Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: 2016 Knee Society Proceedings 14 articles

Articles

No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA

John W. Barrington MD, Roger H. Emerson MD, Scott T. Lovald PhD, Adolph V. Lombardi MD, Keith R. Berend MD

Opioid analgesics have been a standard modality for postoperative pain management after total knee arthroplasty (TKA) but are also associated with increased risk of nausea, pruritus, vomiting, respiratory depression, prolonged ileus, and cognitive dysfunction. There is still a need for a method of anesthesia that can deliver effective long-term postoperative pain relief without incurring the high cost and health burden of opioids and nerve blocks.

No Difference Between Trabecular Metal Cones and Femoral Head Allografts in Revision TKA: Minimum 5-year Followup

Nemandra A. Sandiford MSc, FRCS(Tr&Orth), Peter Misur FRACS, Donald S. Garbuz MD, MHSc, FRCS(C), Nelson V. Greidanus MSc, FRCS (C), Bassam A. Masri MD, FRCS(C)

Encouraging clinical results have been reported with the use of femoral head structural allografts and, more recently, trabecular metal cones for the management of large structural defects of the femur and tibia during revision total knee arthroplasty (TKA). However, to our knowledge, there are no published studies comparing these two techniques.

The Mark Coventry, MD, Award: Oral Antibiotics Reduce Reinfection After Two-Stage Exchange: A Multicenter, Randomized Controlled Trial

Jonathan M. Frank MD, Erdan Kayupov MSE, Mario Moric MS, John Segreti MD, Erik Hansen MD, Curtis Hartman MD, Kamil Okroj BS, Katherine Belden MD, Brian Roslund PharmD, Randi Silibovsky MD, Javad Parvizi MD, Craig J. Valle MD

Many patients develop recurrent periprosthetic joint infection after two-stage exchange arthroplasty of the hip or knee. One potential but insufficiently tested strategy to decrease the risk of persistent or recurrent infection is to administer additional antibiotics after the second-stage reimplantation.

Can Original Knee Society Scores Be Used to Estimate New 2011 Knee Society Scores?

Susan M. Odum PhD, Thomas K. Fehring MD

The Knee Society Score (KSS) instrument is one of the most commonly reported primary outcome measures for total knee arthroplasty (TKA). Originally developed in 1989, the KSS was expanded and updated in 2011; however, the original KSS does not directly translate into the 2011 KSS. To date, no conversion algorithm has been developed, hindering the ability of researchers to adopt the 2011 KSS while maintaining their historical/longitudinal original KSS data.

The Chitranjan S. Ranawat Award

Simon W. Young FRACS, Matthew L. Walker FRACS, Ali Bayan FRACS, Toby Briant-Evans FRCS, Paul Pavlou FRCS, Bill Farrington FRCS, FRACS

Neutral mechanical alignment (MA) in total knee arthroplasty (TKA) aims to position femoral and tibial components perpendicular to the mechanical axis of the limb. In contrast, kinematic alignment (KA) attempts to match implant position to the prearthritic anatomy of the individual patient with the aim of improving functional outcome. However, comparative data between the two techniques are lacking.

Length of Endoprosthetic Reconstruction in Revision Knee Arthroplasty Is Associated With Complications and Reoperations

Jeffrey J. Barry MD, Zachary Thielen MD, David C. Sing BS, Paul H. Yi MD, Erik N. Hansen MD, Michael Ries MD

Complex revision total knee arthroplasty (TKA) often calls for endoprosthetic reconstruction to address bone loss, poor bone quality, and soft tissue insufficiency. Larger amounts of segmental bone loss in the setting of joint replacement may be associated with greater areas of devascularized tissue, which could increase the risk of complications and worsen functional results.

Crosslink Density Is Reduced and Oxidation Is Increased in Retrieved Highly Crosslinked Polyethylene TKA Tibial Inserts

Tong Liu MD, Christina I. Esposito PhD, Jayme C. Burket PhD, Timothy M. Wright PhD

The wear resistance of highly crosslinked polyethylene depends on crosslink density, which may decrease with in vivo loading, leading to more wear and increased oxidation. The relationship among large and complex in vivo mechanical stresses, breakdown of the polyethylene crosslinks, and oxidative degradation is not fully understood in total knee arthroplasty (TKA). We wished to determine whether crosslink density is reduced at the articular surfaces of retrieved tibial inserts in contact areas exposed to in vivo mechanical stress.

Higher Frequency of Reoperation With a New Bicruciate-retaining Total Knee Arthroplasty

Jesse C. Christensen PT, DPT, Justin Brothers MD, Gregory J. Stoddard MPH, MBA, Mike B. Anderson MSc, Christopher E. Pelt MD, Jeremy M. Gililland MD, Christopher L. Peters MD

With as many as 25% of patients reporting residual knee symptoms after primary total knee arthroplasty (TKA), alternative implant designs and surgical techniques have been proposed to further reduce these symptoms. There is growing evidence that retention of the anterior cruciate ligament (ACL) results in more natural knee kinematics; thus, implants with more normal joint mechanics could provide improved physical function postoperatively and reduce the amount of residual symptoms. Advancements in the bicruciate-retaining (BCR) TKA implant design have been made, and based on these, we wished to compare the BCR with a more traditional cruciate-retaining (CR) implant.

Do Stemmed Tibial Components in Total Knee Arthroplasty Improve Outcomes in Patients With Obesity?

Sébastien Parratte MD, Matthieu Ollivier MD, Alexandre Lunebourg MD, Nicolas Verdier MD, Jean Noel Argenson MD, PhD

Recent clinical studies have reported that patients with higher body mass index (BMI) are more likely to experience premature failure of total knee arthroplasty (TKA), lower knee scores, and perhaps more pain in the prosthetic joint. However, it is not known whether certain implant design features such as tibial stems might be associated with differences in the frequency of tibial pain in patients with higher BMIs.

Can Preoperative Patient-reported Outcome Measures Be Used to Predict Meaningful Improvement in Function After TKA?

Jonathan L. Berliner MD, Dane J. Brodke BA, Vanessa Chan MPH, Nelson F. SooHoo MD, Kevin J. Bozic MD, MBA

Despite the overall effectiveness of total knee arthroplasty (TKA), a subset of patients do not experience expected improvements in pain, physical function, and quality of life as documented by patient-reported outcome measures (PROMs), which assess a patient’s physical and emotional health and pain. It is therefore important to develop preoperative tools capable of identifying patients unlikely to improve by a clinically important margin after surgery.

The John N. Insall Award: Do Intraarticular Injections Increase the Risk of Infection After TKA?

Nicholas A. Bedard MD, Andrew J. Pugely MD, Jacob M. Elkins MD, PhD, Kyle R. Duchman MD, Robert W. Westermann MD, Steve S. Liu MD, Yubo Gao PhD, John J. Callaghan MD

Infection after total knee arthroplasty (TKA) can result in disastrous consequences. Previous research regarding injections and risk of TKA infection have produced conflicting results and in general have been limited by small cohort size.

Pain Control and Functional Milestones in Total Knee Arthroplasty: Liposomal Bupivacaine versus Femoral Nerve Block

Stephen Yu MD, Alessandra Szulc MA, Sharon Walton MD, Joseph Bosco MD, Richard Iorio MD

Although pain management after total knee arthroplasty (TKA) affects rehabilitation, length of stay, and functional outcomes, pain management for patients undergoing TKA has yet to be standardized. Femoral nerve blocks (FNBs) are commonly used as an adjunct; however, these can result in transient quadriceps weakness and have been associated with in-hospital falls. Periarticular infiltration of liposomal bupivacaine has been recently introduced as a long-acting analgesic that can be administered without affecting motor function.

What Is the Frequency of Noise Generation in Modern Knee Arthroplasty and Is It Associated With Residual Symptoms?

Denis Nam MD, MSc, Toby Barrack BA, Ryan M. Nunley MD, Robert L. Barrack MD

Prior investigations have recognized the presence of patient-perceived noise generation after total knee arthroplasty (TKA). However, questions remain regarding its overall frequency after both TKA and unicompartmental knee arthroplasty (UKA) as well as with respect to its association with demographic and prosthesis-related factors and its association with patient-reported outcomes.