Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Knee 447 articles

Articles

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.

The Knee Society Short Form Reduces Respondent Burden in the Assessment of Patient-reported Outcomes

Giles R. Scuderi MD, Alla Sikorskii PhD, Robert B. Bourne MD, Jess H. Lonner MD, James B. Benjamin MD, Philip C. Noble PhD

The patient’s own evaluation of function and satisfaction is a fundamental component of assessing outcomes after total knee arthroplasty (TKA). The new Knee Society Knee Score was introduced in 2012 and has been shown to be a valid and reliable instrument for measuring the outcome of TKA. This score combines an objective, physician-derived component and a patient-reported component to characterize the expectations, satisfaction, and functional activities of diverse lifestyles of contemporary patients undergoing TKA. However, in the routine clinical setting, the administration and scoring of outcome measures is often resource-intensive, as the expenditure of time and budget for outcome measurement increase with the length and complexity of the instrument used, and so a short-form assessment can help to reduce the burden the assessment of outcomes.

What Is the Role for Patelloplasty With Gullwing Osteotomy in Revision TKA?

Jeremy M. Gililland MD, Presley Swann MD, Christopher E. Pelt MD, Jill Erickson PA, Nadia Hamad MSc, ATC, Christopher L. Peters MD

Management of the patella in revision total knee arthroplasty (TKA) is challenging as a result of the deficient or unusable bone stock for patellar resurfacing that is frequently encountered. Options proposed in this setting include various patelloplasty procedures, patellectomy, and special patellar components. We sought to better define the role and results of one patelloplasty procedure, the gullwing osteotomy, used in revision TKA.

What Are the Prognostic Factors for Radiographic Progression of Knee Osteoarthritis? A Meta-analysis

Alex N. Bastick MD, MSc, Janneke N. Belo MD, PhD, Jos Runhaar PhD, Sita M. A. Bierma-Zeinstra PhD

A previous systematic review on prognostic factors for knee osteoarthritis (OA) progression showed associations for generalized OA and hyaluronic acid levels. Knee pain, radiographic severity, sex, quadriceps strength, knee injury, and regular sport activities were not associated. It has been a decade since the literature search of that review and many studies have been performed since then investigating prognostic factors for radiographic knee OA progression.

Surface Damage Is Not Reduced With Highly Crosslinked Polyethylene Tibial Inserts at Short-term

Tong Liu MD, Christina Esposito PhD, Marcella Elpers BS, Timothy Wright PhD

Highly crosslinked ultrahigh-molecular-weight polyethylene (XLPE) has been shown to reduce wear in hip arthroplasty, but the advantages over conventional polyethylene (PE) in total knee arthroplasty (TKA), if any, remain unclear.

Fixator-assisted Technique Enables Less Invasive Plate Osteosynthesis in Medial Opening-wedge High Tibial Osteotomy: A Novel Technique

Dong Hoon Lee MD, PhD, Keun Jung Ryu MD, Hae Hwa Kim MD, PhD, Sahyun Soung MD, Soowan Shin BS

Opening-wedge high tibial osteotomy is a well-established procedure in the management of medial osteoarthritis of the knee and correction of proximal tibia vara. Recently, surgical approaches using less invasive plate osteosynthesis have been used with the goal of minimizing complications from more extensive soft tissue exposures. However, to our knowledge, less invasive fixator-assisted plate osteosynthesis has not been tested in the setting of opening-wedge high tibial osteotomy.

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

Ivan Martino MD, Vincenzo Santis MD, Peter K. Sculco MD, Rocco D’Apolito MD, Joseph B. Assini MD, Giorgio Gasparini MD

Multiple studies have reported favorable short-term outcomes using tantalum cones to reconstruct massive bone defects during revision TKA. However, longer-term followup is needed to determine the durability of these reconstructions.