Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1698769Robotic-assisted unicompartmental knee arthroplasty (RAUKA) is an emerging area of interest. The purpose of this study was to compare (1) different patient demographic profiles; (2) annual primary and revision utilization rates; (3) risk factors for revision procedures; and (4) survivorship between RAUKA and manual UKA (MUKA). Using the PearlDiver database, patients who underwent RAUKA or MUKA between 2005 and 2014 within the Medicare database were identified, yielding a total of 35,061 patients (RAUKA = 13,617; manual = 21,444). Patient demographics (age, ...
Source: Journal of Knee Surgery - October 22, 2019 Category: Orthopaedics Authors: Vakharia, Rushabh M. Sodhi, Nipun Cohen-Levy, Wayne B. Vakharia, Ajit M. Mont, Michael A. Roche, Martin W. Tags: Original Article Source Type: research

Preoperative Expectations of Patients Undergoing Knee Surgery
J Knee Surg DOI: 10.1055/s-0039-1698805There is limited validated data regarding the relationship between preoperative expectations and patient-reported outcomes (PROs) in patients undergoing knee surgery. The purpose of this study was to (1) assess the preoperative expectations of patients undergoing knee surgery and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. We hypothesized that younger patients with worse function and worse general health status would have greater expectations of knee surgery. We analyzed data from 399 patients undergoing knee s...
Source: Journal of Knee Surgery - October 22, 2019 Category: Orthopaedics Authors: Stevens, Kali N. Nadarajah, Vidushan Jauregui, Julio J. Song, Xuyang Medina, Shaun H. Smuda, Michael P. Packer, Jonathan D. Henn, R. Frank Tags: Original Article Source Type: research

Robot-Assisted Unicompartmental Knee Arthroplasty: Increasing Surgical Accuracy? A Cadaveric Study
The objective of this study is to evaluate the precision of the Navio robot-assisted system in the position and alignment of medial UKA compared with the conventional technique. This is an experimental pilot study. Twenty-six cadaveric models were randomized into 2 groups: Robot-Assisted surgery (R) and Conventional Surgery (C). Radiological study was performed pre- and post-surgery, evaluating the medial distal femoral angle (MDFA), medial proximal tibial angle (MPTA), tibial slope, tibiofemoral angle (TFA), sagittal femoral angle (SFA), and size of the femoral and tibial components. The main result measurement was the ch...
Source: Journal of Knee Surgery - October 22, 2019 Category: Orthopaedics Authors: I ñiguez, Magaly Negr ín, Roberto Duboy, Jaime Reyes, Nicol ás O. D íaz, Rodrigo Tags: Original Article Source Type: research

Factors Complicating Discharge to Home Following Total Knee Arthroplasty —A Single Institution Initiative
J Knee Surg DOI: 10.1055/s-0039-1700491Recently, with the Medicare bundled payments initiative for total knee arthroplasty (TKA), there has been a move by many institutions to further streamline costs associated with the entire operative and perioperative process. One of these cost-saving strategies has been to favor discharging patients to home with outpatient services as opposed to discharging to the relatively more expensive rehabilitation facilities. Our aim was to determine the success of a teaching institute's initiative in discharging patients to home instead of a rehabilitation facility. Specifically, we evaluated ...
Source: Journal of Knee Surgery - October 22, 2019 Category: Orthopaedics Authors: Issa, Kimona Kurowicki, Jennifer Novack, Thomas A. Pierce, Todd P. Festa, Anthony Scillia, Anthony J. McInerney, Vincent K. Tags: Original Article Source Type: research

Serum D-Dimer in the Diagnosis of Periprosthetic Knee Infection: Where Are We Today?
In conclusion, high D-dimer levels in primary or revision knee arthroplasty seem indicative of diagnosis of PJI. However, future studies are warranted to conclusively support the routine use of this marker and to validate the performance of the newly developed PJI diagnostic criteria under different clinical scenarios. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - October 21, 2019 Category: Orthopaedics Authors: Pannu, Tejbir S. Villa, Jesus M. Riesgo, Aldo M. Patel, Preetesh D. Barsoum, Wael K. Higuera, Carlos A. Tags: Special Focus Section Source Type: research

Predictive Factors for Hamstring Autograft Diameter in Anterior Cruciate Ligament Reconstruction
This study aimed to determine which preoperative measurements are associated with HT autograft diameter in ACL reconstruction by directly comparing patient characteristics and cross-sectional area (CSA) measurement of the semitendinosus and gracilis tendon on magnetic resonance imaging (MRI). Fifty-three patients with a primary ACL reconstruction with a four-stranded HT autograft were included in this study. Preoperatively we recorded length, weight, thigh circumference, gender, age, preinjury Tegner activity score, and CSA of the semitendinosus and gracilis tendon on MRI. Total CSA on MRI, weight, height, gender, and thig...
Source: Journal of Knee Surgery - October 21, 2019 Category: Orthopaedics Authors: Heijboer, Willem M.P. Suijkerbuijk, Mathijs A.M. van Meer, Belle L. Bakker, Eric W.P. Meuffels, Duncan E. Tags: Original Article Source Type: research

The Effect of ACL Reconstruction on Involved and Contralateral Limb Vastus Lateralis Morphology and Histology: A Pilot Study
J Knee Surg DOI: 10.1055/s-0039-1697899Quadriceps muscle weakness is a commonly reported issue post anterior cruciate ligament reconstruction (ACLR), with minimal information related to skeletal muscle morphology following surgery. The purpose is to examine the morphological and functional differences in the vastus lateralis muscle from patient's ACLR and contralateral leg. Three physically active ACLR participants were recruited and secured to a dynamometer to perform maximal voluntary isometric knee extension contractions (MVIC) of the ACLR and contralateral limb. Muscle biopsies of the ACLR and contralateral vastus late...
Source: Journal of Knee Surgery - September 30, 2019 Category: Orthopaedics Authors: Leszczynski, Eric C. Kuenze, Christopher Brazier, Brett Visker, Joseph Ferguson, David P. Tags: Original Article Source Type: research

A Comparison of Mobile- and Fixed-Bearing Unicompartmental Knee Arthroplasties in the Treatment of Medial Knee Osteoarthritis: A Systematic Review and Meta-analysis of 1,861 Patients
J Knee Surg DOI: 10.1055/s-0039-1697901Many studies have compared mobile-bearing (MB) and fixed-bearing (FB) unicompartmental knee arthroplasties (UKAs) in patients with unicompartmental knee osteoarthritis (OA). The present systematic review and meta-analysis examined the differences in the clinical and radiological outcomes of MB UKA and FB UKA. PubMed, EMBASE, and Cochrane databases, as well as Google Scholar were searched for relevant studies. Randomized controlled trials (RCTs) and cohort studies that compared MB UKA and FB UKA were included. The weighted mean difference in the knee scores and range of motion (ROM) as...
Source: Journal of Knee Surgery - September 30, 2019 Category: Orthopaedics Authors: Huang, Fei Wu, Dan Chang, Jun Zhang, Chi Qin, Kunpeng Liao, Faxue Yin, Zongsheng Tags: Original Article Source Type: research

Results of Using a “2-in-1” Single-Stage Revision Total Knee Arthroplasty for Infection with Associated Bone Loss: Prospective 2-Year Follow-Up
Conclusion The use of “2-in-1” single-stage revision can be considered as an effective option for treating infection following TKR and associated bone loss. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - September 30, 2019 Category: Orthopaedics Authors: Holland, George Brown, Gavin Goudie, Stuart Brenkel, Ivan Walmsley, Philip J. Tags: Original Article Source Type: research

The REVision Using Imaging to Guide Staging and Evaluation (REVISE) in ACL Reconstruction Classification
J Knee Surg DOI: 10.1055/s-0039-1697902Revision anterior cruciate ligament (ACL) procedures are increasing in incidence and possess markedly inferior clinical outcomes (76% satisfaction) and return-to-sports (57%) rates than their primary counterparts. Given their complexity, a universal language is required to identify and communicate the technical challenges faced with revision procedures and guide treatment strategies. The proposed REVision using Imaging to guide Staging and Evaluation (REVISE) ACL (anterior cruciate ligament) Classification can serve as a foundation for this universal language that is feasible and prac...
Source: Journal of Knee Surgery - September 30, 2019 Category: Orthopaedics Authors: de SA, Darren Crum, Raphael J. Rabuck, Stephen Ayeni, Olufemi Bedi, Asheesh Baraga, Michael Getgood, Alan Kaar, Scott Kropf, Eric Mauro, Craig Peterson, Devin Vyas, Dharmesh Musahl, Volker Lesniak, Bryson P. Tags: Original Article Source Type: research

A Simple Method to Reduce the Incidence of Cyclops Lesion after Anterior Cruciate Ligament Reconstruction
J Knee Surg DOI: 10.1055/s-0039-1697625The purpose of this study is to determine the influence of debridement in and around the bone tunnels on the prevalence of cyclops lesion (CL), after anterior cruciate ligament reconstruction (ACLR) with hamstring grafts. Our hypothesis was that bone tunnel debridement during ACLR would reduce the prevalence of CL. Methods for debridement in and around the bone tunnels after tunnel drilling were standardized and applied to 38 knees undergoing double-bundle ACLR between 2011 and 2014, Group A (debridement group). Group B (nondebridement group) included 56 knees in which bone tunnel deb...
Source: Journal of Knee Surgery - September 27, 2019 Category: Orthopaedics Authors: Nagira, Keita Enokida, Makoto Hayashi, Ikuta Ishida, Koji Kanaya, Haruhisa Nagashima, Hideki Tags: Original Article Source Type: research

The Effect of Cartilage Lesion in the Lateral Compartment of the Knee on the Surgical Outcome of Medial Open-Wedge High Tibial Osteotomy
J Knee Surg DOI: 10.1055/s-0039-1697623The aim of this study was to identify the effect of cartilage lesion in the lateral compartment of the knee on the surgical outcome of medial open-wedge high tibial osteotomy (MOWHTO). A total of 172 consecutive patients who underwent MOWHTO were evaluated retrospectively. Among the patients who underwent second-look arthroscopic assessment, 30 patients with lateral compartment cartilage lesion (group 1: ≥ grade 2 cartilage lesion according to the International Cartilage Repair Society [ICRS] grading system) and 64 patients with normal or near-normal lateral compartme...
Source: Journal of Knee Surgery - September 24, 2019 Category: Orthopaedics Authors: Moon, Hyun-Soo Choi, Chong-Hyuk Jung, Min Park, Sang-Hoon Lee, Dae-Young Shin, Ju-Cheol Kim, Sung-Hwan Tags: Original Article Source Type: research

Current State of Care for Pediatric ACL Ruptures in the Netherlands: A Survey
In conclusion, this survey shows that the current state of care for pediatric ACL injuries is variable and a matter of debate in the Netherlands. Although the response rate seems low, this survey provides an overview of the opinions of specialized orthopaedic surgeons in the Netherlands. The results of this survey led to the development of the national registry for pediatric ACL in the Netherlands. The level of evidence for this study is V. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full ...
Source: Journal of Knee Surgery - September 24, 2019 Category: Orthopaedics Authors: Dietvorst, Martijn Reijman, Max van Zutven, Rein van den Bekerom, Michel P. J. Meuffels, Duncan E. Somford, Matthijs P. Janssen, Rob P. A. Tags: Original Article Source Type: research

High Medium-Term Survivorship of Cruciate-Retaining Total Knee Arthroplasties (110 Knees) for Valgus Deformity
This article is retrospective consecutive series of 110 valgus knees using CR implants with a minimum 2-year follow-up. Deformity correction was achieved using stepwise sequential soft tissue releases (iliotibial band, popliteus tendon, lateral collateral release through sliver femoral condylar osteotomy). Demographic data, range of movement, and degrees of deformity were collected. The Oxford Knee Score (OKS) was used as patients' reported outcome measure at final follow-up. One-hundred and four patients (110 knees) were included (87 females/17 males) with mean age of 68.7 years. Primary diagnosis was osteoarthritis in 85...
Source: Journal of Knee Surgery - September 18, 2019 Category: Orthopaedics Authors: Matar, Hosam E. Thangaraj, R. Saraogi, Akash Raut, Videshnandan Tags: Original Article Source Type: research

A Randomized Controlled Single-Blind Study Demonstrating Superiority of Amniotic Suspension Allograft Injection Over Hyaluronic Acid and Saline Control for Modification of Knee Osteoarthritis Symptoms
J Knee Surg DOI: 10.1055/s-0039-1696672Placental-derived tissues are a known source of anti-inflammatory and immune modulating factors. Published pilot data on amniotic suspension allograft (ASA) for the treatment of osteoarthritis (OA) demonstrated safety and trends for improved pain and function. A multicenter randomized controlled trial was designed to evaluate the efficacy of symptom modulation with ASA compared with saline and hyaluronic acid (HA) in subjects with knee OA. A total of 200 subjects were randomized 1:1:1 to ASA, HA, or saline, with subjects blinded to their allocation. Changes from baseline of patient-re...
Source: Journal of Knee Surgery - September 18, 2019 Category: Orthopaedics Authors: Farr, Jack Gomoll, Andreas H. Yanke, Adam B. Strauss, Eric J. Mowry, Katie C. Tags: Original Article Source Type: research

Narcotic-Free Perioperative Total Knee Arthroplasty: Does the Periarticular Injection Medication Make a Difference?
J Knee Surg DOI: 10.1055/s-0039-1696975Multimodal pain management strategies are critical in total knee arthroplasty (TKA). There has recently been a shift toward opioid sparing protocols, yet most publications continue to use narcotics in the perioperative period. Periarticular injections are a popular adjunct but studies regarding the optimal medications have high variability making it difficult to choose the optimal medication. The purpose of this study is to validate a perioperative, opioid-free protocol and compare two different periarticular injections without the variability in previous reports. A multimodal pain pr...
Source: Journal of Knee Surgery - September 16, 2019 Category: Orthopaedics Authors: Schneider, J. Broome, B. Keeley, D. Tags: Original Article Source Type: research

Infrapatellar Fat Pad Resection or Preservation during Total Knee Arthroplasty: A Systematic Review
J Knee Surg DOI: 10.1055/s-0039-1696692Considerations of how to improve postoperative outcomes for total knee arthroplasty (TKA) have included preservation of the infrapatellar fat pad (IPFP). Although the IPFP is commonly resected during TKA procedures, there is controversy regarding whether resection or preservation should be implemented, and how this influences outcomes. Therefore, the purpose of this systematic review was to evaluate how IPFP resection and preservation impacts postoperative flexion, pain, Insall-Salvati Ratio (ISR), Knee Society Score (KSS), patellar tendon length (PTL), and satisfaction in primary TKA...
Source: Journal of Knee Surgery - September 10, 2019 Category: Orthopaedics Authors: Yao, Benjamin Samuel, Linsen T. Acu ña, Alexander J. Faour, Mhamad Roth, Alexander Kamath, Atul F. Mont, Michael A. Tags: Original Article Source Type: research

Mid-Term Evaluation of the Unicompartmental Knee Arthroplasty in Patients with BMI of 40 or Greater
J Knee Surg DOI: 10.1055/s-0039-1696735Limited evidence is available on mid-term follow-up for patients with body mass index (BMI) ≥ 40 receiving a unicompartmental knee arthroplasty (UKA). The primary objective of this study was to investigate survival of the UKA in patients with BMI ≥ 40. Secondary objectives were to assess functional and patient reported outcome measures (PROMs). Survival analysis with endpoint revision of any component for any reason was conducted using Kaplan–Meier technique on 121 knees (103 patients) that underwent UKA with Oxford Phase 3 implant (Oxford Knee,...
Source: Journal of Knee Surgery - September 10, 2019 Category: Orthopaedics Authors: Seth, Akshay Dobransky, Johanna Albishi, Waleed Dervin, Geoffrey F. Tags: Original Article Source Type: research

Revision of a Medial UKA to a Kinematic Aligned TKA: Comparison of Operative Complexity, Postoperative Alignment, and Outcome Scores to a Primary TKA
J Knee Surg DOI: 10.1055/s-0039-1696734Revision of a medial unicompartmental knee arthroplasty (UKA) to a mechanically aligned total knee arthroplasty (MA TKA) is inferior to a primary TKA; however, revision with kinematic alignment (KA) has not been well studied. The present study determined whether patients revised with KA had a higher use of revision components, different postoperative alignment, and different clinical outcome scores from patients with a primary KA TKA. From 2006 to 2017, all patients suitable for a revision of a failed medial UKA to a TKA and a primary TKA were treated with KA. Reasons for the revision...
Source: Journal of Knee Surgery - September 9, 2019 Category: Orthopaedics Authors: Shelton, Trevor J. Gill, Manpreet Athwal, Gurbir Howell, Stephen M. Hull, Maury L. Tags: Original Article Source Type: research

Total Knee Arthroplasty among Medicare Beneficiaries with Hemophilia A and B Is Associated with Increased Complications and Higher Costs
J Knee Surg DOI: 10.1055/s-0039-1696691Operations on patients with hemophilia A and B are complex. Studies evaluating postoperative outcomes and costs following total knee arthroplasty (TKA) in patients with hemophilia are limited. A retrospective review of the entire Medicare dataset from 2005 to 2014 was performed. International Classification of Disease 9th revision codes were used to identify patients with hemophilia A and B and they were matched to controls using a 1:1 random matching process based on age, gender, Charlson Comorbidity Index (CCI), and select comorbidity burden. The 90-day preoperative period was evalu...
Source: Journal of Knee Surgery - September 9, 2019 Category: Orthopaedics Authors: Rosas, Samuel Buller, Leonard T. Plate, Johannes Higuera, Carlos Barsoum, Wael K. Emory, Cynthia Tags: Original Article Source Type: research

In Vivo Kinematics of Bicruciate-Retaining Total Knee Arthroplasty with Anatomical Articular Surface under High-Flexion Conditions
The objective of this study was to evaluate in vivo kinematics of BCR-TKA with the anatomical articular surface during high-flexion activities. For this purpose, 17 knees after BCR-TKA with an anatomical articular surface were examined. Under fluoroscopy, each patient performed squatting and cross-legged sitting motions. To estimate the spatial position and orientation of the knee, a two-dimensional or three-dimensional registration technique was used. Rotation, varus-valgus angle, and anteroposterior translation of medial and lateral contact points of the femoral component relative to the tibial component were evaluated i...
Source: Journal of Knee Surgery - September 9, 2019 Category: Orthopaedics Authors: Kono, Kenichi Inui, Hiroshi Tomita, Tetsuya Yamazaki, Takaharu Taketomi, Shuji Tanaka, Sakae Tags: Original Article Source Type: research

Influence of Variation in Sagittal Placement of the Femoral Component after Cruciate-Retaining Total-Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1696958Prosthetic alignment is an important factor for long-term survival in cruciate-retaining (CR) total knee arthroplasty (TKA). The purpose of this study is to investigate the influence of sagittal placement of the femoral component on tibiofemoral (TF) kinematics and kinetics in CR-TKA. Five sagittal placements of femoral component models with −3, 0, 3, 5, and 7 degrees of flexion are developed. The TF joint kinematics, quadriceps force, patellofemoral contact force, and posterior cruciate ligament force are evaluated using the models under deep knee-bend loading. The kinematics o...
Source: Journal of Knee Surgery - September 9, 2019 Category: Orthopaedics Authors: Koh, Yong-Gon Hong, Hyoung-Taek Lee, Hwa-Yong Kim, Hyo-Jeong Kang, Kyoung-Tak Tags: Original Article Source Type: research

First Comparative Study of the Effectiveness of the Use of Tranexamic Acid against ε-Aminocapróic Acid via the Oral Route for the Reduction of Postoperative Bleeding in TKA: A Clinical Trial
J Knee Surg DOI: 10.1055/s-0039-1696722Total primary knee replacement results in significant postoperative bleeding. There are reports that 20 to 50% of the patients require a blood transfusion, which has been related to many complications, resulting in the search for strategies to reduce bleeding. The use of oral antifibrinolytics is becoming a low cost and safe way of achieving this goal. The hypothesis of this study was that the use of oral aminocaproic acid could provide similar results to the use of oral tranexamic acid (TXA). The purpose was to compare the effects of oral aminocaproic acid as a hemostatic agent versu...
Source: Journal of Knee Surgery - September 6, 2019 Category: Orthopaedics Authors: Morales-Avalos, Rodolfo Ramos-Morales, Tomas Espinoza-Galindo, Ana Mar ía Garay-Mendoza, Domingo Pe ña-Martínez, Víctor M. Marfil-Rivera, Luis Javier Garza-Oca ñas, Lourdes Acosta-Olivo, Carlos Cerda-Barbosa, Jessica K. Vald és-González, Nancy L. V Tags: Original Article Source Type: research

Annual Nationwide Infection Trends for Revision Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1696690Several recent intraoperative and wound management techniques have been developed and implemented in the United States over the past decade; however, it is unclear what the effects of these newer modalities have on reducing surgical site infection (SSI) rates. Therefore, the purpose of this study was to track the annual rate and trends of (1) overall, (2) deep, and (3) superficial SSIs following revision total knee arthroplasty (TKA). The National Surgical Quality Improvement Program database was queried for all revision TKA cases performed between 2011 and 2016, which yielded 9,887 c...
Source: Journal of Knee Surgery - September 6, 2019 Category: Orthopaedics Authors: Gold, Peter Garbarino, Luke J. Sodhi, Nipun Anis, Hiba K. Ehiorobo, Joseph O. Kurtz, Steven M. Danoff, Jonathan R. Rasquinha, Vijay R. Higuera, Carlos A. Mont, Michael A. Tags: Original Article Source Type: research

Timing for Safe Return to Sport after Medial Patellofemoral Ligament Reconstruction: The Role of a Functional Test Battery
J Knee Surg DOI: 10.1055/s-0039-1696647The purpose of this article was to analyze clinical and functional results after medial patellofemoral ligament (MPFL) reconstruction and to establish if a computer-assisted physical test battery could determine a “safe timing” to return to sport. We hypothesized that “time-based” criteria to declare safe return to sport could not be reliable to predict functional recover. Fifty-eight young athletic patients were selected after isolated reconstruction of MPFL. The minimum follow-up was 8 months. All the patients were evaluated subjectively with Kujala an...
Source: Journal of Knee Surgery - September 4, 2019 Category: Orthopaedics Authors: Matassi, Fabrizio Innocenti, Matteo Andrea, Cozzi Lepri Zanna, Luigi Malone, Joseph Civinini, Roberto Innocenti, Massimo Tags: Original Article Source Type: research

Evaluation of the Asymmetry of Leg Muscles Forces in the Subjects with Anterior Cruciate Ligament Reconstruction
J Knee Surg DOI: 10.1055/s-0039-1695703Running asymmetry has not been assessed among patients with anterior cruciate ligament (ACL) deficiency. The aim of this study was to evaluate the spatiotemporal and muscle force asymmetry indexes in the subjects with ACL reconstruction (ACLR) compared with normal subjects. Eight individuals with a reconstructed ACL and eight individuals with intact ACLs were participated in this study. A Vicon motion analysis system and two Kistler force plates were used to record data. Muscle forces analysis was done by the use of OpenSim software. The results of this study showed that ACLR group ha...
Source: Journal of Knee Surgery - September 2, 2019 Category: Orthopaedics Authors: Sharifmoradi, Keyvan Karimi, Mohammad Taghi Hoseini, Yasin Tags: Original Article Source Type: research

Health Care Utilization and Payer Cost Analysis of Robotic Arm Assisted Total Knee Arthroplasty at 30, 60, and 90 Days
This study performed a health care utilization analysis between robotic arm assisted total knee arthroplasty (rTKA) and manual total knee arthroplasty (mTKA) techniques. Specifically, we compared (1) index costs and (2) discharge dispositions, as well as (3) 30-day (4) 60-day, and (5) 90-day (a) episode-of-care costs, (b) postoperative health care utilization, and (c) readmissions. The 100% Medicare Standard Analytical Files were used for rTKAs and mTKAs performed between January 1, 2016, and March 31, 2017. Based on strict inclusion–exclusion criteria and 1:5 propensity score matching, 519 rTKA and 2,595&thin...
Source: Journal of Knee Surgery - September 2, 2019 Category: Orthopaedics Authors: Mont, Michael A. Cool, Christina Gregory, David Coppolecchia, Andrea Sodhi, Nipun Jacofsky, David J. Tags: Original Article Source Type: research

Dual Antibiotic Prophylaxis in Total Knee Arthroplasty: Where Do We Stand?
J Knee Surg DOI: 10.1055/s-0039-1695742The risk of surgical site infection in primary total knee arthroplasty (TKA) has been reduced with the use of prophylactic antibiotics. First or second generation cephalosporins are still recommended as the primary prophylactic choice, but with the rise in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections, evidence has emerged in favor of using dual antibiotics including vancomycin. However, it is unclear whether these combinations of antibiotic regimens further reduce postoperative infection rates. As a result, the objective of this review is to summarize...
Source: Journal of Knee Surgery - August 30, 2019 Category: Orthopaedics Authors: Villa, Jesus M. Pannu, Tejbir S. Riesgo, Aldo M. Patel, Preetesh D. Mont, Michael A. Higuera-Rueda, Carlos A. Tags: Special Focus Section Source Type: research

Patellar Impingement on Tibial Polyethylene after Primary Total Knee Arthroplasty without Patellar Resurfacing
J Knee Surg DOI: 10.1055/s-0039-1695704Patellar impingement on tibial polyethylene (PIP) is one potential complication of total knee arthroplasty (TKA). When PIP occurs, it is often related to inaccurate restoration of the joint line or due to soft-tissue contracture. We investigated the prevalence and etiology of PIP in Asian patients with deeply flexed knees following posterior stabilized (PS)-TKA. We retrospectively reviewed 54 patients (65 knees) with PIP after primary PS-TKAs without patellar resurfacing performed between 2008 and 2011. These patients were compared with a group of 124 patients (130 knees) without PIP ...
Source: Journal of Knee Surgery - August 30, 2019 Category: Orthopaedics Authors: Hwang, Bo-Hyun Jung, Kwang-Am Ong, Alvin Ahn, Hye-Sun Moon, Seong-Hwan Lee, Su-Chan Tags: Original Article Source Type: research

Greater Blood Loss in Contemporary Cementless Total Knee Arthroplasty than Cemented Total Knee Arthroplasty despite Tranexamic Acid Use: A Match-Controlled Retrospective Study
J Knee Surg DOI: 10.1055/s-0039-1695796The purpose of this retrospective study was to assess whether tranexamic acid (TXA) reduces blood loss in cementless total knee arthroplasty (TKA) comparable to levels observed with cemented fixation. After exclusions from 109 consecutive TKAs, 76 cementless knees were matched to 78 cemented knees of identical implant and surgeon. Blood loss with and without TXA was compared. There was no difference between cohorts in sex, age, body mass index, American Society of Anesthesiologists Physical Status classification, or preoperative hemoglobin (p ≥ 0.119). Use of TXA reduced median dra...
Source: Journal of Knee Surgery - August 30, 2019 Category: Orthopaedics Authors: Hood, Mark Dilley, Julian E. Ziemba-Davis, Mary Meneghini, R. Michael Tags: Original Article Source Type: research

Impact of Chronic Obstructive Pulmonary Disease on Postoperative Complications Following Simultaneous Bilateral Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1695766For patients who qualify, simultaneous bilateral total knee arthroplasty (TKA) is a viable option for the treatment of bilateral symptoms. However, the incidence of chronic obstructive pulmonary disease (COPD) has been steadily rising over the past few decades and may impact those who qualify as candidates for bilateral TKA. As such, the aim of this study was to determine the impact of COPD on postoperative outcomes in patients who receive simultaneous bilateral TKA. A retrospective cohort study was conducted utilizing data provided through the American College of Surgeons National Su...
Source: Journal of Knee Surgery - August 30, 2019 Category: Orthopaedics Authors: Gu, Alex Wu, Shitong Mancino, Fabio Liu, Jiabin Ast, Michael P. Abdel, Matthew P. Sculco, Peter K. Tags: Original Article Source Type: research

Meta-analysis Comparing Allograft to Synthetic Reconstruction for Extensor Mechanism Disruption after Total Knee Arthroplasty
This study aims to compare both allograft and synthetic reconstructive techniques for success, reoperation, and infection rates and functional outcomes. The search on PubMed, MEDLINE, Embase, BIOSIS, and Cochrane databases was performed on March 15, 2019, using the following keyword groups: (1) “extensor mechanism” and “total knee arthroplasty,” (2) “extensor mechanism” and “knee arthroplasty,” (3) “extensor mechanism” and “revision total knee arthroplasty,” and (4) “extensor mechanism” and “revision knee arthroplasty”. Only stu...
Source: Journal of Knee Surgery - August 30, 2019 Category: Orthopaedics Authors: Deren, Matthew E. Pannu, Tejbir S. Villa, Jesus M. Firtha, Michael Riesgo, Aldo M. Higuera, Carlos A. Tags: Original Article Source Type: research

Patellar Bone –Tendon–Bone Autografts versus Quadriceps Tendon Allograft with Synthetic Augmentation in a Canine Model
J Knee Surg DOI: 10.1055/s-0039-1695040Patellar bone–tendon–bone (pBTB) autografts are often considered the “gold standard” for complete anterior cruciate ligament (ACL) reconstruction and are also associated with significant complications and early-onset knee osteoarthritis (OA). A novel quadriceps tendon allograft with synthetic augmentation, or “internal brace” (QTIB), has been reported to have potential advantages for ACL reconstruction based on animal model data. In this preclinical canine comparison study, we hypothesized that QTIB allograft compared with pBTB autograft would provi...
Source: Journal of Knee Surgery - August 28, 2019 Category: Orthopaedics Authors: Smith, Patrick A. Stannard, James P. Bozynski, Chantelle C. Kuroki, Keiichi Cook, Cristi R. Cook, James L. Tags: Original Article Source Type: research

A History of Past Prostate Cancer Still Carries Risk After Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1695706Prostate cancer (PCa) is one of the most prevalent diseases in the North American elderly population. Moreover, many patients undergo prostate resection without further treatment and are often considered cured. As such, it is expected that many undergo total knee arthroplasty (TKA) for osteoarthritis while having a history of PCa. Nonetheless, limited research is available on this topic, and without it, surgeons may not be aware of increased complication rates. Therefore, the purpose of this study was to evaluate whether patients at a national level with a history of PCa are at increa...
Source: Journal of Knee Surgery - August 28, 2019 Category: Orthopaedics Authors: Rosas, Samuel Tipton, Shane Luo, T. David Kerr, Bethany A. Plate, Johannes F. Willey, Jeffrey S. Emory, Cynthia L. Tags: Original Article Source Type: research

The Impact of Resident Involvement on Surgical Outcomes following Anterior Cruciate Ligament Reconstruction
This study aims to assess the effect of resident involvement on short-term outcomes following anterior cruciate ligament reconstruction (ACLR). The National Surgical Quality Improvement Program (NSQIP) database was queried to identify all patients who underwent ACLR from 2005 to 2012. Demographic variables, resident participation, 30-day complications, and intraoperative time parameters were assessed for all cases. Resident and nonresident cases were matched using propensity scores. Outcomes were analyzed using univariate and multivariate regression analyses, as well as stratified by resident level of training. Univariate ...
Source: Journal of Knee Surgery - August 28, 2019 Category: Orthopaedics Authors: Lebedeva, Kate Bryant, Dianne Docter, Shgufta Litchfield, Robert B. Getgood, Alan Degen, Ryan M. Tags: Original Article Source Type: research

Predictors of Meniscal Allograft Transplantation Outcome: A Systematic Review
J Knee Surg DOI: 10.1055/s-0039-1695043This systematic review investigates factors associated with outcomes after meniscal allograft transplantation (MAT). The PubMed, Scopus, and Cochrane Central Register databases were used to search relevant articles in April 2018. Studies that evaluated at least one association between a factor and outcomes were extracted. Of 3,381 titles, 52 studies were finally analyzed. Data about predictors, patient-reported outcome scores (PROMs), and failure rates were extracted for quantitative and qualitative analysis. A total of 3,382 patients and 3,460 transplants were identified. Thirty diff...
Source: Journal of Knee Surgery - August 28, 2019 Category: Orthopaedics Authors: Fanelli, Daniele Mercurio, Michele Gasparini, Giorgio Galasso, Olimpio Tags: Original Article Source Type: research

Cost Analysis of Medicare Patients with Varying Complexities Who Underwent Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1695716The effort to reduce overall healthcare costs may affect more complex patients, as their pre- and postoperative care can be substantially involved. Therefore, the purpose of this study was to use a large nationwide insurance database to compare (1) costs, (2) reimbursements, and (3) net losses of 90-day episodes of care (EOC) for total knee arthroplasty (TKA) patients according to Elixhauser's comorbidity index (ECI) scores. All TKAs performed between 2005 and 2014 in the Medicare Standard Analytic Files were extracted from the database and stratified based on ECI scores, ranging from...
Source: Journal of Knee Surgery - August 28, 2019 Category: Orthopaedics Authors: Anis, Hiba K. Sodhi, Nipun Vakharia, Rushabh M. Scuderi, Giles R. Malkani, Arthur L. Roche, Martin W. Mont, Michael A. Tags: Original Article Source Type: research

Six-Dose Intravenous Tranexamic Acid Regimen Further Inhibits Postoperative Fibrinolysis and Reduces Hidden Blood Loss Following Total Knee Arthroplasty
This study aimed to assess the effect of six-dose IV-TXA with the total dosage more than 6 g on postoperative fibrinolysis and hidden blood loss (HBL) after primary TKA. A total of 175 patients were randomized into three groups to receive placebo (group A), or a single preoperative dose of 20 mg/kg IV-TXA (group B), or six-dose IV-TXA from the beginning of the procedure to subsequent 24 hours with the total dosage more than 6 g (group C). The calculated HBL, maximum hemoglobin (Hb) drop, transfusion rate, and the incidence of thromboembolic events were compared among groups. The levels of fibrin...
Source: Journal of Knee Surgery - August 21, 2019 Category: Orthopaedics Authors: Zhang, Shaoyun Xie, Jinwei Cao, Guorui Lei, Yiting Huang, Qiang Pei, Fuxing Tags: Original Article Source Type: research

Short-Term Outcomes of Synovectomy and Total Knee Replacement in Patients with Diffuse-Type Pigmented Villonodular Synovitis
J Knee Surg DOI: 10.1055/s-0039-1694736Diffuse-type pigmented villonodular synovitis is a rare benign disease that causes disorders of the knee, including erosion of subchondral bone and cyst formation, with eventual osteoarthritis. The purpose of this study was to evaluate the short-term outcomes of synovectomy and total knee replacement in patients with the diffuse type of pigmented villonodular synovitis. From November 2011 to May 2015, we performed synovectomy and total knee replacement in 28 patients with diffuse pigmented villonodular synovitis diagnosed on the basis of histopathology of biopsy specimens. Clinical da...
Source: Journal of Knee Surgery - August 21, 2019 Category: Orthopaedics Authors: Su, Weiping Zhou, Yangying Lu, Wei Zeng, Min Hu, Yihe Xie, Jie Tags: Original Article Source Type: research

Nonoperative Management of Minimally Displaced Patellar Sleeve Fractures
J Knee Surg DOI: 10.1055/s-0039-1694742Patellar sleeve fractures primarily occur in the adolescent population from a rapid contraction of the quadriceps with the knee in a flexed position. Several small case reports describe operative reduction and fixation for displaced fractures. However, there is sparse literature on nonoperative management of these injuries. Retrospective review and prospective follow-up of all patients diagnosed with patellar sleeve fracture between 1991 and 2014 at a single institution. Patients with superior pole avulsion fractures, history of prior knee surgery, and fractures managed operatively we...
Source: Journal of Knee Surgery - August 21, 2019 Category: Orthopaedics Authors: Sousa, Paul L. Stuart, Michael J. Prince, Matthew R. Dahm, Diane L. Tags: Original Article Source Type: research

Femoral Cementation in Knee Arthroplasty —A Comparison of Three Cementing Techniques in a Sawbone Model Using the ATTUNE Knee
J Knee Surg DOI: 10.1055/s-0039-1694795Femoral component loosening is a rare but severe complication in total knee arthroplasty. Former studies have repeatedly demonstrated radiolucent lines behind the ventral and dorsal anchoring shields of the femoral components, which has led us to investigate this matter further. Therefore, three different cementing techniques were tested in a group of nine Sawbone samples each. These differed in the amount of cement applied on the femoral component as well as in the pressure application. Computed tomography was performed to evaluate and classify the cement penetration into the bone ad...
Source: Journal of Knee Surgery - August 21, 2019 Category: Orthopaedics Authors: Schwarze, M. Schonhoff, M. Beckmann, N. A. Eckert, J. A. Bitsch, R. G. J äger, S. Tags: Original Article Source Type: research

Patch Test Results and Outcome in Patients with Complications from Total Knee Arthroplasty: A Consecutive Case Series
The objectives of our study were to (1) establish the prevalence of hypersensitivity to components of knee prostheses in patients referred to our contact dermatitis clinic, (2) determine if patients with post-surgery dermatitis have become sensitized, and (3) describe the outcome of patients with and without hypersensitivity. We reviewed the charts of patients referred from 2007 to 2018 and extracted demographic information, date, type, and site of implant, clinical presentation, and results of patch testing (PT) or lymphocyte transformation tests (LTT). We called most patients to gather data such as clinical outcome, natu...
Source: Journal of Knee Surgery - August 21, 2019 Category: Orthopaedics Authors: Sasseville, Denis Alfalah, Khuzama Savin, Evgeny Tags: Original Article Source Type: research

Anatomical Medial Patellofemoral Ligament Reconstruction for Recurrent Patella Dislocation: Two-Strand Grafts versus Four-Strand Grafts
J Knee Surg DOI: 10.1055/s-0039-1694039The purpose of this study was to describe two anatomical medial patellofemoral ligament (MPFL) reconstruction methods: reconstruction with two-strand grafts and reconstruction with four-strand grafts and to evaluate the clinical and radiological results. From January 2010 to January 2013, patients who sustained recurrent patella dislocation and met inclusion criteria were included in the study and divided into two groups randomly to undergo MPFL reconstruction either by two-strand grafts (T group) or four-strand grafts (F group). Patients were followed up 1 month, 1 year...
Source: Journal of Knee Surgery - August 21, 2019 Category: Orthopaedics Authors: Niu, Jinghui Lin, Wei Qi, Qi Lu, Jiangfeng Dai, Yike Wang, Fei Tags: Original Article Source Type: research

Evaluation of Knee Cartilage Diurnal, Activity, and BMI-Related Variations Using Quantitative T2 Mapping MRI and Fitbit Activity Tracking
J Knee Surg DOI: 10.1055/s-0039-1695000The aim of this study is to evaluate diurnal variation in knee cartilage 3 Tesla magnetic resonance imaging (MRI) T2 mapping relaxation times, as well as activity- and body mass index (BMI)-dependent variability, using quantitative analysis of T2 values from segmented regions of the weight-bearing articular surfaces of the medial and lateral femoral condyles and tibial plateaus. Ten healthy volunteers' daily activity (steps) were tracked with Fitbit pedometers. Sagittal MRI T2 maps were obtained in the morning and afternoon on days 2 and 3. Mean T2 values were analyzed for vari...
Source: Journal of Knee Surgery - August 21, 2019 Category: Orthopaedics Authors: Matcuk, George R. Jones, Ian A. McIntyre, J. Alex Burt, Robert Hwang, Darryl Cen, Steven Schein, Aaron J. Vangsness, C. Thomas Tags: Original Article Source Type: research

Kinematically Aligned TKA Aligns the Ankle Joint Line Closer to Those of the Native Ankle than Mechanically Aligned TKA in Bipedal Stance
In this study, we examined results from KATKA and MATKA to determine which surgery restores the ankle joint orientation closer to the native ankle joint in bipedal stance and hypothesized that KATKA, rather than MATKA, would be more effective. Data from long-leg standing radiographs of 60 healthy adults (control group, n = 120 knees), patients who underwent MATKA (n = 90 knees), and patients who underwent KATKA (n = 90 knees) were retrospectively reviewed. The hip–knee–ankle angle, orientation of the tibial plafond and the talar dome relative to the ground (G-plafond an...
Source: Journal of Knee Surgery - August 21, 2019 Category: Orthopaedics Authors: Kim, Jung-Taek Han, Jun Lim, Sumin Shen, Quan Hu Won, Ye Yeon Tags: Original Article Source Type: research

Obesity and Meniscal Transplant Failure: A Retrospective Cohort Study
In this study, a BMI ≥ 30 kg/m2 resulted in higher MAT failure rates. Nonobese patients had better knee functional results compared with obese individuals. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - August 21, 2019 Category: Orthopaedics Authors: Jim énez-Garrido, Carlos G ómez-Cáceres, Abel Espejo-Reina, Mar ía Josefa Espejo-Reina, Alejandro Tamimi, Iskandar Serrano-Fern ández, José Miguel Dalla Rosa-Nogales, Jaime Espejo-Baena, Alejandro Tags: Original Article Source Type: research

Sealing the Intramedullary Femoral Canal for Blood Loss in Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trials
J Knee Surg DOI: 10.1055/s-0039-1694025Blood loss after total knee arthroplasty (TKA) is a potentially serious medical problem since it leads to anemia, increased need for transfusion, and prolonged hospitalization. Some studies have reported that sealing of the intramedullary femoral canal during TKA may decrease postoperative blood loss. The purpose of this study is to determine the effects of sealing of the intramedullary femoral canal during TKA on blood loss and transfusion rate. Electronic databases, PubMed, EMBASE, the Cochrane Library, Web of Science, and Chinese Biomedical Database, were systematically searched. O...
Source: Journal of Knee Surgery - August 8, 2019 Category: Orthopaedics Authors: Wang, Keping Yuan, Wenhua An, Jiangdong Cheng, Peng Song, Pengjie Li, Shaolong Jiang, Jin Zhou, Haiyu Tags: Original Article Source Type: research

Primary Stability in Cementless Rotating Platform Total Knee Arthroplasty
This study was designed to evaluate the effect of porous ingrowth surface on primary stability in the implanted cementless tibial component. Three tibial tray designs possessing sintered bead or roughened porous coating ingrowth surfaces were implanted into a foam tibia model with primary stability assessed via digital image correlation during stair descent and condylar liftoff loading. Follow-up testing was conducted by implanting matched-pair cadaveric tibias with otherwise identical trays with two iterations of ingrowth surface design. Trays were loaded and micromotion evaluated in a condylar liftoff model. The sintered...
Source: Journal of Knee Surgery - August 8, 2019 Category: Orthopaedics Authors: Small, Scott R. Rogge, Renee D. Reyes, Eric M. Seale, Ryan B. Elliott, Jeffrey B. Malinzak, Robert A. Tags: Original Article Source Type: research

Neutrophil –Lymphocyte Ratio as a Predictor of Venous Thromboembolism after Total Knee Replacement
This study was performed to investigate the precise incidence of postoperative VTE and the role of NLR for predicting VTE in patients receiving thromboprophylaxis after TKR. We retrospectively enrolled 264 patients undergoing TKR who underwent routine screening enhanced pulmonary artery and lower extremity venography computed tomography (CT) scan within 7 postoperative days. Biochemical tests were performed within 2 weeks prior to surgery, and the NLR was defined as the absolute neutrophil count in peripheral blood divided by lymphocyte count. All patients received thromboprophylaxis with enoxaparin postoperatively....
Source: Journal of Knee Surgery - August 8, 2019 Category: Orthopaedics Authors: Seo, Won-Woo Park, Myung-Soo Kim, Sung Eun Lee, Jun-Hee Park, Dae-Gyun Han, Kyoo-Rok Oh, Dong-Jin Hyon, Min-Su Tags: Original Article Source Type: research

Objective Measurement of Medial Joint Space Widening with Percutaneous “Pie Crust” Release of Medial Collateral Ligament during Knee Arthroscopy
J Knee Surg DOI: 10.1055/s-0039-1694711Knee arthroscopy may be called the most commonly and increasingly performed orthopaedic procedure. Posterior medial compartment visualization may be quite challenging. The aim of the present study is to detect objective measurement of medial joint space widening with percutaneous “pie crust” release of medial collateral ligament (MCL) during knee arthroscopy. We used this technique for all knees that require any intervention in the posteromedial compartment and for tight knees in which adequate visualization of the posteromedial compartment cannot be obtained. Eighteen pat...
Source: Journal of Knee Surgery - August 8, 2019 Category: Orthopaedics Authors: Polat, Bar ış Ayd ın, Deniz Polat, Ay şe Esin G ürpınar, Tahsin Sar ı, Enes Özmanevra, Ramadan Yal çınozan, Mehmet Erler, Kaan Tags: Original Article Source Type: research