Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Knee 450 articles

Articles

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Sally Arno PhD, Christopher P. Bell MSc, Michael J. Alaia MD, Brian C. Singh BS, Laith M. Jazrawi MD, Peter S. Walker PhD, Ankit Bansal MD, Garret Garofolo BS, Orrin H. Sherman MD

Considerable debate remains over which anterior cruciate ligament (ACL) reconstruction technique can best restore knee stability. Traditionally, femoral tunnel drilling has been done through a previously drilled tibial tunnel; however, potential nonanatomic tunnel placement can produce a vertical graft, which although it would restore sagittal stability, it would not control rotational stability. To address this, some suggest that the femoral tunnel be created independently of the tibial tunnel through the use of an anteromedial (AM) portal, but whether this results in a more anatomic footprint or in stability comparable to that of the intact contralateral knee still remains controversial.

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.

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.