Neuromas and Persistent Postoperative Pain Following Total Knee Arthroplasty.

Purpose: Persistent postoperative knee pain after primary total knee arthroplasty (TKA) is often an indication for revision surgery and has a multifactorial etiology. Periarticular neuromas of nerves innervating the joint, ligaments, or overlying skin are important but misdiagnosed causes of persistent knee pain following knee surgery. This study aimed to characterize the incidence and sequelae of peripheral neuromas in TKA patients.

Highlights of the 2024 American Joint Replacement Registry Annual Report.

The American Joint Replacement Registry continues to grow, as represented by the 4.3 million hip and knee arthroplasties analyzed in the 2024 American Joint Replacement Registry . Highlights of this report are found in the following article.

Epidemiology, Management, and Systematic Review of Surgical Trends for Patients Who Have Osteonecrosis of the Femoral Head.

Background: Osteonecrosis is a debilitating condition characterized by bone tissue death and disrupted vascular circulation, most commonly affecting the femoral head. This study aimed to assess the epidemiology and surgical trends of hip osteonecrosis in the United States using a comprehensive national database, as well as to review the current literature on historical and contemporary surgical trends for patients who have osteonecrosis of the femoral head (ONFH).

Methods: Data from a research network (2015 to 2024) were used to identify patients diagnosed with ONFH using International Classification of Diseases, 10th revision, Clinical Modification codes.

Condylar-Stabilized Designs in Total Knee Arthroplasty: A Classification System and Review of Outcomes.

Background: Increased use of condylar-stabilized (CS) bearings in primary total knee arthroplasty can be attributed to bony preservation with the option for posterior cruciate ligament resection without compromising kinematics. There are a variety of CS designs, but no system of nomenclature, making comparisons challenging. A comprehensive classification system of differing CS designs based on articular surface and femoral component geometries and kinematic principles is proposed.

Mobile Bearing Total Knee Arthroplasty Is Associated With an Increased Risk of Mechanical Loosening: A Follow-Up Analysis of the American Joint Replacement Registry.

Background: Mobile-bearing (MB) total knee arthroplasty (TKA) designs have proposed biomechanical benefits, including improved patellar tracking and reduction in polyethylene wear. Yet, prior work using the American Joint Replacement Registry (AJRR) has demonstrated an increased risk of all-cause revision with MB-TKA. We therefore utilized the AJRR to further characterize reasons for the increased risk of revision with MB-TKA compared to fixed-bearing (FB) TKA designs.

Decreased Revision Risk With Cementless Collared Metadiaphyseal-Filling Stems Compared to Cemented Fixation in Patients 65 Years and Older.

Background: Compared to other cementless designs, collared metadiaphyseal-filling femoral stems are associated with a lower risk of revision and periprosthetic femoral fracture after total hip arthroplasty (THA) in patients ≥ 65 years. However, it is unclear how these designs compare to cemented femoral stems. We utilized the American Joint Replacement Registry to examine the risk of revision comparing cementless collared metadiaphyseal-filling versus cemented femoral stem designs.

Is Patella Resurfacing Associated With Postoperative Extensor Mechanism Disruption After Total Knee Arthroplasty? A Systematic Review and Meta-Analysis.

Background: Patella resurfacing in total knee arthroplasty (TKA) involves surgical manipulation of the extensor mechanism, which can weaken or devascularize the patellar bone, quadriceps, and patellar tendon. Patella resurfacing may, in theory, increase the risk of postoperative extensor mechanism disruption (EMD).

Methods: We systematically searched the Cochrane, Embase, and PubMed databases to identify randomized controlled trials that reported the overall incidence of complications and surgery for EMD for resurfaced and unresurfaced patellae in patients who underwent primary TKA with a 2-year follow-up.

Prevalence of Depressive Symptoms in Patients Undergoing Aseptic Revision Total Hip Arthroplasty Differs Based on Mode of Failure.

Background: Complications following total hip arthroplasty (THA) may necessitate a revision and patients who go on to a revision THA may experience depressive symptoms. The objective of this study was to investigate the prevalence of depressive symptoms before and after revision THA for six different failure modes.

Methods: Patients who underwent a THA revision with minimum 1-year follow-up at a single institution from 2008 to 2022 were retrospectively reviewed.

Body Mass Index Is Not Associated With Risk for Mechanical Loosening Following Primary Total Knee Arthroplasty: An Analysis From the American Joint Replacement Registry.

Background: Conflicting evidence leaves surgeons without clarity on the association of elevated body mass index (BMI) with the risk of mechanical loosening after total knee arthroplasty (TKA). This investigation examined the associated risk of mechanical loosening following TKA based on BMI.

Methods: We analyzed American Joint Replacement Registry data in patients aged 65 years or more from January 2012 to March 2022 who had a minimum of 2-year follow-up linked to supplemental Centers for Medicare and Medicaid data.

Racial, socioeconomic, and payer status disparities in utilization of unicompartmental knee arthroplasty in the USA.

Background: Unicompartmental knee arthroplasty (UKA) is a surgical treatment for knee osteoarthritis associated with lower morbidity compared with total knee arthroplasty (TKA) in patients with isolated unicompartmental knee arthritis. As disparities have been noted broadly in arthroplasty care, it follows that such disparities might be present in the utilization of UKA relative to TKA. This study therefore examined racial/ethnic, socioeconomic, and payer status differences in utilization of UKA.

Access to robot-assisted total knee arthroplasty varies significantly by race/ethnicity.

Background: Racial/ethnic disparities in access to total knee arthroplasty (TKA) have been extensively demonstrated. Over the past several years, there has been a rapid increase in the utilization of robot-assisted TKA (RA-TKA). Therefore, this study sought to determine whether previously established racial/ethnic disparities extend to access to RA-TKA relative to conventional TKA.

Leaving the Patella Unresurfaced Does Not Increase the Risk of Short-Term Revision Following Total Knee Arthroplasty: An Analysis from the American Joint Replacement Registry.

The benefit of patellar resurfacing in total knee arthroplasty (TKA) remains uncertain, with conflicting evidence regarding associated revision rates and clinical outcomes. Although initial studies have reported higher revision rates associated with unresurfaced patellae, recent evidence questions the necessity of routine patellar resurfacing. This study aimed to evaluate the risk of revision following TKA performed with and without patellar resurfacing using data from the American Joint Replacement Registry (AJRR).

Routine Prescription of Proton Pump Inhibitors in the Perioperative Period is Associated With Decreased Rates of 2-Year Revision Surgery After Total Hip and Knee Arthroplasty.

Background: Proton pump inhibitors (PPIs) are often prescribed in conjunction with nonsteroidal anti-inflammatory drugs after total hip arthroplasty (THA) and total knee arthroplasty (TKA) due to their gastroprotective effects. In animal studies, it has been suggested that PPIs have immunosuppressive effects and impair fracture healing; however, the association between PPI use and adverse events following THA and TKA has not been well-studied.

Methods: An administrative claims database was queried for patients who underwent elective THA from 2010 to 2019.

Decreased Risk of Readmission and Complications With Preoperative GLP-1 Analog Use in Patients Undergoing Primary Total Joint Arthroplasty.

Background: There has been considerable interest in the use of GLP-1 receptor analogs (GLP-1 RAs) for weight optimization in patients undergoing elective arthroplasty. As there is limited data regarding the implications of their use, our study aimed to evaluate the association between preoperative GLP-1 RA use and postoperative outcomes in patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods: The TrinetX research network was queried to identify all patients undergoing primary THA or TKA between May 2005 and December 2023 across 84 health care organizations.

Cemented Stem Design in Total Hip Arthroplasty: Fixation Philosophies, Biomechanics, and an Updated Classification System.

There is renewed interest in cemented femoral fixation in total hip arthroplasty in the United States, and to fully appreciate the evolution of cemented femoral stem designs, an understanding of their history and design rationale is essential. To adequately study the outcomes of modern-day designs, a comprehensive classification system is also necessary. The biomechanical principles, failure mechanisms, and clinical outcomes associated with various cemented femoral stems are described in this comprehensive review.

The Definition of Anemia Matters When Using Preoperative Hemoglobin as a Screening Tool Prior to Total Hip and Knee Arthroplasty.

Background: Preoperative anemia is common in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Several definitions of anemia have been described, with no clear consensus on the optimal one for preoperative screening. We hypothesized that depending on the definition used preoperatively, the proportion of anemic patients identified who would require a postoperative allogeneic blood transfusion would vary significantly.

Mapping the course to recovery: a prospective study on the anatomic distribution of early postoperative pain after total knee arthroplasty.

Introduction: Early postoperative pain following total knee arthroplasty significantly impacts outcomes and patient satisfaction. However, the characteristics and sources of early pain after total knee arthroplasty remain unclear. Therefore, the purpose of this study was to determine the anatomic distribution and course of postoperative pain in the acute and subacute period following total knee arthroplasty.