Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Knee 450 articles


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 d├ębridement with component retention in acute periprosthetic joint infection (PJI). There is a poor understanding of the role of biofilm antibiotic tolerance in PJI.

Validation of the KOOS, JR: A Short-form Knee Arthroplasty Outcomes Survey

Stephen Lyman PhD, Yuo-Yu Lee MS, Patricia D. Franklin MD, MBA, MPH, Wenjun Li PhD, Michael B. Cross MD, Douglas E. Padgett MD

Medicare is rapidly moving toward using patient-reported outcome measures (PROMs) for outcomes assessment and justification of orthopaedic and other procedures. Numerous measures have been developed to study knee osteoarthritis (OA); however, many of these surveys are long, disruptive to clinic flow, and result in incomplete data capture and/or low followup rates. The Knee injury and Osteoarthritis Outcome (KOOS) physical function short-form (KOOS-PS), while shorter, ignores pain, which is a primary concern of patients with advanced knee OA.

Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation

Salvatore J. Frangiamore MD, Marcelo B. P. Siqueira MD, Anas Saleh MD, Thomas Daly MD, Carlos A. Higuera MD, Wael K. Barsoum MD

Diagnosing periprosthetic joint infection (PJI) requires a combination of clinical and laboratory parameters, which may be expensive and difficult to interpret. Synovial fluid cytokines have been shown to accurately differentiate septic from aseptic failed total knee (TKA) and hip (THA) arthroplasties. However, after first-stage explantation, there is still no reliable test to rule out PJI before a second-stage reimplantation procedure.

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.

What Factors Influence the Success of Medial Gastrocnemius Flaps in the Treatment of Infected TKAs?

Matthew W. Tetreault MD, Craig J. Della Valle MD, Daniel D. Bohl MD, MPH, Sameer J. Lodha MD, Debdut Biswas MD, Robert W. Wysocki MD

Soft tissue defects after TKA are a potentially devastating complication. Medial gastrocnemius flaps occasionally are used to provide soft tissue coverage, most commonly with a periprosthetic joint infection.

Risk of Post-TKA Acute Myocardial Infarction in Patients With a History of Myocardial Infarction or Coronary Stent

Atul Kumar MBBS, DRE, Wen-Chen Tsai DrPH, Tai-Sheng Tan MD, Li-Ting Chiu MHA, Pei-Tseng Kung ScD, Ching-Kan Lo MD, Ming-Chou Ku MD

Acute myocardial infarction (AMI) is one of the most important perioperative complications of total knee arthroplasty (TKA). Although risk-stratification tools exist for the prediction of cardiac complications including AMI after noncardiac surgery, such stratification does not differentiate the patients with a coronary stent alone, AMI without a stent, or AMI with a stent. The risk of postoperative AMI in these patient groups may vary. Several studies have recommended suitable times for noncardiac surgery in patients with a coronary stent; however, they do not differentiate between the patients with AMI and no AMI. The suitable time of noncardiac surgery for patients with AMI and stent may vary from those with a stent alone. Moreover, a study to evaluate the risk of AMI within 1 year in an Asian population with a history of AMI or coronary stent who underwent TKA has not been reported.

Is There an Association Between Whole-body Pain With Osteoarthritis-related Knee Pain, Pain Catastrophizing, and Mental Health?

Amish J. Dave MD, Faith Selzer PhD, Elena Losina PhD, Kristina M. Klara BS, Jamie E. Collins PhD, Ilana Usiskin BS, Philip Band PhD, David F. Dalury MD, Richard Iorio MD, Kirk Kindsfater MD, Jeffrey N. Katz MD, MSc

Greater levels of self-reported pain, pain catastrophizing, and depression have been shown to be associated with persistent pain and functional limitation after surgeries such as TKA. It would be useful for clinicians to be able to measure these factors efficiently.

Arthroscopy for Knee Osteoarthritis Has Not Decreased After a Clinical Trial

Muyibat A. Adelani MD, Alexander H. S. Harris PhD, Thomas R. Bowe PhD, Nicholas J. Giori MD, PhD

Multiple clinical trials have shown that arthroscopy for knee osteoarthritis is not efficacious. It is unclear how these studies have affected orthopaedic practice in the USA.