year Follow-Up.

Background: Periprosthetic joint infection (PJI) continues to be one of the leading causes of failure following total hip arthroplasty (THA). The objectives of the study were to (1) determine the minimum 2-year infection-free survivorship of 2-stage revision THA, (2) determine the causative organisms for repeat 2-stage revision THA, and (3) characterize the results of failed 2-stage revisions and evaluate patient-reported outcome measures (PROMs).

Methods: A retrospective chart review was completed for patients who underwent 2-stage revision THA for PJI.

Evaluation of the Effectiveness of Canadian Cardiovascular Society Guidelines in Minimizing Cardiac Events After Total Hip Arthroplasty.

Background: The aim of the study was to analyze the Canadian Cardiovascular Society (CCS) guidelines for routine postoperative troponin testing after elective total hip arthroplasty (THA) to reduce the mortality rate resulting from myocardial injury. The purpose of this study was to assess the prognostic relevance of implementing these guidelines to minimize cardiac events in patients undergoing elective THA.

Methods: Patients who underwent THA surgery in 2020 were included in the study.

Minimum 15-Year Survival of a Biconvex Inlay Patellar Component in Primary Total Knee Arthroplasty: An Analysis of 2,530 Total Knee Arthroplasties From a Single Institution.

Background: Routine patellar resurfacing during primary total knee arthroplasty (TKA) remains controversial. To our knowledge, there are no studies reporting the long-term performance of a cemented biconvex all-polyethylene inlay component implanted at the time of primary TKA. The purpose of this study was to examine the 15-year survivorship and long-term clinical outcomes of this biconvex inlay patella used at our institution.

Secondary Patellar Resurfacing Following Primary Unresurfaced Total Knee Arthroplasty: Beware of the Incidence of Late Patellar Erosion.

Background: The primary aim of this study was to evaluate secondary patellar resurfacing (SPR) indications and rates in a single-surgeon series utilizing a modern TKA design and additionally, to review the functional outcomes of patients after undergoing SPR.

Methods: A retrospective review of a prospectively collected institutional database was performed. All patients undergoing primary TKA by a single surgeon between 2013 and 2021 were included.

Minimum 2-Year Outcomes of a Modern Monoblock Titanium Fluted Tapered Revision Stem for Complex Primary and Revision Total Hip Arthroplasty.

Background: Modular titanium fluted tapered (TFT) stems have demonstrated excellent clinical success for femoral revision total hip arthroplasty (THA) surgery. This study reports the short-term outcomes of a novel modern monoblock TFT stem used for revision and complex primary THA with a minimum of 2 years of follow-up.

Methods: We identified 126 patients who received a single monoblock TFT stem: 26 patients for complex THA (failed fracture fixation) and 100 patients for revision THA.

Quantification of trunnion damage in a series of intact total hip arthroplasty femoral stems previously identified to be at risk of catastrophic failure.

Background: Corrosion at the head-neck junction of femoral stems is a rare complication of total hip arthroplasty (THA) with manifestations ranging from subclinical wear to failure. Prior studies have identified a single femoral component design with an increased propensity for catastrophic trunnion failure. The purpose of the present study was to quantify trunnion damage of this femoral component retrieved from patients undergoing revision THA for non-trunnionosis indications.

Predictors of Undergoing Revision Within 5 Years of Total Knee Arthroplasty: A Population-Based Study.

Background: The objective of this study was to identify the rate and risk factors for revision total knee arthroplasty (TKA) within the first 5 years postoperative. Our secondary objective was to identify the rate of additional surgical procedures and death.

Methods: We conducted a retrospective cohort study among patients in Ontario, Canada who underwent an elective, primary TKA between April 1, 2007, and March 31, 2014, for osteoarthritis.

No Difference in Subsidence Between Modern Monoblock and Modular Titanium Fluted Tapered Femoral Stems.

Background: Subsidence remains a concern when utilizing tapered fluted titanium (TFT) femoral stems and may lead to leg length discrepancy, impingement, instability, and failure to obtain osseointegration. This study aims to compare stem subsidence across 3 modern TFT stems. Our secondary aim was to investigate the influence of bicortical contact or "scratch fit" on subsidence, as well as the role of intraoperative imaging in maximizing bicortical contact and preventing stem subsidence.

Dissatisfaction With Total Knee Arthroplasty at 1 Year Post Surgery Can be Predicted Using a Short Questionnaire Early in the Recovery Process.

Background: Approximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA). Identifying patients likely to be dissatisfied early in the recovery process could help reduce the number of dissatisfied patients. The purpose of this study was to create an easily administered short questionnaire to identify patients likely to be dissatisfied at 1 year post surgery early in the recovery process.

Primary care physicians' perceptions of the utility of novel education materials for patients with knee osteoarthritis.

Purpose: To support primary care physicians (PCPs) and their patients with knee osteoarthritis (OA), we created a series of evidence-based whiteboard educational videos for patients with knee OA. In a previous study we piloted these videos with patients to understand their acceptability and impact. The purpose of this study was to explore PCPs' perspectives to understand the utility of novel patient education videos to support management.

Unit Sales Trends of Hip Arthroplasty Procedures Performed in Ontario in 2020.

Background: In March 2020, an emergency was declared in the province of Ontario owing to the COVID-19 pandemic. From March 19 to May 26, all elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures were deferred. The purpose of this study was to review the unit sales data of THA and TKA procedures in Ontario over this time period to identify any trends in surgical activity.

Survivorship of Metaphyseal Cones and Sleeves in Revision Total Knee Arthroplasty.

Background: Bone loss remains an anticipated challenge in revision total knee arthroplasty (rTKA). Recent efforts to enhance rTKA fixation and stability have focused on metaphyseal implants, namely cones and sleeves. We sought to compare cone and sleeve implant survivorship in rTKA.

Logistic Regression and Machine Learning Models Cannot Discriminate Between Satisfied and Dissatisfied Total Knee Arthroplasty Patients.

Background: Approximately 20% of total knee arthroplasty (TKA) patients are found to be dissatisfied or unsure of their satisfaction at 1-year post-surgery. This study attempted to predict 1-year post-surgery dissatisfied/unsure TKA patients with pre-surgery and surgical variables using logistic regression and machine learning methods.

Methods: A retrospective analysis of patients who underwent primary TKA for osteoarthritis between 2012 and 2016 at a single institution was completed.

Comparison of long-term kinematics and wear of total knee arthroplasty implant designs.

We sought to evaluate wear and kinematics in well-established implants of posterior stabilized (PS) and cruciate retaining (CR) designs. Ninety-one knees implanted for at least five years were examined. The implants were Genesis II PS (Smith & Nephew, Memphis, TN), Sigma PS (DePuy Synthes, Warsaw, IN), or Sigma CR.

Prevalence and Outcomes of Unexpected Positive Intraoperative Cultures in Presumed Aseptic Revision Hip Arthroplasty.

Background: The prevalence and outcomes of unexpected positive cultures (UPCs) of specimens taken during presumed aseptic revision total hip arthroplasty (THA) are unclear. The purpose of this study was to determine the prevalence of UPC and infection-free implant survival in this patient population. Secondary aims included identifying factors associated with subsequent infection-related failure in patients with UPC.

Wait times, resource use and health-related quality of life across the continuum of care for patients referred for total knee replacement surgery.

Background: The escalating socioeconomic burden of knee osteoarthritis (OA) underscores the need for innovative strategies to reduce wait times for total knee arthroplasty (TKA). The purpose of this study was to evaluate resource use, costs and health-related quality of life (HRQoL) across the continuum of care for patients with knee OA.

Methods: This was a prospective study of 383 patients recruited from a high-volume teaching hospital at different stages of care (referral, consultation and presurgery).

The Effect of Sensory Deficit After Total Knee Arthroplasty on Patient Satisfaction and Kneeling Ability.

Background: Skin numbness after total knee arthroplasty is a common complication. The incidence in the literature is variable from 27% to 100%. However, there is conflicting evidence about the consequences of this complication.

Quantifying the Level of Evidence of Podium Presentations at the American Association of Hip and Knee Surgeons From 2015 to 2019.

Background: The American Association of Hip and Knee Surgeons (AAHKS) Annual Scientific Meeting is a leading forum for the presentation and dissemination of research regarding the management of hip and knee pathology making research presented at these meetings a representation of the current literature in the field. The purpose of this study was to quantify the level of evidence of podium presentations presented at the AAHKS annual meeting from 2015 to 2019.

Methods: Two reviewers evaluated the abstracts for the available presentations.

Can Met Expectations Moderate the Relationship Between Pain/Function and Satisfaction in Total Knee Arthroplasty?

Background: Approximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA) at 1-year post-surgery. Met expectations have been found by some to significantly predict satisfaction. The role of met expectations in determining patient satisfaction has not been exhaustively explored.

Outcomes of Stemmed versus Un-Stemmed Varus-Valgus Constrained Components in Primary Total Knee Arthroplasty.

Purpose: The necessity of stemmed components when performing a varus-valgus constrained (VVC) primary total knee arthroplasty (TKA) is unclear. The purpose of this study is to compare the outcomes of primary VVC TKA with and without stems at a minimum of two years.

Methods: Patients in our prospectively collected database with primary VVC TKAs were identified.

A qualitative dominant mixed methods exploration of novel educational material for patients considering total knee arthroplasty.

Purpose: To optimize non-operative management and decision making surrounding TKR we created educational whiteboard videos for patients with knee OA. The purpose of this study was to pilot our educational videos with end-users (patients) to determine patients' experiences and perspectives regarding the content and clarity of videos and to better understand their potential impact on patient's health behaviour.

Materials And Methods: This was a mixed methods evaluation, using a qualitative descriptive approach, of patients attending their first consultation with an arthroplasty surgeon for TKR.