Time Required for Planned and Unplanned Episodes of Care in Aseptic Hip and Knee Revision Arthroplasty.

Background: Studies indicate aseptic revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) requires much more effort but is reimbursed less than primary procedures per minute work time. This study quantified planned and unplanned work performed by the surgeon and/or their team during the entire episode of care "reimbursement window" and compared it to allowed reimbursement times by Centers for Medicare and Medicaid Services (CMS).

Methods: Between October, 2010, and December, 2020, all unilateral aseptic rTHA and rTKA procedures performed by a single surgeon at a single institution were retrospectively reviewed.

The Fate and Relevance of the Patella in Two-Stage Revision Total Knee Arthroplasty for Periprosthetic Joint Infection.

Background: It remains unclear whether reimplantation of a patellar component during a two-stage revision for periprosthetic total knee arthroplasty infection (PJI) affects patient reported outcome measures (PROMs) or implant survivorship. The purpose of this study was to evaluate whether patellar resurfacing during reimplantation confers a functional benefit or increases implant survivorship after two-stage treatment for PJI.

Methods: Two-stage revisions for knee PJI performed by three surgeons at a single tertiary care center were reviewed retrospectively.

Osteoarthritic Severity in Unresurfaced Patellae Does Not Adversely Affect Patient-reported Outcomes in Contemporary Primary TKA.

Introduction: The degree of osteoarthritis (OA) acceptable to leave in a native patella during unresurfaced total knee arthroplasty (TKA) remains unknown. This study's purpose was to examine the effect of patellofemoral OA severity on patient-reported outcome measures (PROMs) in primary TKAs performed without patellar resurfacing.

Methods: One hundred ninety-three primary TKAs performed without patellar resurfacing were retrospectively reviewed.

Large Femoral Heads in Total Hip Arthroplasty With Vitamin E Highly Cross-Linked Polyethylene: Head Penetration Rates Compared to Highly Cross-Linked Polyethylene.

Background: Highly cross-linked polyethylene with vitamin E (VE-HXLPE) has shown superior tribological properties and has been rapidly adopted in total hip arthroplasty. However, the majority of studies compare VE-HXLPE to conventional or moderately cross-linked polyethylene using standard femoral head sizes. This study's purpose was 2-fold: (1) compare radiographic femoral head penetration (FHP) between VE-HXLPE and HXLPE and (2) evaluate FHP in large femoral heads ≥40 mm.

The Effect of Posterior Cruciate Ligament Release on Kinematics and Outcomes in Primary Total Knee Arthroplasty With a Dual-Pivot Conforming Polyethylene.

Background: Ultracongruent bearings are increasingly utilized in total knee arthroplasty (TKA); however, implications of surgical technique on knee kinematics and outcomes with these bearings are not well understood. This study's purpose was to evaluate the relationship of 3-dimensional knee kinematics and patient-reported outcome measures (PROMs) in a dual-pivot congruent bearing TKA with and without posterior cruciate ligament (PCL) release.

Methods: Forty patients undergoing TKA with an asymmetric ultracongruent bearing were prospectively enrolled for gait analysis preoperatively and 4 months postoperatively.

The Effect of Joint Line Elevation on Patient-Reported Outcomes After Contemporary Revision Total Knee Arthroplasty.

Background: Joint line elevation in revision total knee arthroplasty (rTKA) is considered a risk factor for inferior outcomes, engendering a dogmatic protocol of joint line restoration. However, this precedent is based on historical data using rudimentary revision systems and unvalidated outcome measures. This study's purpose was to evaluate the effect of joint line height elevation on validated patient-reported outcome measures (PROMs) using modern revision implants.

No Difference in Dislocation Rates Comparing Large Diameter Jumbo Femoral Heads and Dual-Mobility Bearings in Revision Total Hip Arthroplasty.

Background: Dual-mobility (DM) bearings reduce instability in revision total hip arthroplasty (THA); however, DM bearings are costly and reports of corrosion have recently emerged. Furthermore, no study has compared DM to standard bearings with large diameter femoral heads ≥40-mm. This study's purpose was to compare postoperative dislocation rates of standard and DM bearings with large femoral heads after revision THA.

Techniques and Strategies to Optimize Efficiencies in the Office and Operating Room: Getting Through the Patient Backlog and Preserving Hospital Resources.

The effects of the coronavirus disease 2019 pandemic are pervasive and have decreased the volume of hip and knee arthroplasty procedures since the mandated cessation of elective surgical procedures at the height of the pandemic in early 2020. Therefore, a backlog of patients in need of these elective procedures is a probable consequence and increased productivity and efficiency in patient care delivery is essential now and into the future. This article outlines multiple strategies and techniques to develop and optimize efficiency in the hip and knee arthroplasty practice.

Machine Learning Algorithms Identify Optimal Sagittal Component Position in Total Knee Arthroplasty.

Background: Advanced technologies, like robotics, provide enhanced precision for implanting total knee arthroplasty (TKA) components; however, the optimal targets for implant position specifically in the sagittal plane do not exist. This study identified sagittal implant position which may predict improved outcomes using machine learning algorithms.

Methods: A retrospective review of 1091 consecutive TKAs was performed.

The Fate of Zone 2 Radiolucencies in Contemporary Highly Porous Acetabular Components: Not All Designs Perform Equally.

Background: The enhanced frictional resistance of modern ultraporous acetabular components can impede complete seating; however, surgeons expect the enhanced ingrowth surface to resolve polar (zone 2) gaps over time via osseointegration. This study characterized zone 2 radiographic osseointegration in 3 acetabular component designs: 2 highly porous ingrowth and one traditional ongrowth.

Methods: A consecutive cohort of primary total hip arthroplasties was reviewed which utilized 3 different acetabular cup designs: ongrowth titanium with hydroxyapatite (HA), highly porous titanium with machined radial grooves (MRG), and dual-porous titanium substrate with micropore (MP).

Utility and Prognostic Ability of a Diagnostic Injection Before Revision Total Knee Arthroplasty.

Background: Diagnostic injections are commonly utilized in the workup of painful total knee arthroplasties (TKA), particularly when the diagnosis remains unclear. However, current literature provides limited evidence regarding the utility and prognostic capability of anesthetic injections in this scenario. This study sought to establish the role of diagnostic injections in predicting successful revision TKA.

Posterior Cruciate Ligament Resection Does Not Consistently Increase the Flexion Space in Contemporary Total Knee Arthroplasty.

Introduction: It is accepted dogma in total knee arthroplasty (TKA) that resecting the posterior cruciate ligament (PCL) increases the flexion-space by approximately 4mm. Unfortunately, this doctrine is based on historical studies of limited size with variable technique. The aim of this study was to determine the effect of PCL-resection on in vivo tibiofemoral joint space dimensions in a cohort of modern TKAs.

Intra-articular Injections of the Hip and Knee With Triamcinolone vs Ketorolac: A Randomized Controlled Trial.

Background: Clinicians commonly utilize intra-articular injections to treat symptomatic primary arthritis. Steroid injections are common yet have immune-modulating effects and can alter gene expression which may delay definitive arthroplasty and further damage cartilage. Nonsteroidal anti-inflammatory injections may offer a safer profile due to their differing mechanism of action; however, there is a relative dearth of information regarding their efficacy.

How Has COVID-19 Affected Our Orthopedic Implant Industry Partners? Implications for the Surgeon-Industry Relationship in 2020 and Beyond.

Background: The COVID-19 pandemic has had far-reaching societal and financial consequences. The purpose of this study was to evaluate how COVID-19 has affected AAHKS industry partners and the surgeon-industry relationship, emphasizing education, resource allocation, and strategic direction for the second half of 2020.

Methods: AAHKS industry partners were contacted to participate in a blinded survey and optional interview with the AAHKS Industry Relations Committee.

An Experienced Surgeon Can Meet or Exceed Robotic Accuracy in Manual Unicompartmental Knee Arthroplasty.

Background: Reports in the literature indicate that implant placement is more accurate with robotic-assisted unicompartmental knee arthroplasty (UKA); however, these studies have not always accounted for surgeon experience. The purpose of the present study was to compare the accuracy of tibial component alignment in UKA between an experienced high-volume surgeon and the published data on robotic-assisted surgery.

Methods: The radiographs made before and after 128 consecutive medial UKAs performed manually by a single surgeon using a cemented fixed-bearing implant were reviewed.

Energy Harvesting and Sensing with Embedded Piezoelectric Ceramics in Knee Implants.

The knee replacement is one of the most common orthopedic surgical interventions in the United States; however, recent studies have shown up to 20% of patients are dissatisfied with the outcome. One of the key issues to improving these operations is a better understanding of the ligamentous balance during and after surgery. The goal of this work is to investigate the feasibility of embedding piezoelectric transducers in the polyethylene bearing of a total knee replacement to act as self-powered sensors to aid in the alignment and balance of the knee replacement by providing intra- and postoperative feedback to the surgeon.

Tourniquetless Total Knee Arthroplasty With Modern Perioperative Protocols Decreases Pain and Opioid Consumption in Women.

Background: This study examined whether a modern total knee arthroplasty (TKA) protocol without a tourniquet results in less patient-reported pain and in-hospital opioid consumption compared to TKA with a tourniquet.

Methods: A retrospective study of 203 primary unilateral cemented TKAs consecutively performed with or without tourniquet was performed. Identical perioperative pain and blood loss protocols were used in all cases.

Patient Perceptions Regarding Outpatient Hip and Knee Arthroplasties.

Background: There has been increasing interest in outpatient total joint arthroplasty (TJA) in the orthopedic community, but how patients feel about outpatient TJA is unknown. The purpose of this study was to understand patient perspectives on hip and knee replacements performed in an outpatient setting.

Methods: We surveyed 110 consecutive patients scheduled for primary TJA in an academic suburban arthroplasty practice regarding their knowledge and perceptions of outpatient TJA.

Leaving Residual Varus Alignment After Total Knee Arthroplasty Does Not Improve Patient Outcomes.

Background: Recent popularity of kinematic alignment and constitutional varus has caused some surgeons to leave varus limbs in residual varus after total knee arthroplasty (TKA). This study assessed whether if patients left in residual varus have improved outcomes compared with those fully corrected to neutral alignment.

Methods: A retrospective review of 361 consecutive primary TKAs was performed.

Does an Anterior-Lipped Tibial Insert Adequately Substitute for a Post-Cam Articulation in Total Knee Arthroplasty.

Introduction: Newer tibial inserts with enhanced conformity (cruciate stabilizing anterior lip; CS) to obviate the need for a posteriorly stabilized (PS) post-cam articulation in posterior cruciate ligament-deficient knees have been recently introduced in modern total knee arthroplasty (TKA). The purpose of this study was to evaluate whether clinical and functional outcomes differ in TKA cohorts without a posterior cruciate ligament (PCL) utilizing either CS anterior-lipped or PS post-cam articulation.

Materials And Methods: Prospectively collected outcomes were compared in matched cohorts of modern TKAs implanted with either CS anterior-lipped tibial inserts or PS post-cam articulations.

Cementless Tapered Wedge Femoral Stems Decrease Subsidence in Obese Patients Compared to Traditional Fit-and-Fill Stems.

Background: Femoral component stability and resistance to subsidence is critical for osseointegration and clinical success in cementless total hip arthroplasty. The purpose of this study was to radiographically evaluate the anatomic fit and subsidence of 2 different proximally tapered, porous-coated modern cementless femoral component designs.

Methods: A retrospective cohort study of 126 consecutive cementless total hip arthroplasties was performed.

Can Intraoperative Sensors Determine the "Target" Ligament Balance? Early Outcomes in Total Knee Arthroplasty.

Background: The optimal "target" ligament balance for each patient undergoing total knee arthroplasty (TKA) remains unknown. The study purpose was to determine if patient outcomes are affected by intraoperative ligament balance measured with force-sensing implant trials and if an optimal "target" balance exists.

Methods: A multicenter, retrospective study reviewed consecutive TKAs performed by 3 surgeons.