Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Knee 447 articles

Articles

Does a Patient-centered Educational Intervention Affect African-American Access to Knee Replacement? A Randomized Trial

Ernest R. Vina MD, MS, Diane Richardson PhD, Elina Medvedeva MS, C. Kent Kwoh MD, Aliya Collier BS, Said A. Ibrahim MD, MPH

A TKA is the most effective and cost-effective surgical option for moderate to severe osteoarthritis (OA) of the knee. Yet, black patients are less willing to undergo knee replacement surgery than white patients. Decision aids help people understand treatment options and consider the personal importance of possible benefits and harms of treatments, including TKA.

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.

Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Knee Arthroplasty?

Bhaveen H. Kapadia MD, Peter L. Zhou BA, Julio J. Jauregui MD, Michael A. Mont MD

Many preventive methodologies seek to reduce the risk of surgical site infections after total knee arthroplasty (TKA), including the use of preoperative chlorhexidine baths and cloths. Although we have demonstrated in previous studies that this may be an efficacious method for infection prevention, our study was underpowered and we therefore set out to evaluate this with a larger sample size.

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.

How Does Wear Rate Compare in Well-functioning Total Hip and Knee Replacements? A Postmortem Polyethylene Liner Study

Robin Pourzal PhD, Christopher B. Knowlton BS, Deborah J. Hall BS, Michel P. Laurent PhD, Robert M. Urban, Markus A. Wimmer PhD

The longevity of total hip (THR) and knee replacements (TKR) that used historical bearing materials of gamma-in-air sterilized UHMWPE was affected more by osteolysis in THRs than in TKRs, although osteolysis remains a concern in TKRs. Therefore, the study of polyethylene wear is still of interest for the knee, particularly because few studies have investigated volumetric material loss in tibial knee inserts. For this study, a unique collection of autopsy-retrieved TKR and THR components that were well-functioning at the time of retrieval was used to compare volumetric wear differences between hip and knee polyethylene components made from identical material.

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.

Antibiotic-tolerant Staphylococcus aureus Biofilm Persists on Arthroplasty Materials

Kenneth L. Urish MD, PhD, Peter W. DeMuth BS, Brian W. Kwan PhD, David W. Craft PhD, Dongzhu Ma PhD, Hani Haider PhD, Rocky S. Tuan PhD, Thomas K. Wood PhD, Charles M. Davis MD

The continued presence of biofilm may be one cause of the high risk of failure observed with irrigation and débridement with component retention in acute periprosthetic joint infection (PJI). There is a poor understanding of the role of biofilm antibiotic tolerance in PJI.