Biomechanical Comparison of Kinematic and Mechanical Knee Alignment Techniques in a Computer Simulation Medial Pivot Total Knee Arthroplasty Model
This study aimed to compare motions, contact forces, and contact stress between mechanically aligned (MA) and KA (medial tilt 3° [KA3] and 5° [KA5]) models in MPK. An MPK design was virtually implanted with MA, KA3, and KA5 in a validated musculoskeletal computer model of a healthy knee, and the simulation of motion and contact forces was implemented. Anteroposterior (AP) positions, mediolateral positions, external rotation angles of the femoral component relative to the tibial insert, and tibiofemoral contact forces were evaluated at different knee flexion angles. Contact stresses on the tibial insert were calculated us...
Source: Journal of Knee Surgery - December 10, 2021 Category: Orthopaedics Authors: Song, Young Dong Nakamura, Shinichiro Kuriyama, Shinichi Nishitani, Kohei Ito, Hiromu Morita, Yugo Yamawaki, Yusuke Matsuda, Shuichi Tags: Original Article Source Type: research
Does MRI Knee in Those over 50 Years with Knee Pain in Osteoarthritis Alter Management? A Retrospective Review
J Knee Surg DOI: 10.1055/s-0041-1740390Knee osteoarthritis (OA) is a significant cause of pain and disability worldwide. Imaging provides diagnosis, prognostication, and follow-up. Radiographs are first line, useful, and inexpensive. Magnetic resonance imaging (MRI) can detect additional features not seen on radiograph, but it is of questionable usefulness in the management of knee OA. Our aim was to investigate the usefulness of MRI in the workup of knee OA and whether MRI alters management in knee OA. A retrospective review was performed of consecutive MRI knees performed for knee pain in those over 50 years. Clinical in...
Source: Journal of Knee Surgery - December 8, 2021 Category: Orthopaedics Authors: Murphy, Alexandra N. Yelverton, Bryan Clesham, Kevin Hassell, Kathy Kavanagh, Eoin Eustace, Stephen Cashman, James Tags: Original Article Source Type: research
Tourniquet Use Does Not Affect Pain and Function after Total Knee Arthroplasty: Patient Evaluation According to Pain Threshold
J Knee Surg DOI: 10.1055/s-0041-1740385We evaluated the effect of using a tourniquet on early-stage pain and 1-year postoperative functional outcomes when patients were divided into two groups according to the pain threshold (PT). Overall, 120 patients who were assessed preoperatively with an algometer were recruited for this prospective, double-blinded, randomized controlled trial. Patients were randomized to undergo total knee arthroplasty (TKA) with a tourniquet (group 1, 60 patients) and without tourniquet (group 2, 60 patients). Primary outcome measures were visual analog scale (VAS) pain scores at 24, 36, and 48 ho...
Source: Journal of Knee Surgery - December 7, 2021 Category: Orthopaedics Authors: Çamur, Savaş Bayram, Serkan Kara, Adnan Se çkin, Mustafa Faik Sa ğlam, Necdet Batibay, Sefa Giray Tags: Original Article Source Type: research
The Utility of Perioperative Products for the Prevention of Surgical Site Infections in Total Knee Arthroplasty and Lower Extremity Arthroplasty: A Systematic Review
J Knee Surg DOI: 10.1055/s-0041-1740394Surgical site infections (SSIs) are among the most prevalent and devastating complications following lower extremity total joint arthroplasty (TJA). Strategies to reduce the rates can be divided into preoperative, perioperatives, and postoperative measures. A multicenter trial is underway to evaluate the efficacy of implementing a bundled care program for SSI prevention in lower extremity TJA including: (1) nasal decolonization; (2) surgical skin antisepsis; (3) antimicrobial incise draping; (4) temperature management; and (5) negative-pressure wound therapy for selected high-risk pat...
Source: Journal of Knee Surgery - December 7, 2021 Category: Orthopaedics Authors: Salem, Hytham S. Sherman, Alain E. Chen, Zhongming Scuderi, Giles R. Mont, Michael A. Tags: Original Article Source Type: research
Total Knee Arthroplasty following Knee Arthroscopy in Patients over 50
J Knee Surg DOI: 10.1055/s-0041-1740391The purpose of this study was to evaluate the conversion rate of knee arthroscopy to ipsilateral total knee arthroplasty (TKA) within 2 years in patients aged 50 or older at the time of arthroscopy. The administrative database from a large, physician-owned orthopaedic practice (>100 surgeons) was queried to identify patients over the age of 50 who had undergone arthroscopic knee surgery between January 1, 2006 and January 2, 2015. The subset of patients who converted to TKA within 2 years after knee arthroscopy was identified and matched by age and sex to a control population that ...
Source: Journal of Knee Surgery - December 7, 2021 Category: Orthopaedics Authors: Buck, J. Stewart Odum, Susan M. Salava, Jonathan K. Macknet, David M. Fehring, Thomas K. Springer, Bryan D. Tags: Original Article Source Type: research
Synergistic Effect of a Prolonged Combination Course of Tranexamic Acid and Dexamethasone Involving High Initial Doses in Total Knee Arthroplasty: A Randomized Controlled Trial
J Knee Surg DOI: 10.1055/s-0041-1739197The optimal regimes of tranexamic acid (TXA) and dexamethasone (DXM) in total knee arthroplasty (TKA) are still uncertain. The aim of this study was to assess the efficacy and safety of a prolonged course of intravenous TXA and DXM involving a high initial dose in TKA. Patients who underwent primary TKA at our center were randomized to receive one of four regimes: control (group A), prolonged course of TXA (B), prolonged course of DXM (C), or the combination of a prolonged course of TXA and DXM (D). The four groups were compared in primary outcomes (fibrinolytic and inflammatory marke...
Source: Journal of Knee Surgery - November 18, 2021 Category: Orthopaedics Authors: Xu, Hong Xie, Jinwei Yang, Jingli Huang, Zeyu Wang, Duan Pei, Fuxing Tags: Original Article Source Type: research
Intraoperative Assessment of Gap Balancing in Total Knee Arthroplasty Using Navigation with Joint Stability Graphs
J Knee Surg DOI: 10.1055/s-0041-1739200The purpose of this study was to assess continuous gaps in the replaced knee throughout the full range of motion (ROM) after total knee arthroplasty (TKA) using a joint stability graph, and to analyze the gap laxity in the mid-flexion range. Ninety-three TKAs were performed using imageless navigation with a joint stability graph. While positioning guides for each respective cut, the surgeon can safely preview the resection's impact for the resulting joint gaps and control the soft tissue balance at the knee flexion of 0° (extension) and 90° (flexion). The gaps between the femoral co...
Source: Journal of Knee Surgery - November 18, 2021 Category: Orthopaedics Authors: Song, Sang Jun Lee, Hyun Woo Park, Cheol Hee Tags: Original Article Source Type: research
Crohn's Disease Increases In-Hospital Lengths of Stay, Medical Complications, and Costs of Care following Primary Total Knee Arthroplasty
This study demonstrated that, after adjusting for age, sex, and medical comorbidities, patients with CD have prolonged in-hospital LOS, increased medical complications, and higher EOC costs following primary TKA. Therefore, it establishes the importance for orthopaedists to adequately counsel CD patients of the potential complications and outcomes following their procedure. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents | Abstract | Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - November 18, 2021 Category: Orthopaedics Authors: Hadid, Bana Buehring, Weston Mannino, Angelo Weisberg, Miriam D. Golub, Ivan J Ng, Mitchell K Razi, Afshin E. Tags: Original Article Source Type: research
Dark Cartilage Lesions in the Knee: MRI Appearance and Clinical Significance
J Knee Surg DOI: 10.1055/s-0041-1739259Early investigations into the magnetic resonance imaging (MRI) appearance of articular cartilage imaging relied on assessment of the morphology, with subsequent investigators reporting identifying increased T2 signal intensity, bright signal, in degenerated cartilage. The cartilage “black line sign” is a finding that has recently been described in the radiology literature to characterize cartilage pathology. This sign refers to a focal linear hypointense signal within articular cartilage that is oriented perpendicular to the subchondral bone on T2-weighted MRI. The diagnostic sign...
Source: Journal of Knee Surgery - November 15, 2021 Category: Orthopaedics Authors: Knoth, John Christopher Long, Jeremiah R. Stensby, J. Derek Tags: Special Focus Section Source Type: research
Initial Validation of a Modified MRI Scoring System for Assessing Outcomes after Single-Surface Osteochondral Shell Allograft Transplantation in the Knee
J Knee Surg DOI: 10.1055/s-0041-1739202The Osteochondral Allograft Magnetic Resonance Imaging Scoring System (OCAMRISS) provides a reproducible method for imaging-based grading for osteochondral allograft (OCA) transplants. However, the OCAMRISS does not account for larger whole-surface OCA shell grafts, and has not been validated for assessing outcomes after shell OCA transplantation. Therefore, the objective of this study was to evaluate a modified OCAMRISS for assessing single-surface shell OCAs in the knee based on strength of correlations for a modified OCAMRISS score with graft success and patient-reported outcomes f...
Source: Journal of Knee Surgery - November 15, 2021 Category: Orthopaedics Authors: Wissman, Robert Cook, Cristi Cook, James L. Okoye, Munachukwudi Rucisnki, Kylee Stannard, James P. Tags: Original Article Source Type: research
Adjusting Insert Thickness and Tibial Slope Do Not Correct Internal Tibial Rotation Loss Caused by PCL Resection: In Vitro Study of a Medial Constraint TKA Implanted with Unrestricted Calipered Kinematic Alignment
J Knee Surg DOI: 10.1055/s-0041-1739147Most medial stabilized (MS) total knee arthroplasty (TKA) implants recommend excision of the posterior cruciate ligament (PCL), which eliminates the ligament's tension effect on the tibia that drives tibial rotation and compromises passive internal tibial rotation in flexion. Whether increasing the insert thickness and reducing the posterior tibial slope corrects the loss of rotation without extension loss and undesirable anterior lift-off of the insert is unknown. In 10 fresh-frozen cadaveric knees, an MS design with a medial ball-in-socket (i.e., spherical joint) and lateral flat in...
Source: Journal of Knee Surgery - November 15, 2021 Category: Orthopaedics Authors: Nedopil, Alexander J. Thadani, Peter J. McCoy, Thomas H. Howell, Stephen M. Hull, Maury L. Tags: Original Article Source Type: research
Similar Healthcare Utilization and 1-Year Patient-Reported Outcomes between Cemented and Cementless Primary Total Knee Arthroplasty: A Propensity Score-Matched Analysis
This study assessed (1) healthcare utilization (length of stay (LOS), nonhome discharge, 90-day readmission, and 1-year reoperation); (2) 1-year mortality; and (3) 1-year joint-specific and global health-related patient-reported outcome measures (PROMs) among patients who received cementless versus cemented TKA. Patients who underwent cementless and cemented TKA at a single institution (July 2015–August 2018) were prospectively enrolled. A total of 424 cementless and 5,274 cemented TKAs were included. The cementless cohort was propensity score-matched to a group cemented TKAs (1:3-cementless: n = 424; cemented: n =...
Source: Journal of Knee Surgery - November 15, 2021 Category: Orthopaedics Authors: Erossy, Michael P. Emara, Ahmed K. Rothfusz, Christopher A. Klika, Alison K. Bloomfield, Michael R. Higuera, Carlos A. Jin, Yuxuan Krebs, Viktor E. Mesko, Nathan W. Molloy, Robert M. Murray, Trevor G. Patel, Preetesh D. Stearns, Kim L. Schaffer, Jonathan Tags: Original Article Source Type: research
Biologic Augmentation during Meniscal Repair
J Knee Surg DOI: 10.1055/s-0041-1739198We reviewed the literature regarding utility of biologic augmentation in meniscal repair. We hypothesized that the addition of biologic augmentation during meniscal repair improves postoperative knee function and reduces risk of repair failure. PubMed and Embase databases were systematically searched. Included studies were clinical studies in humans, published in English, and reported use of biologic augmentation techniques in addition to meniscal repair (including platelet-rich plasma [PRP], fibrin clot, bone marrow stimulation, meniscal wrapping, and bioscaffolds) for treatment of k...
Source: Journal of Knee Surgery - November 15, 2021 Category: Orthopaedics Authors: Blough, Christian L. Bobba, Christopher M. DiBartola, Alex C. Everhart, Joshua S. Magnussen, Robert A. Kaeding, Christopher Flanigan, David C. Tags: Original Article Source Type: research
Effect of Tibial Slope on Coronal Alignment in Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0041-1736604Malalignment of total knee arthroplasty (TKA) components affects function and survivorship. Common practice is to set coronal alignment prior to adjusting slope. With improper jig placement, adjustment of the slope may alter coronal alignment. The purpose of this study was to quantify the change in coronal alignment with increasing posterior tibial slope while comparing two methods of jig fixation. A prospective consecutive series of 100 patients underwent TKA using computer navigation. Fifty patients had the extramedullary cutting jig secured proximally with one pin and 50 patients h...
Source: Journal of Knee Surgery - November 15, 2021 Category: Orthopaedics Authors: Betzle, Christopher J. Bringe, Kariline E. Horberg, John V. Moskal, Joseph T. Mann, John W. Tags: Original Article Source Type: research
Hypoalbuminemia Predicts Adverse Events following Unicompartmental Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0041-1739146Hypoalbuminemia is a potentially modifiable risk factor associated with adverse events following total knee arthroplasty. The present study aimed to evaluate whether hypoalbuminemia similarly predisposes to adverse events following unicompartmental knee arthroplasty (UKA). Patients who underwent UKA during 2006–2018 were identified through the American College of Surgeons National Surgical Quality Improvement Program. Only patients with preoperative serum albumin concentration were included. Outcomes were compared between patients with and without hypoalbuminemia (serum albumin conc...
Source: Journal of Knee Surgery - November 12, 2021 Category: Orthopaedics Authors: Hur, Edward S. Bohl, Daniel D. Della Valle, Craig J. Villalobos, Felipe Gerlinger, Tad L. Tags: Original Article Source Type: research
