Patients Requiring Manipulation Under Anesthesia After Total Knee Arthroplasty Have Higher Rates of Preoperative Depression.

Arthrofibrosis is a complication after total knee arthroplasty (TKA) that can limit functionality and cause dissatisfaction. This study assesses the prevalence of preoperative depressive symptoms amongst patients who required manipulation under anesthesia (MUA) for arthrofibrosis after TKA. Patients who underwent primary TKA with need for subsequent MUA were age and sex matched to control patients who underwent primary TKA without requiring MUA.

Repeat Revision Total Knee Arthroplasty Has Significantly Lower Survivorship Compared to First-Time Revisions.

Background: Revision total knee arthroplasty (rTKA) is an increasingly common challenge for arthroplasty surgeons. Compared to first-time rTKA, re-rTKA presents additional challenges, including further compromised soft tissues and bone loss, abundant scar tissue, stemmed revision implants, and metaphyseal fixation. The goal of this study was to compare the survivorship and clinical outcomes of aseptic first-time rTKAs and re-rTKAs.

Simulated Partial and Complete Resection of the Posterior Cruciate Ligament in Medially Conforming Total Knee Arthroplasty Causes a Graded Reduction in Femoral Rollback and Increase in Posterior Tibial Sag: A Computational Study.

Background: Medially conforming (MC) total knee arthroplasty (TKA) has seen increased clinical utilization. This design allows for either retention or resection of the posterior cruciate ligament (PCL); however, the impact of the PCL on femoral rollback and posterior tibial sag is unknown. Therefore, we developed a computational model to quantify how the PCL affects femoral rollback and posterior sag in MC-TKA.

Complete and Selective Resection of the Posterior Cruciate Ligament Reduces Contact Forces Asymmetrically in Cruciate-Retaining Total Knee Arthroplasty: A Computational Study.

Background: Assessing intraoperative ligament balance in the posterior cruciate ligament (PCL)-retaining total knee arthroplasty (TKA) can be achieved by quantifying tibio-femoral contact forces. Ligament balancing may involve selectively releasing PCL fibers; however, the effects of the extent and location of PCL release on compartmental contact forces are not well understood. To investigate these effects, we developed a computational model to quantify changes in medial and lateral contact forces resulting from targeted PCL fiber release.

A Novel Radiographic Methodology to Measure Knee Adduction Moment Using Routine Biplane Radiographs: Initial Results of 20 Patients.

Background: Compromised function is a common reason for patient dissatisfaction after total knee arthroplasty. However, objectively evaluating function often requires costly, time-consuming, and highly specialized data collection and analysis in a dedicated motion analysis laboratory. To overcome this practical barrier, we developed a radiographic-based method to quantify knee joint moments in routine clinical care and to explore the relationship between knee moments in the sagittal plane and the Knee Osteoarthritis Outcomes Score for Joint Replacement (KOOS JR).

Robotic-Assisted Surgery Does Not Decrease Prosthetic Impingement in Total Hip Arthroplasty: A Retrieval Analysis.

Background: Prosthetic impingement after total hip arthroplasty (THA) has been associated with instability and may be a cause of accelerated polyethylene wear and pain. Previous retrieval studies report a high prevalence of impingement in acetabular liners. Robotic technology has the potential to reduce THA instability as it enables technical precision and optimizes implant positioning.

Operative Time Learning Curve for an Image-Free Robotic Arm Assisted Total Knee Arthroplasty: A Cumulative Sum Analysis.

Background: Robotic arm assisted total knee arthroplasty (RA-TKA) aims to improve accuracy in bone resection, implant positioning, and joint alignment compared to manual TKA (M-TKA). However, the learning curve of RA-TKA can disrupt operating room efficiency, increase complications, and raise costs. This study examines the operative time learning curve of RA-TKA using a single robotic system.

Robotic-Assisted Direct Anterior Approach Total Hip Arthroplasty: A 6.5-fold Reduction in Fluoroscopic Radiation Exposure.

Background: Direct anterior approach (DAA) for total hip arthroplasty (THA) is increasing in popularity. Fluoroscopy is commonly utilized during DAA THA to increase the accuracy of component placement. The objective of this study was to compare the mean fluoroscopy time and radiation dose for DAA THA when utilizing robotic-assisted (RA), computer-assisted navigation (CAN), or manual (M) technique.

Range-of-Motion Predictors for Repeat Manipulation Under Anesthesia and Revision Surgery for Stiffness After Total Knee Arthroplasty.

Introduction: Manipulation under anesthesia (MUA) is a first-line treatment for stiffness after total knee arthroplasty (TKA), but predicting outcomes after MUA can be difficult.

Purpose: We sought to determine the association between pre-MUA range-of-motion (ROM) and the risk of repeat MUA and revision in patients who underwent primary TKA.

Methods: We conducted a retrospective review of 543 MUAs for stiffness at a single institution.

Functional assessment in patients undergoing total hip arthroplasty.

Aims: Conventional patient-reported surveys, used for patients undergoing total hip arthroplasty (THA), are limited by subjectivity and recall bias. Objective functional evaluation, such as gait analysis, to delineate a patient's functional capacity and customize surgical interventions, may address these shortcomings. This systematic review endeavours to investigate the application of objective functional assessments in appraising individuals undergoing THA.

Use of Computer Navigation for Optimal Acetabular Cup Placement in Revision Total Hip Arthroplasty: Case Reports and Surgical Techniques.

Background: The outcomes of revision total hip arthroplasty (rTHA) have become increasingly important as their volume increases. Computer navigation, a reliable method to improve component positioning during primary total hip arthroplasty (THA), is not well studied in the rTHA setting. Given that dislocation rates following rTHA are significantly higher than those of primary THA, component positioning becomes paramount in these cases.

Changing the definition of treatment success alters treatment outcomes in periprosthetic joint infection: a systematic review and meta-analysis.

: Variability in the definition of treatment success poses difficulty when assessing the reported efficacy of treatments for hip and knee periprosthetic joint infection (PJI). To address this problem, we determined how definitions of PJI treatment success have changed over time and how this has affected published rates of success after one-stage and two-stage treatments for hip and knee PJI. : A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted to identify one-stage and two-stage revision hip and knee PJI publications in major databases (2006-2021).

A Comparison of Clinical Outcomes After Total Knee Arthroplasty in Patients Who Have and Do Not Have Self-Reported Nickel Allergy: Matched and Unmatched Cohort Comparisons.

Background: The impact of a preoperative self-reported nickel allergy in patients undergoing primary total knee arthroplasty (TKA) remains unclear. The aim of this study was to compare the revision rates and outcomes of patients who have a self-reported nickel allergy undergoing primary TKA to patients who do not have a self-reported nickel allergy.

Methods: Over 5 years, a total of 284 TKAs in patients who have and 17,735 in patients who do not have a self-reported nickel allergy were performed.

Characterizing the Magnitude and Risk Factors of Functional and Anatomic Limb Lengthening in Patients Undergoing Revision Total Knee Arthroplasty.

Background: In revision total knee arthroplasty (TKA), there is little information on the magnitude of potential limb lengthening, risk factors for lengthening, or its impact on patient-reported outcome measures. We aimed to quantify limb length alteration during revision TKA and assess risk factors for lengthening.

Methods: We identified 150 patients over a 3-year period who underwent revision TKA and had preoperative and postoperative EOS hip-to-ankle standing radiographs.

Clinical Outcomes of Isolated Polyethylene Exchange Versus Full Component Revision for the Management of Instability Following Total Knee Arthroplasty.

Background: Instability following total knee arthroplasty (TKA) is a common cause for revision. Isolated polyethylene exchange (IPE) can be performed to increase knee joint stability, but results have been mixed. The purpose of this study was to compare the survivorship and patient-reported outcomes of patients undergoing revision TKA for instability with IPE versus full component revision.

Impact of Selective Posterior Cruciate Ligament Fiber Release on Femoral Rollback in Cruciate-Retaining Total Knee Arthroplasty: A Computational Study.

Background: Partial or total release of the posterior cruciate ligament (PCL) is often performed intraoperatively in cruciate-retaining total knee arthroplasty (CR-TKA) to alleviate excessive femoral rollback. However, the effect of the release of selected fibers of the PCL on femoral rollback in CR-TKA is not well understood. Therefore, we used a computational model to quantify the effect of selective PCL fiber releases on femoral rollback in CR-TKA.

No Difference in Limb Alignment Between Kinematic and Mechanical Alignment Robotic-Assisted Total Knee Arthroplasty.

Background: Individualized alignment techniques have gained major interest in an effort to increase satisfaction among total knee arthroplasty patients. This study aimed to compare postoperative alignment between kinematic alignment (KA) and mechanical alignment (MA) and assess whether KA significantly deviates from the principle of aligning the limb as close to neutral alignment as possible.

Methods: There were 234 patients who underwent robotic-assisted total knee arthroplasty using an unrestricted KA and a strict MA technique (KA: 145, MA: 89).

Contemporary Isolated Bearing Exchange for the Management of Hip Instability Following Primary Total Hip Arthroplasty.

Background: Isolated ball and liner exchanges (IBLEs) can be performed to increase hip joint stability, but historical results have been mixed due to a lack of head size options or dual mobility articulations. The purpose of this study was to evaluate the contemporary results of IBLEs in patients who have instability following primary total hip arthroplasty (THA).

Methods: We retrospectively reviewed 65 primary THAs from 2016 to 2020 with hip instability undergoing IBLE or conversion to dual mobility articulation.

Joint Replacement Technology in the Ambulatory Surgery Center: Current and Future Applications.

Total joint replacement (TJR) surgery in the ambulatory surgery centers (ASCs) has grown significantly over the past several years, along with the ability to improve the value of care. Standardization of high-quality, perioperative care is pivotal to the success of a TJR ASC program. As surgeons are experiencing increasing overhead with decreasing reimbursement, technology integration can provide major advantages.

The Efficacy and Safety of Tranexamic Acid in Total Hip and Knee Arthroplasty: A Literature Review.

Historically, total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been associated with significant perioperative blood loss and a relatively high rate of allogeneic blood transfusions. However, in recent years, tranexamic acid (TXA), a competitive inhibitor of tissue plasminogen activator, inhibiting fibrinolysis of existing thrombi, has substantially decreased the need for blood transfusion in THA and TKA. Various administration strategies have been studied, but there remains a lack of consensus on an optimal route and dosing regimen, with intravenous and topical regimens being widely used.

A novel computational workflow to holistically assess total knee arthroplasty biomechanics identifies subject-specific effects of joint mechanics on implant fixation.

Computational studies of total knee arthroplasty (TKA) often focus on either joint mechanics (kinematics and forces) or implant fixation mechanics. However, such disconnect between joint and fixation mechanics hinders our understanding of overall TKA biomechanical function by preventing identification of key relationships between these two levels of TKA mechanics. We developed a computational workflow to holistically assess TKA biomechanics by integrating musculoskeletal and finite element (FE) models.

Total Hip Arthroplasty: An Update on Navigation, Robotics, and Contemporary Advancements.

While total hip arthroplasty (THA) remains effective for improvement of pain and function in patients with osteoarthritis and avascular necrosis, there remain areas of continued pursuit of excellence, including decreasing rates of dislocation, leg length discrepancy, implant loosening, and infection. This review article covers several bearing surfaces and articulations, computer-assisted navigation and robotic technology, and minimally invasive surgical approaches that have sought to improve such outcomes. Perhaps the most significant improvement to THA implant longevity has been the broad adoption of highly cross-linked polyethylene, with low wear rates.

Isolated Liner Exchange Versus All-Component Revision for Instability After Total Knee Arthroplasty.

Background: Instability is a common cause for revision total knee arthroplasty (TKA). The risks and benefits of polyethylene liner exchange (LE) as compared to full metal component revision continue to be debated. The purpose of this study was to investigate the success rate and complication profiles of revision TKA for instability based on surgical procedure.