The Microbiology of Knee Prosthetic Joint Infection and its Influence on Persistent Infection.

Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a severe complication causing a significant burden. The study aims were to establish the epidemiology of microorganisms in TKA PJI, the rate of persistent infection requiring further surgery, and the risk factors for this. Microbiological specimens between June 2002 and March 2017 at five regional hospital sites were identified with revision TKA procedures in the National Joint Replacement Registry.

The effect of different alignment strategies on trochlear orientation after total knee arthroplasty.

Purpose: When planning and delivering total knee arthroplasty (TKA), there are multiple coronal alignment strategies such as functional alignment (FA), kinematic alignment (KA), mechanical and adjusted mechanical alignment (MA, aMA). Recent three-dimensional and robotic-assisted surgery (RAS) studies have demonstrated that KA potentially better restores the trochlear anatomy than MA. The purpose of this study was to compare the restoration of the native trochlear orientation in patients undergoing RAS TKA using four different alignment strategies.

Severe obesity in total knee arthroplasty occurs in younger patients with a greater healthcare burden and complication rate.

Background: Knee osteoarthritis in the presence of severe obesity (BMI ≥ 40) is becoming an increasing presentation to healthcare services. When progressing to arthroplasty, this group is known to have higher complication rates.

Method: A retrospective cohort study at a tertiary referral centre (UK) with all sequential patients undergoing TKA between 2019 and 2020 included following identification from the UK National Joint Registry.

Contribution of the Medial Hamstrings to Valgus Stability of the Knee.

Background: Multiligament knee injuries involving the medial side are common. When performing surgical reconstruction, use of the medial hamstrings (HS) as grafts remains controversial in this setting.

Purpose: To determine the role of the medial HS in stabilizing the valgus knee for different types of medial-sided knee injury.

Increased Femoral Component Flexion and No Difference in Slope in Robotic- versus Computer-Assisted Total Knee Arthroplasty When Targeting Mechanical Alignment.

Robotic-assisted surgery (RAS) in total knee arthroplasty (TKA) is becoming popular due to better precision, when compared with other instrumentation. Although RAS has been validated in comparison with computer-assisted surgery (CAS), data from clinical settings comparing these two techniques are lacking. This is especially the case for sagittal alignment.

Magnetic Resonance Imaging Assessment of Hamstring Graft Healing and Integration 1 and Minimum 2 Years after ACL Reconstruction.

Background: An increase has been seen in the number of studies of anterior cruciate ligament reconstruction (ACLR) that use magnetic resonance imaging (MRI) as an outcome measure and proxy for healing and integration of the reconstruction graft. Despite this, the MRI appearance of a steady-state graft and how long it takes to achieve such an appearance have not yet been established.

Purpose: To establish whether a hamstring tendon autograft for ACLR changes in appearance on MRI scans between 1 and 2 years and whether this change affects a patient's ability to return to sports.

Optimal Combination of Femoral Tunnel Orientation in Anterior Cruciate Ligament Reconstruction Using an Inside-out Femoral Technique Combined With an Anterolateral Extra-articular Reconstruction.

Background: The optimal orientation of the anterolateral extra-articular reconstruction (ALLR) femoral tunnel to avoid collision with the anterior cruciate ligament reconstruction (ACLR) femoral tunnel is not clearly defined in the literature.

Purpose: To define the optimal combination of orientations of the ALLR femoral tunnel and the ACLR femoral tunnel using an inside-out technique to minimize risk of collision between these tunnels.

Study Design: Descriptive laboratory study.

Total Knee Arthroplasty in a Transtibial Amputee.

Introduction: With the diversity of prosthetic components patients with a transtibial amputation can now expect to return to high function. Subsequently, the ipsilateral knee is at risk of developing osteoarthritis with a need for a provision of total knee arthroplasty (TKA).

Case Report: We describe a novel technique for TKA in a transtibial amputee utilizing navigation with a tibial jig.

Magnetic Resonance Imaging 1 Year After Hamstring Autograft Anterior Cruciate Ligament Reconstruction Can Identify Those at Higher Risk of Graft Failure: An Analysis of 250 Cases.

Background: There is currently no analysis of 1-year postoperative magnetic resonance imaging (MRI) that reproducibly evaluates the graft of a hamstring autograft anterior cruciate ligament reconstruction (ACLR) and helps to identify who is at a higher risk of graft rupture upon return to pivoting sports.

Purpose: To ascertain whether a novel MRI analysis of ACLR at 1 year postoperatively can be used to predict graft rupture, sporting level, and clinical outcome at a 1-year and minimum 2-year follow-up.

Study Design: Case-control study; Level of evidence, 3.

Blood loss after revision knee arthroplasty is 1.38- to 2.17-fold higher than after primary knee arthroplasty: A retrospective analysis of 898 cases.

Background: There are a number of factors that influence blood loss during and after primary total knee arthroplasty (TKA) and revision TKA (rTKA). The purpose of this study was to provide a factorial assessment that would aid surgeons in managing expected blood loss in rTKA, when compared to TKA. The first question asked was the blood loss and transfusions between TKA and rTKA and the second question was risk factors for blood loss after rTKA.

Adjustable suspension versus hybrid fixation in hamstring autograft anterior cruciate ligament reconstruction.

Background: There has been increased use of adjustable suspensory fixation (ASF) for anterior cruciate ligament reconstruction (ACLR). Potential benefits are the ability to use a shorter graft and to prevent graft displacement and damage. The purpose of this study was to establish the efficacy of this fixation method and assess whether it leads to less tunnel widening, and avoids known complications of screw fixation.

Predictors of Functional Outcome After Microfracture Treatment of Cartilage Defects of the Knee.

Introduction: Microfracture (MFx) is a widely used technique in the treatment of articular cartilage defects of the knee. The objective of this study was to determine the prognostic factors of functional outcomes after MFx treatment of knee cartilage defects ≤ 4 cm2.

Materials And Methods: Forty-eight patients who were to be treated by MFx for knee cartilage defects ≤ 4 cm2 were prospectively included.

Ileus, Gastrointestinal Bleeding and Clostridium difficile Colitis after Hip and Knee Replacement - a Systematic Review.

Introduction: Major gastrointestinal complications after arthroplasty are rare, but can have detrimental effects on the patient and can substantially increase the overall cost of treatment. This systematic review provides an overview of ileus, gastrointestinal bleeding and C. difficile colitis after total hip and knee arthroplasty.

Tegner level is predictive for successful return to sport 2 years after anterior cruciate ligament reconstruction.

Purpose: For a successful return to sport (RTS) after an anterior cruciate ligament reconstruction (ACLR), patients are recommended to attend a comprehensive rehabilitation program, followed by an RTS assessment, that is a combination of tests. The purpose of this study was to predict a successful return to sport using the results of the RTS assessment and self-reported questionnaires at minimum 2 years after ACLR.

Methods: A total of 123 consecutive ACLR patients undertook an intensive rehabilitation program followed by a comprehensive RTS assessment that included an established combination of balance and strength tests, the ACL-return to sport after Injury scale (ACL-RSI) questionnaire and a KT1000 laximetry test.

Patients with lateral compartment knee osteoarthritis during arthroscopy are at highest risk of subsequent knee arthroplasty.

Background: Arthroscopic treatment of knee osteoarthritis has declined, in part due to concerns with conversion to arthroplasty. Some studies have investigated the demographic predictors for conversion to arthroplasty, few have assessed the risk factors within the knee itself. Our aim was to analyse the demographics and anatomical wear features of a large cohort of patients undergoing knee arthroscopy.

Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study.

Despite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA).

Anterior knee translation measurements after ACL reconstruction are influenced by the type of laximeter used.

Purpose: Laximeters were designed to diagnose an anterior cruciate ligament (ACL) deficient knee, but their use has now focused on providing an objective assessment of the anterior translation (AT) of an intact and ACL-reconstructed knee. In this study we report the introduction and direct comparison of an automated and computerized AT measurement device, GNRB, with the device previously established by the institute and as the current literature standard, the KT1000.

Methods: A prospective data collection was commenced upon introduction of the GNRB.

Conventional instruments are more accurate for measuring the depth of the tibial cut than computer-assisted surgery in total knee arthroplasty: a prospective study.

Introduction: The most commonly used tool for implant positioning are conventional instruments (CI) followed by computer-assisted surgery (CAS). A number of studies have investigated the cutting error of the tibial component when CAS is used, but most of them were focused on the cutting angles. The accuracy of CAS to determine the depth of the cut has not received much attention, even though implications are similar or worse, than with an angle mismatch.

Large osteophyte removal from the posterior femoral condyle significantly improves extension at the time of surgery in a total knee arthroplasty.

Unlabelled: Removing osteophytes from the posterior compartment of the femur eliminates the tenting effects on the joint capsule and consequently increases the extension gap in total knee arthroplasty. However, there is no clear association with the size of osteophytes removed and the potential degree of additional extension achieved at time of surgery.

Aims: Correlate the size of posterior osteophytes removed with the degree of extension gained intraoperatively in total knee arthroplasty and develop a radiological classification system to grade these osteophytes.

Healthy knee KT1000 measurements of anterior tibial translation have significant variation.

Purpose: The most commonly used arthrometer for measuring and reporting anterior tibial translation after anterior cruciate ligament reconstruction is the KT1000. Reports on its consistency and reproducibility vary in the literature, but it remains the "gold standard". The purpose of this study was to assess agreement of KT1000 measurements in a daily clinical setting.

One-Stage Sequential Bilateral Total Knee Arthroplasty: An Effective Treatment for Advanced Bilateral Knee Osteoarthritis Providing High Patient Satisfaction.

Background: The mortality and risks of bilateral total knee arthroplasty (BTKA) have been reported to be far greater than in unilateral total knee arthroplasty (UTKA). This study aimed to determine whether this remains the case using contemporary anesthetic and surgical techniques for one-stage single anesthetic sequential BTKA.

Methods: Two cohorts of 394 patients were created by propensity matching for gender, age, body mass index, American Society of Anesthesiologists grade, and Veterans Rand-12 health survey scores.