Recovery of Ambulation After Staged Bilateral Total Knee Arthroplasty Is Not Affected by Timing of Second Side Surgery: A Retrospective Analysis of Implanted Sensor Data.

Background: Bilateral knee osteoarthritis is often treated with staged bilateral total knee arthroplasty (BTKA). However, the optimal surgical timing for staging remains contended. In this study, a smart implant sensor was used to assess the association between surgical timing of stages and recovery of ambulation after the second total knee arthroplasty (TKA).

Patellar Overstuffing in Total Knee Arthroplasty Results in Decreased Extensor Mechanism Efficiency.

Patellofemoral offset is influenced by patellar thickness in total knee arthroplasty (TKA), with effects on extensor mechanism efficiency (EME), patellar contact moment arm (PCMA), and patellar contact force (PCF). This study utilized a computational model to better quantify these measures during knee range of motion (ROM). A computational model of a cruciate-sacrificing, posterior-stabilized TKA design was used to quantify moments at knee flexion angles from 0° to 135° when patella thickness was increased ("overstuffed") or decreased ("understuffed") by 2 mm and 5 mm from normal.

Staying Ahead of the Curve: The Case for Recovery Curves in Total Knee Arthroplasty.

Background: Sensor technology embedded within the total knee arthroplasty (TKA) implant has the potential to record data that can track recovery and provide diagnostic information. In this study, we introduce the concept of physical function recovery curve analytics, which are created from daily spatial-temporal gait metrics and step counts from a large cohort of TKA patients.

Methods: In our study population, 258 patients underwent a primary TKA with a smart implanted tibial extension between October 4, 2021, and July 15, 2022, by 33 surgeons.

Is Preoperative Weight Reduction in Patients Who Have Body Mass Index ≥ 40 Associated With Lower Complication Rates After Primary Total Hip Arthroplasty?

Background: Given the heightened risk of postoperative complications associated with obesity, delaying total hip arthroplasty (THA) in patients who have a body mass index (BMI) > 40 to maximize preoperative weight loss has been advocated by professional societies and orthopaedic surgeons. While the benefits of this strategy are not well-understood, previous studies have suggested that a 5% reduction in weight or BMI may be associated with reduced complications after THA.

Methods: We identified 613 patients who underwent primary THA in a single institution during a 7-year period and who had a BMI >40 recorded from 9 to 12 months prior to surgery.

A unique case report of a revision extensor mechanism reconstruction using Marlex mesh in the setting of proximal tibial bone deficiency: The tantalum clamshell technique.

Extensor mechanism (EM) disruption is a rare but severe complication of total knee arthroplasty (TKA) that can greatly impair function. Treatment options for chronic patella tendon ruptures include primary repair, autograft augmentation, and reconstruction with allograft or synthetic material. Despite various techniques, failures can occur, and options for reconstruction after a failed allograft or mesh are limited, especially if the tibial component is well-fixed and cannot be easily removed, and if there is proximal tibial deficiency from a previous failed EM allograft.

Substantial Weight Loss May Not Improve Early Outcomes of Total Knee Arthroplasty in the Morbidly Obese.

Background: Body mass index (BMI) cutoffs for morbidly obese patients otherwise indicated for total knee arthroplasty (TKA) have been widely proposed and implemented, though they remain controversial. Previous studies suggested that a 5% reduction in BMI may be associated with fewer postoperative complications. Thus, the purpose of this study was to determine whether a substantial reduction in preoperative BMI in morbidly obese patients improved 90-day outcomes after TKA.

How Active Are Our Patients in the First 6 Weeks Following Total Knee Arthroplasty?

Background: Patient activity after total knee arthroplasty (TKA) surgery has been estimated through patient-reported outcome measures. The use of data from an implanted sensor that transmits daily gait activity provides a more objective, complete recovery trajectory.

Methods: In this retrospective analysis of 794 patients who received a TKA with sensors in the tibial extension between October 4, 2021, and January 13, 2023, the average age of the patients was 64 years, and the cohort was 54.

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.

What Is the Role of a Periarticular Injection for Knee Arthroplasty Patients Receiving a Multimodal Analgesia Regimen Incorporating Adductor Canal and Infiltration Between the Popliteal Artery and Capsule of the Knee Blocks? A Randomized Blinded Placebo-Controlled Noninferiority Trial.

Background: Optimal analgesic protocols for total knee arthroplasty (TKA) patients remain controversial. Multimodal analgesia is advocated, often including peripheral nerve blocks and/or periarticular injections (PAIs). If 2 blocks (adductor canal block [ACB] plus infiltration between the popliteal artery and capsule of the knee [IPACK]) are used, also performing PAI may not be necessary.

Nonagenarians and Octogenarians Undergoing THA and TKA: A 10-Year Age Difference Increases Rates of In-Hospital Complications But Does Not Affect 90-Day Outcomes.

Background: The population of nonagenarians undergoing total joint arthroplasty (TJA) of the hip or knee is expected to increase, but this population may be reluctant to consider elective surgery because of their advanced age.

Purpose: We sought to compare TJA outcomes between nonagenarians and octogenarians with an exact 10-year age difference.

Methods: We performed a retrospective chart review, including 129 nonagenarians who underwent primary unilateral TJA for osteoarthritis in a 4-year period at a single institution and who were matched with 381 octogenarians based on sex, body mass index, Charlson Comorbidity Index, replaced joint (hip or knee), and a 10-year age difference.

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).

A Cadaveric Study Addressing the Feasibility of Remote Patient Monitoring Prosthesis for Total Knee Arthroplasty.

Background: Since the COVID-19 pandemic of 2020, there has been a marked rise in the use of telemedicine to evaluate patients after total knee arthroplasty (TKA). The purpose of our study was to assess a novel stem with an embedded sensor that can remotely and objectively monitor a patient's mobility after TKA.

Methods: A single anatomically designed knee system was implanted in concert with an interconnected tibial stem extension containing 3D accelerometers, 3D gyroscopes, a power source, and a telemetry transmission capability in 3 cadaveric pelvis to toe specimens.

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 Effectiveness of Closed-Incision Negative-Pressure Therapy Versus Silver-Impregnated Dressings in Mitigating Surgical Site Complications in High-Risk Patients After Revision Knee Arthroplasty: The PROMISES Randomized Controlled Trial.

Background: Revision total knee arthroplasty (rTKA) is associated with significant risk of wound-related morbidity. The present study aimed to evaluate the 1) efficacy of closed-incision negative-pressure therapy (ciNPT) vs silver-impregnated antimicrobial dressing (AMD) in mitigating postoperative surgical site complications (SSCs), 2) the effect of ciNPT vs AMD on certain postoperative health utilization parameters, and on 3) patient-reported outcomes (PROs) improvement at 90-day postoperative follow-up.

Methods: This multicenter randomized controlled trial was conducted between December 2017 and August 2019.

Is There a Synergistic Effect of Topical Plus Intravenous Tranexamic Acid Versus Intravenous Administration Alone on Blood Loss and Transfusions in Primary Total Hip and Knee Arthroplasties?

Background: The optimal route and dosing regimen of tranexamic acid (TXA) in primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) remain unclear. As such, we sought to analyze if there was a synergistic effect of intravenous (IV) and topical TXA on blood loss and transfusions.

Methods: We retrospectively analyzed 6720 primary TKAs and 6559 THAs performed from February 1, 2016 to December 31, 2019 at a single institution in patients who received a double IV dose (6159 TKAs and 6276 THAs) compared with a combined single IV and topical dose (561 TKAs and 283 THAs) of TXA.

Simultaneous Bilateral Primary Total Knee Arthroplasty With TXA and Restrictive Transfusion Protocols: Still a 1 in 5 Risk of Allogeneic Transfusion.

Background: Historically, there was up to a 60% risk of blood transfusion for patients undergoing simultaneous bilateral total knee arthroplasty (SBTKA). As such, the goal of this study was to analyze the rate and risk factors for allogeneic blood transfusions in patients undergoing SBTKA with tranexamic acid (TXA).

Methods: We retrospectively identified 475 patients who underwent SBTKA with a double dose TXA regimen at a single institution from 2016 to 2019.

Operative Times Can Predict and Are Correlated With Lengths-of-Stay in Primary Total Knee Arthroplasty: A Nationwide Database Study.

Background: The specific influence of operative times on lengths-of-stay (LOS) has not been well assessed and is therefore an important topic of evaluation for multiple reasons, including potential economic implication. The purpose of this study is to (1) identify predictors of longer operative times; (2) identify predictors of longer LOS; and (3) evaluate the effects of operative times on LOS in primary total knee arthroplasty (TKA).

Methods: The National Surgical Quality Improvement Program database was queried for primary TKAs performed between 2008 and 2016, yielding 225,344 cases.

Cementless versus Cemented Fixation in Total Knee Arthroplasty.

Despite the success of total knee arthroplasty (TKA), more than 20,000 revision TKA procedures are performed annually. In an effort to decrease failures due to loosening in the past, cementless fixation of TKA was suggested. The preliminary results of cementless fixation for TKA proved to be discouraging, with midterm results linking the use of uncemented components to early aseptic loosening.

Total Knee Arthroplasty Wound Complication Treatment Algorithm: Current Soft Tissue Coverage Options.

Background: Wound complications associated with soft tissue defects following total knee arthroplasty present challenges for the orthopedic surgeon. The scale of early complications include less morbid problems, such as quickly resolving drainage and small superficial eschars, to persistent drainage and full-thickness tissue necrosis, which may require advanced soft tissue coverage.

Methods: This review outlines current wound management strategies and provides an algorithm to help guide treatment and clinical decision-making.

A Modern Approach to Preventing Prosthetic Joint Infections.

Total knee arthroplasty (TKA) is recognized as one of the most successful surgical procedures performed today. One of the most common and dreaded complications of TKA is postoperative infection. To prevent infections, it is critical to identify patients at high risk through analyzing their risk factors, and help in addressing them prior to surgery.

Bicompartmental Knee Arthroplasty.

Knee arthritis is one of the leading causes of disability and functional limitations in the United States and worldwide. Total knee arthroplasty results in good functional outcomes and high survival rates in patients who have tricompartmental arthritis. Bicompartmental knee arthroplasty is being used more often in patients who have arthritis that is isolated to two compartments: the patellofemoral compartment and either the medial or the lateral compartment.

Characterization of the Neural Anatomy in the Hip Joint to Optimize Periarticular Regional Anesthesia in Total Hip Arthroplasty.

The purpose of the current study was to identify and map the periarticular neural anatomy of the hip to optimize periarticular injection techniques in total hip arthroplasty. A literature review of common search engines was performed using terms associated with hip innervation and 17 met the inclusion criteria. The studies addressed both gross and microscopic neural anatomy of the human hip joint, and the findings summarize key areas of hip mechanoreceptors and free nerve endings to provide a framework for targeted periarticular hip infiltration.

Do Regional Analgesia and Peripheral Blocks Still Have a Place in Joint Arthroplasty?

The efficacy of regional anesthesia and peripheral nerve blocks in the management of postoperative pain has resulted in widespread use of this approach in hip and knee arthroplasty. With extensive clinical use, however, the limitations of this approach have become apparent. These limitations include delays for the surgeon, inefficient use of the operating room, muscular weakness, and associated delays in physical therapy.

The Risk of a Deep Infection Associated With Intraarticular Injections Before a Total Knee Arthroplasty.

The aim of the study is to identify the risks associated with an intraarticular injection before a total knee arthroplasty (TKA). A total of 1628 patients were retrospectively studied over a 7-year period. The patients were divided into 2 groups: patient who received an intraarticular injection before a TKA and patients who did not receive an injection before a TKA.