Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: 2014 Knee Society Proceedings 30 articles


A New Method for Calculating Femoral Anterior Cortex Point Location and Its Effect on Component Sizing and Placement

Mohamed R. Mahfouz PhD, Emam ElHak Abdel Fatah PhD, Lyndsay Bowers MSc, Giles Scuderi MD

Variation in anterior femoral cortex morphology can cause improper component placement and alignment. When surgical inaccuracies occur, the mechanical properties of the distal femur may be altered, which could result in lower surgical success rates and an increased chance of postoperative complications.

Infrapatellar Saphenous Neuralgia After TKA Can Be Improved With Ultrasound-guided Local Treatments

Steven Clendenen MD, Roy Greengrass MD, Joseph Whalen MD, PhD, Mary I. O’Connor MD

Current opinion suggests that in some patients, chronic pain after total knee arthroplasty (TKA) has a neuropathic origin. Injury to the infrapatellar branch of the saphenous nerve (IPSN) has been implicated as a cause of medial knee pain; however, local treatments for this condition remain controversial.

Systematic Review of Patient-specific Instrumentation in Total Knee Arthroplasty: New but Not Improved

Adam Sassoon MD, Denis Nam MD, Ryan Nunley MD, Robert Barrack MD

Patient-specific cutting blocks have been touted as a more efficient and reliable means of achieving neutral mechanical alignment during TKA with the proposed downstream effect of improved clinical outcomes. However, it is not clear to what degree published studies support these assumptions.

Correlation of Knee and Hindfoot Deformities in Advanced Knee OA: Compensatory Hindfoot Alignment and Where It Occurs

Adam A. Norton BA, John J. Callaghan MD, Annunziato Amendola MD, Phinit Phisitkul MD, Siwadol Wongsak MD, Steve S. Liu MD, Catherine Fruehling-Wall BA

Many patients undergoing TKA have both knee and ankle pathology, and it seems likely that some compensatory changes occur at each joint in response to deformity at the other. However, it is not fully understood how the foot and ankle compensate for a given varus or valgus deformity of the knee.

How Do Knee Implants Perform Past the Second Decade? Nineteen- to 25-year Followup of the Press-fit Condylar Design TKA

Shantanu Patil MD, Julie C. McCauley MPHc, Pamela Pulido BSN, Clifford W. Colwell MD

At 14- to 17-year followup, we reported successful outcomes of the Press-fit Condylar total knee arthroplasty (TKA) system in 160 TKAs performed between 1986 and 1989. However, there are few published reports on TKA survivorship and patient function that include patients evaluated into the third decade after surgery.

How Precise Is Computer-navigated Gap Assessment in TKA?

James B. Stiehl MD, David A. Heck MD

Methods to improve gap balancing in total knee arthroplasty (TKA) include the development of calibrated distractors and various devices to determine the distances of the gaps. However, few studies have validated the accuracy or precision of computer navigation to determine these measurements, especially gaps created after bone cuts have been made; doing so would be important, because optimal surgical technique relies on appropriate gap spacing.

Do Various Factors Affect the Frequency of Manipulation Under Anesthesia After Primary Total Knee Arthroplasty?

Kimona Issa MD, Aiman Rifai MD, Matthew R. Boylan ScB, Sina Pourtaheri MD, Vincent K. McInerney MD, Michael A. Mont MD

One of the most important goals of primary total knee arthroplasty (TKA) is to achieve a functional range of motion (ROM). However, up to 20% of patients fail to do so, which can impair activities of daily living.

What Is the Role of Mental Health in Primary Total Knee Arthroplasty?

Carlos J. Lavernia MD, Jesus M. Villa MD, David A. Iacobelli MD

Psychological distress has been associated with inferior scores for pain after total knee arthroplasty (TKA). However, its relationships with scores and arthrofibrosis after TKA remain unclear.

High Degree of Accuracy of a Novel Image-free Handheld Robot for Unicondylar Knee Arthroplasty in a Cadaveric Study

Jess H. Lonner MD, Julie R. Smith PhD, Frederic Picard MD, Brian Hamlin MD, Philip J. Rowe PhD, Philip E. Riches PhD

Surgical robotics has been shown to improve the accuracy of bone preparation and soft tissue balance in unicondylar knee arthroplasty (UKA). However, although extensive data have emerged with regard to a CT scan-based haptically constrained robotic arm, little is known about the accuracy of a newer alternative, an imageless robotic system.

Cruciate-retaining TKA Is an Option in Patients With Prior Patellectomy

Keith R. Reinhardt MD, Stephen J. Huffaker MD, PhD, Thomas S. Thornhill MD, Richard D. Scott MD

The recommendation for using posterior-stabilized (PS) implants in patellectomy patients undergoing total knee arthroplasty (TKA) is based on older case series with heterogeneous patient populations. The use of cruciate-retaining implants in these patients has not been evaluated with more contemporary implant designs.

Perioperative Morbidity and Mortality of Same-admission Staged Bilateral TKA

Lazaros A. Poultsides MD, Stavros G. Memtsoudis MD, Huong T. Do MA, Thomas P. Sculco MD, Mark P. Figgie MD

Controversy continues regarding the optimal timing of surgery for patients with symptomatic bilateral degenerative knee arthritis who are not considered eligible for same-day bilateral TKA (BTKA).

Are Revisions of Patellofemoral Arthroplasties More Like Primary or Revision TKAs

Sébastien Parratte MD, PhD, Alexandre Lunebourg MD, Matthieu Ollivier MD, Matthew P. Abdel MD, Jean-Noël A. Argenson MD, PhD

Patellofemoral arthroplasty (PFA) can be considered in patients with patellofemoral disease. However, the use of partial arthroplasty often causes concern among clinicians and patients that revision to total knee arthroplasty (TKA) will be needed and, if so, whether this revision will be straightforward or more complicated.

What Can Be Learned From Minimum 20-year Followup Studies of Knee Arthroplasty?

John J. Callaghan MD, Christopher T. Martin MD, Yubo Gao PhD, Andrew J. Pugely MD, Steve S. Liu MD, Devon D. Goetz MD, Scott S. Kelley MD, Richard C. Johnston MD

Long-term evaluation of knee arthroplasty should provide relevant information concerning the durability and performance of the implant and the procedure. Because most arthroplasties are performed in older patients, most long-term followup studies have been performed in elderly cohorts and have had low patient survivorship to final followup; the degree to which attrition from patient deaths over time in these studies might influence their results has been poorly characterized.

The Alpha-defensin Test for Periprosthetic Joint Infection Outperforms the Leukocyte Esterase Test Strip

Carl Deirmengian MD, Keith Kardos PhD, Patrick Kilmartin MS, Alexander Cameron BS, Kevin Schiller BS, Robert E. Booth MD, Javad Parvizi MD, FRCS

Synovial fluid biomarkers have demonstrated diagnostic accuracy surpassing the currently used diagnostic tests for periprosthetic joint infection (PJI).

Is Single-stage Revision According to a Strict Protocol Effective in Treatment of Chronic Knee Arthroplasty Infections?

Fares Sami Haddad FRCS (Tr&O), Mohamed Sukeik MRCSEd, Sulaiman Alazzawi MRCSEd

The increasing number of patients experiencing periprosthetic total knee arthroplasty (TKA) infections and the cost of treating them suggest that we seek alternatives to two-stage revision. Single-stage revision is a potential alternative to the standard two-stage procedure because it involves only one surgical procedure, so if it is comparably effective, it would be associated with less patient morbidity and lower cost.

Preoperative Pain and Function Profiles Reflect Consistent TKA Patient Selection Among US Surgeons

David C. Ayers MD, Wenjun Li PhD, Leslie Harrold MD, MPH, Jeroan Allison MD, MS, Patricia D. Franklin MD, MBA, MPH

As the number of primary total knee arthroplasties (TKAs) performed in the United States increases, policymakers have questioned whether the indications and timing of TKA have evolved so that surgery is offered earlier.

New Total Knee Arthroplasty Designs: Do Young Patients Notice?

Ryan M. Nunley MD, Denis Nam MD, Keith R. Berend MD, Adolph V. Lombardi MD, Douglas A. Dennis MD, Craig J. Della Valle MD, Robert L. Barrack MD

Although the volume of total knee arthroplasties (TKAs) performed in the United States continues to increase, recent reports have shown the percentage of patients who remain “unsatisfied” is as high as 15% to 30%. Recently, several newer implant designs have been developed to potentially improve patient outcomes.

The Risk of Revision After TKA Is Affected by Previous HTO or UKA

Otto Robertsson MD, PhD, Annette W-Dahl RN, PhD

High tibial osteotomy (HTO) and unicompartmental arthroplasty (UKA) are reconstructive surgeries advocated for younger patients. In case of failure or progression of osteoarthritis, they can both be converted to a total knee arthroplasty (TKA).

Is Potential Malnutrition Associated With Septic Failure and Acute Infection After Revision Total Joint Arthroplasty?

Paul H. Yi MD, Rachel M. Frank MD, Elliott Vann MD, Kevin A. Sonn MD, Mario Moric MS, Craig J. Della Valle MD

Although malnutrition has been hypothesized to increase the risk of periprosthetic joint infection (PJI), strong evidence linking the two is lacking.

The John Insall Award: Morbid Obesity Independently Impacts Complications, Mortality, and Resource Use After TKA

Michele R. D’Apuzzo MD, Wendy M. Novicoff PhD, James A. Browne MD

The importance of morbid obesity as a risk factor for complications after total knee arthroplasty (TKA) continues to be debated. Obesity is rarely an isolated diagnosis and tends to cluster with other comorbidities that may independently lead to increased risk and confound outcomes. It is unknown whether morbid obesity independently affects postoperative complications and resource use after TKA.

The KSS 2011 Reflects Symptoms, Physical Activities, and Radiographic Grades in a Japanese Population

Naoya Taniguchi MD, Shuichi Matsuda MD, PhD, Takahisa Kawaguchi MS, Yasuharu Tabara PhD, Tome Ikezoe PhD, Tadao Tsuboyama MD, PhD, Noriaki Ichihashi PhD, Takeo Nakayama MD, PhD, Fumihiko Matsuda PhD, Hiromu Ito MD, PhD

Cultural and ethnic differences are present both in subjective and objective measures of patient health, but scoring systems do not always reflect these differences, and so validation of outcomes tools in different cultural settings is important. Recently, a revised version of The Knee Society Score(KSS 2011) was developed, but to our knowledge, the degree that this tool evaluates clinical symptoms, physical activities, and radiographic grades in the general Japanese population is not known.

Does Increased Topside Conformity in Modular Total Knee Arthroplasty Lead to Increased Backside Wear?

Ran Schwarzkopf MD, MSc, Richard D. Scott MD, Evan M. Carlson MSc, John H. Currier MSc

Modular metal-backed tibia components allow surgeons intraoperative flexibility. Although it is known that modular tibia components introduce the possibility for backside wear resulting from relative motion between the polyethylene insert and the tibial baseplate, it is not known to what degree variability in the conformity of the tibial polyethylene liner itself might contribute to backside wear.

Does Operative Time Affect Infection Rate in Primary Total Knee Arthroplasty?

Sameer Naranje MD, Lisa Lendway PhD, Susan Mehle BS, Terence J. Gioe MD

Prolonged operative time may increase the risk of infection after total knee arthroplasty (TKA). Both surgeon-related and patient-related factors can contribute to increased operative times.

Intraoperative Angiography Provides Objective Assessment of Skin Perfusion in Complex Knee Reconstruction

Cody C. Wyles BS, Michael J. Taunton MD, Steven R. Jacobson MD, Nho V. Tran MD, Rafael J. Sierra MD, Robert T. Trousdale MD

Wound necrosis is a potentially devastating complication of complex knee reconstruction. Laser-assisted indocyanine green angiography (LA-ICGA) is a technology that has been described in the plastic surgery literature to provide an objective assessment of skin perfusion in the operating room. This novel technology uses a plasma protein bound dye (ICG) and a camera unit that is calibrated to view the frequency emitted by the dye. The intention of this technology is to offer real-time visualization of blood flow to skin and soft tissue in a way that might help surgeons make decisions about closure or coverage of a surgical site based on blood flow, potentially avoiding soft tissue reconstruction while preventing skin necrosis or wound breakdown after primary closures, but its efficacy is untested in the setting of complex TKA.

The Chitranjan Ranawat Award: Periarticular Injections and Femoral & Sciatic Blocks Provide Similar Pain Relief After TKA: A Randomized Clinical Trial

Mark J. Spangehl MD, Henry D. Clarke MD, Joseph G. Hentz MS, Lopa Misra MD, Joshua L. Blocher PA-C, David P. Seamans MD

Two of the more common methods of pain management after TKA are peripheral nerve blocks and intraarticular/periarticular injections. However, we are not aware of any study directly comparing the commonly used combination of a continuous femoral block given with a single-shot sciatic block with that of a periarticular injection after TKA.

The Mark Coventry Award

Luis Pulido MD, Matthew P. Abdel MD, David G. Lewallen MD, Michael J. Stuart MD, Joaquin Sanchez-Sotelo MD, PhD, Arlen D. Hanssen MD, Mark W. Pagnano MD

Although highly porous metals have demonstrated excellent bone ingrowth properties and so are an intriguing option for fixation in total knee arthroplasty (TKA), some surgeons are skeptical about the durability of uncemented tibial fixation and the potential for soft tissues to adhere to these porous metals and perhaps cause knee stiffness or pain.

A 30-mm Cemented Stem Extension Provides Adequate Fixation of the Tibial Component in Revision Knee Arthroplasty

Paul F. Lachiewicz MD, Elizabeth S. Soileau BSN

The optimal stem length and method of fixation for the tibial component in revision knee arthroplasty remains controversial. The use of a cemented 30-mm stem extension provides certain advantages compared with other methods of fixation, but there are few published results.