Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Knee 443 articles


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.

A Porcine Knee Model Is Valid for Use in the Evaluation of Arthroscopic Skills: A Pilot Study

R. Kyle Martin MD, Danny Gillis MD, Jeff Leiter MSc, PhD, Jesse Slade Shantz MD, MBA, Peter MacDonald MD

Previously validated knee arthroscopy evaluation tools have used human cadaveric knees. This is unsustainable because of the cost and scarcity of these specimens. Porcine (pig) knees are anatomically similar, affordable, and easily obtainable; however, whether porcine knees represent a suitable alternative to human specimens has not been evaluated.

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

Shobhit V. Minhas MD, Preeya Goyal BA, Alpesh A. Patel MD

Perioperative cerebrovascular accidents (CVAs) are one of the leading causes of patient morbidity, mortality, and medical costs. However, little is known regarding the rates of these events and risk factors for CVA after elective orthopaedic surgery.

Does Race Affect Outcomes in Total Joint Arthroplasty?

Carlos J. Lavernia MD, Jesus M. Villa MD

Several studies suggest worse surgical outcomes among racial/ethnic minorities. There is a paucity of research on preoperative and postoperative pain, general health, and disease-specific measures in which race is the main subject of investigation; furthermore, the results are not conclusive.

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.

What Drives Variation in Episode-of-care Payments for Primary TKA? An Analysis of Medicare Administrative Data

Peter Cram MD, MBA, Bheeshma Ravi MD, PhD, Mary S. Vaughan-Sarrazin PhD, Xin Lu MS, Yue Li PhD, Gillian Hawker MD, MSc

Episode-of-care payments are defined as a single lump-sum payment for all services associated with a single medical event or surgery and are designed to incentivize efficiency and integration among providers and healthcare systems. A TKA is considered an exemplar for an episode-of-care payment model by many policymakers, but data describing variation payments between hospitals for TKA are extremely limited.

Highly Crosslinked-remelted versus Less-crosslinked Polyethylene in Posterior Cruciate-retaining TKAs in the Same Patients

Young-Hoo Kim MD, Jang-Won Park MD, Jun-Shik Kim MD, June-Hyung Lee MD

Concern regarding osteolysis attributable to polyethylene wear after TKA, particularly in younger patients, has prompted the introduction of highly crosslinked-remelted polyethylene (HXLPE) for TKAs. However, few in vivo comparative results of TKAs using HXLPE and less-crosslinked polyethylene inserts in the same patients are available, regarding fracture or failure of the locking mechanism of tibial polyethylene inserts or of osteolysis in patients younger than 60 years.

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.