Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: 2015 Knee Society Proceedings 14 articles

Articles

Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative

David C. Markel MD, Mark W. Allen DO, Nicole M. Zappa DO, MHA

Standardized care plans are effective at controlling cost and quality. Registries provide insights into quality and outcomes for use of implants, but most registries do not combine implant and care quality data. In 2012, several Michigan area hospitals and a major insurance provider formed a voluntary statewide total joint database/registry, the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), to collect procedural, hospital, discharge, and readmission data. Noting substantial variation in transfusion practices after total joint arthroplasty (TJA) in our institutions, we used these prospectively collected data to examine whether awareness and education of the American Association of Blood Banks’ (AABB) transfusion guidelines would result in decreased transfusions.

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Paul Lichstein MD, MS, Sharlene Su BS, Hakan Hedlund MD, PhD, Gina Suh MD, William J. Maloney MD, Stuart B. Goodman MD, PhD, James I. Huddleston MD

Two-stage exchange arthroplasty is a standard approach for treating total knee arthroplasty periprosthetic joint infection in the United States, but whether this should be performed with a static antibiotic spacer or an articulating one that allows range of motion before reimplantation remains controversial. It is unclear if the advantages of articulating spacers (easier surgical exposure during reimplantation and improved postoperative flexion) outweigh the disadvantages of increased cost and complexity in the setting of similar rates of infection eradication.

Can Good Infection Control Be Obtained in One-stage Exchange of the Infected TKA to a Rotating Hinge Design? 10-year Results

Akos Zahar MD, Daniel O. Kendoff MD, PhD, Till O. Klatte MD, Thorsten A. Gehrke MD

Prosthetic joint infection (PJI) occurs in 1% to 2% of total knee arthroplasties (TKAs). Although two-stage exchange is the preferred management method of patients with chronic PJI in TKA in North America, one-stage exchange is an alternative treatment method, but long-term studies of this approach have not been conducted.

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Douglas A. Dennis MD, Andrew J. Kittelson PT, DPT (PhD Candidate), Charlie C. Yang MD, Todd M. Miner MD, Raymond H. Kim MD, Jennifer E. Stevens-Lapsley PT, PhD

Tourniquet use during total knee arthroplasty (TKA) improves visibility and reduces intraoperative blood loss. However, tourniquet use may also have a negative impact on early recovery of muscle strength and lower extremity function after TKA.

The Knee Society Short Form Reduces Respondent Burden in the Assessment of Patient-reported Outcomes

Giles R. Scuderi MD, Alla Sikorskii PhD, Robert B. Bourne MD, Jess H. Lonner MD, James B. Benjamin MD, Philip C. Noble PhD

The patient’s own evaluation of function and satisfaction is a fundamental component of assessing outcomes after total knee arthroplasty (TKA). The new Knee Society Knee Score was introduced in 2012 and has been shown to be a valid and reliable instrument for measuring the outcome of TKA. This score combines an objective, physician-derived component and a patient-reported component to characterize the expectations, satisfaction, and functional activities of diverse lifestyles of contemporary patients undergoing TKA. However, in the routine clinical setting, the administration and scoring of outcome measures is often resource-intensive, as the expenditure of time and budget for outcome measurement increase with the length and complexity of the instrument used, and so a short-form assessment can help to reduce the burden the assessment of outcomes.

What Is the Role for Patelloplasty With Gullwing Osteotomy in Revision TKA?

Jeremy M. Gililland MD, Presley Swann MD, Christopher E. Pelt MD, Jill Erickson PA, Nadia Hamad MSc, ATC, Christopher L. Peters MD

Management of the patella in revision total knee arthroplasty (TKA) is challenging as a result of the deficient or unusable bone stock for patellar resurfacing that is frequently encountered. Options proposed in this setting include various patelloplasty procedures, patellectomy, and special patellar components. We sought to better define the role and results of one patelloplasty procedure, the gullwing osteotomy, used in revision TKA.

Surface Damage Is Not Reduced With Highly Crosslinked Polyethylene Tibial Inserts at Short-term

Tong Liu MD, Christina Esposito PhD, Marcella Elpers BS, Timothy Wright PhD

Highly crosslinked ultrahigh-molecular-weight polyethylene (XLPE) has been shown to reduce wear in hip arthroplasty, but the advantages over conventional polyethylene (PE) in total knee arthroplasty (TKA), if any, remain unclear.

Knee Society Award Papers Are Highly Cited Works

Tommy P. Mroz, Henry D. Clarke MD, Yu-Hui H. Chang PhD, Giles R. Scuderi MD

Since 1993, The Knee Society has presented three annual awards recognizing the best research papers presented at the annual meetings. To date, no quantitative evaluation has determined whether the selection process identifies the most meritorious papers based on subsequent citations. In the absence of validation of this process, it is unclear whether the journal readership should view the award-winning papers as those with potentially greater impact for the specialty.

The John Insall Award: No Functional Benefit After Unicompartmental Knee Arthroplasty Performed With Patient-specific Instrumentation: A Randomized Trial

Matthieu Ollivier MD, Sebastien Parratte MD, PhD, Alexandre Lunebourg MD, Elke Viehweger MD, PhD, Jean-Noel Argenson MD, PhD

Component alignment can influence implant longevity as well as perhaps pain and function after unicompartmental knee arthroplasty (UKA), but correct alignment is not consistently achieved. To increase the likelihood that good alignment will be achieved during surgery, smart tools such as robotics or patient-specific instrumentation (PSI) have been introduced.

Is There a Benefit to Highly Crosslinked Polyethylene in Posterior-stabilized Total Knee Arthroplasty? A Randomized Trial

Paul F. Lachiewicz MD, Elizabeth S. Soileau BSN

Polyethylene wear and osteolysis remain a concern with the use of modular, fixed-bearing total knee arthroplasty (TKA). A variety of highly crosslinked polyethylenes (XLPs) have been introduced to address this problem, but there are few data on the results and complications of this polyethylene in posterior-stabilized knee prostheses.

The Mark Coventry Award: Custom Cutting Guides Do Not Improve Total Knee Arthroplasty Clinical Outcomes at 2 Years Followup

Denis Nam MD, Andrew Park MD, Jeffrey B. Stambough MD, Staci R. Johnson Med, Ryan M. Nunley MD, Robert L. Barrack MD

Custom cutting guides (CCGs; sometimes called patient-specific instrumentation [PSI]) in total knee arthroplasty (TKA) use preoperative three-dimensional imaging to fabricate cutting blocks specific to a patient’s native anatomy.

Time-driven Activity-based Costing More Accurately Reflects Costs in Arthroplasty Surgery

Sina Akhavan BA, Lorrayne Ward MBA, MPP, Kevin J. Bozic MD, MBA

Cost estimates derived from traditional hospital cost accounting systems have inherent limitations that restrict their usefulness for measuring process and quality improvement. Newer approaches such as time-driven activity-based costing (TDABC) may offer more precise estimates of true cost, but to our knowledge, the differences between this TDABC and more traditional approaches have not been explored systematically in arthroplasty surgery.

The Chitranjan Ranawat Award: Running Subcuticular Closure Enables the Most Robust Perfusion After TKA: A Randomized Clinical Trial

Cody C. Wyles BS, Steven R. Jacobson MD, Matthew T. Houdek MD, Dirk R. Larson MS, Michael J. Taunton MD, Franklin H. Sim MD, Rafael J. Sierra MD, Robert T. Trousdale MD

Maintaining robust perfusion is an important physiologic parameter in wound healing. The effect of different closure techniques on wound perfusion after total knee arthroplasty (TKA) has not been established previously and may have implications for wound healing.