Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 471 | Issue 1 | Jan, 2013

Have Bilateral Total Knee Arthroplasties Become Safer?: A Population-Based Trend Analysis

Stavros G. Memtsoudis MD, PhD, Carlos B. Mantilla MD, PhD, Javad Parvizi MD, Ottokar Stundner MD, Madhu Mazumdar PhD

Studies suggest a trend in the selection of younger and healthier individuals to undergo bilateral TKAs in an attempt to diminish the incidence of complications. It remains unclear whether this development has reduced overall perioperative morbidity and mortality.

Genetic Engineering of Juvenile Human Chondrocytes Improves Scaffold-free Mosaic Neocartilage Grafts

Vincent Y. Ng MD, Seth S. Jump PhD, Kelly S. Santangelo DVM, PhD, Duncan S. Russell BVSc, PhD, Alicia L. Bertone DVM, PhD, ACVS

Current cartilage transplantation techniques achieve suboptimal restoration and rely on patient donor cells or living grafts of chondrocytes.

The John Insall Award: No Benefit of Minimally Invasive TKA on Gait and Strength Outcomes: A Randomized Controlled Trial

Julien Wegrzyn MD, PhD, Sebastien Parratte MD, PhD, Krista Coleman-Wood PhD, PT, Kenton R. Kaufman PhD, PE, Mark W. Pagnano MD

While some clinical reports suggest minimally invasive surgical (MIS) techniques improve recovery and reduce pain in the first months after TKA, it is unclear whether it improves gait and thigh muscle strength.

The 2012 Mark Coventry Award: A Retrieval Analysis of High Flexion versus Posterior-stabilized Tibial Inserts

Nicholas R. Paterson BScH, Matthew G. Teeter BScH, PhD, Steven J. MacDonald MD, FRCSC, Richard W. McCalden MD, MPhil(Edin), FRCSC, Douglas D. R. Naudie MD, FRCSC

High flexion (HF) implants were introduced to increase ROM and patient satisfaction, but design changes to the implant potentially have deleterious effects on polyethylene wear. It is unclear whether the HF implants affect wear.

The 2012 Chitranjan Ranawat Award: Intraarticular Analgesia After TKA Reduces Pain: A Randomized, Double-blinded, Placebo-controlled, Prospective Study

Nitin Goyal MD, James McKenzie BS, Peter F. Sharkey MD, Javad Parvizi MD, William J. Hozack MD, Matthew S. Austin MD

Postoperative pain after total knee arthroplasty remains one of the most important challenges facing patients undergoing this surgery. Providing a balance of adequate analgesia while limiting the functional impact of regional anesthesia and minimizing opioid side effects is critical to minimize adverse events and improve patient satisfaction.

Rotating-platform Has No Surface Damage Advantage Over Fixed-bearing TKA

Kirsten Stoner MEng, Seth A. Jerabek MD, Stephanie Tow BA, Timothy M. Wright PhD, Douglas E. Padgett MD

Rotating-platform TKA, although purported to have superior kinematics, has shown no clinical advantages over those of fixed-bearing TKA. Our design-matched retrieval study aimed to investigate if differences in bearing wear damage exist between fixed- and mobile-bearing TKAs with similar condylar geometry.

Can Microcomputed Tomography Measure Retrieved Polyethylene Wear? Comparing Fixed-bearing and Rotating-platform Knees

Charles A. Engh MD, Rebecca L. Zimmerman MS, Robert H. Hopper PhD, Gerard A. Engh MD

Wear of total knee polyethylene has been quantified gravimetrically with thickness measurements and evaluation of surface wear modes. However, these techniques do not localize volumetric wear.

Aseptic Tibial Debonding as a Cause of Early Failure in a Modern Total Knee Arthroplasty Design

Diren Arsoy MD, Mark W. Pagnano MD, David G. Lewallen MD, Arlen D. Hanssen MD, Rafael J. Sierra MD

We observed isolated tibial component debonding from the cement in one modern primary TKA design (NexGen LPS 3° tibial tray; Zimmer, Warsaw, IN, USA). This failure mechanism is sparsely reported in the literature.

Long-term Survivorship and Failure Modes of Unicompartmental Knee Arthroplasty

Jared R. H. Foran MD, Nicholas M. Brown MD, Craig J. Della Valle MD, Richard A. Berger MD, Jorge O. Galante MD

In a previously reported series of 51 patients with 62 cemented, fixed-bearing unicompartmental knee arthroplasties, we reported a 10-year, 98% survival rate with an average knee score of 92 points. The survivorship and modes of failure past 10 years are incompletely understood.

Durability of a Cruciate-retaining TKA With Modular Tibial Trays at 20 Years

John J. Callaghan MD, Mitchell W. Beckert BS, David W. Hennessy MD, Devon D. Goetz MD, Scott S. Kelley MD

Modular tibial trays have been utilized in TKA for more than 20 years. However, concerns have been raised about modular implants and it is unclear whether these devices are durable in the long term.

Robotic-assisted TKA Reduces Postoperative Alignment Outliers and Improves Gap Balance Compared to Conventional TKA

Eun-Kyoo Song MD, PhD, Jong-Keun Seon MD, PhD, Ji-Hyeon Yim MD, PhD, Nathan A. Netravali PhD, William L. Bargar MD

Several studies have shown mechanical alignment influences the outcome of TKA. Robotic systems have been developed to improve the precision and accuracy of achieving component position and mechanical alignment.

Postoperative Alignment and ROM Affect Patient Satisfaction After TKA

Shuichi Matsuda MD, Shinya Kawahara MD, Ken Okazaki MD, Yasutaka Tashiro MD, Yukihide Iwamoto MD

Patient satisfaction has increasingly been recognized as an important measure after total knee arthroplasty (TKA). However, we do not know yet how and why the patients are satisfied or dissatisfied with TKA.

Which Factors Increase Risk of Malalignment of the Hip-Knee-Ankle Axis in TKA?

Arun B. Mullaji FRCS(Ed), MCh(Orth), MS(Orth), Gautam M. Shetty MS(Orth), A. P. Lingaraju MS(Orth), Sagar Bhayde MS(Orth)

Computer navigation has improved accuracy and reduced the percentage of alignment outliers in TKA. However, the characteristics of outliers and the risk factors for limb malalignment after TKA are still unclear.

Does Interlimb Knee Symmetry Exist After Unicompartmental Knee Arthroplasty?

Yang-Chieh Fu PhD, Kathy J. Simpson PhD, Tracy L. Kinsey MSPH, Ormonde M. Mahoney MD

Unicompartmental knee arthroplasty (UKA) has long been a treatment option for patients with disease limited primarily to one compartment with small, correctable deformities. However, some surgeons presume that normal kinematics of a lateral compartment UKA are difficult to achieve. Furthermore, it is unclear whether UKA restores normal knee kinematics and interlimb symmetry.

Low Risk of Thromboembolic Complications With Tranexamic Acid After Primary Total Hip and Knee Arthroplasty

Blake P. Gillette MD, Lori J. DeSimone PA, Robert T. Trousdale MD, Mark W. Pagnano MD, Rafael J. Sierra MD

The use of antifibrinolytic medications in hip and knee arthroplasty reduces intraoperative blood loss and decreases transfusion rates postoperatively. Tranexamic acid (TXA) specifically has not been associated with increased thromboembolic (TE) complications, but concerns remain about the risk of symptomatic TE events, particularly when less aggressive chemical prophylaxis methods such as aspirin alone are chosen.

Total Knee Arthroplasty With a Computer-navigated Saw: A Pilot Study

Kevin L. Garvin MD, Andres Barrera MS, Craig R. Mahoney MD, Curtis W. Hartman MD, Hani Haider PhD

Computer-aided surgery aims to improve implant alignment in TKA but has only been adopted by a minority for routine use. A novel approach, navigated freehand bone cutting (NFC), is intended to achieve wider acceptance by eliminating the need for cumbersome, implant-specific mechanical jigs and avoiding the expense of navigation.

Is Pain and Dissatisfaction After TKA Related to Early-grade Preoperative Osteoarthritis?

Gregory G. Polkowski MD, Erin L. Ruh MS, Toby N. Barrack, Ryan M. Nunley MD, Robert L. Barrack MD

There is growing evidence to suggest many patients experience pain and dissatisfaction after TKA. The relationship between preoperative osteoarthritis (OA) severity and postoperative pain and dissatisfaction after TKA has not been established.

Patient-specific Total Knee Arthroplasty Required Frequent Surgeon-directed Changes

Benjamin M. Stronach MD, Christopher E. Pelt MD, Jill Erickson PA, Christopher L. Peters MD

Patient-specific instrumentation potentially improves surgical precision and decreases operative time in total knee arthroplasty (TKA) but there is little supporting data to confirm this presumption.

Discordance in TKA Expectations Between Patients and Surgeons

Hassan M. K. Ghomrawi PhD, MPH, Carol A. Mancuso MD, Geoffrey H. Westrich MD, Robert G. Marx MD, MSc, Alvin I. Mushlin MD, ScM

Aligning patient and surgeon expectations preoperatively may lead to better postoperative medical and rehabilitation compliance and therefore improve outcomes and increase satisfaction.

The ACL in the Arthritic Knee: How Often Is It Present and Can Preoperative Tests Predict Its Presence?

Aaron J. Johnson MD, Stephen M. Howell MD, Christopher R. Costa MD, Michael A. Mont MD

TKA with retention of the anterior cruciate ligament (ACL) may improve kinematics and function. However, conflicting reports exist concerning the prevalence of intact ACLs at the time of TKA.

Arthroplasty Knee Surgery and Alcohol Use: Risk Factor or Benefit?

Carlos J. Lavernia MD, Jesus M. Villa MD, Juan S. Contreras MD

Excessive alcohol consumption has been associated with adverse measures of health after elective surgery. However, associations of low/moderate consumption remain uncertain.

Voriconazole Is Delivered From Antifungal-Loaded Bone Cement

Ryan B. Miller MD, Alex C. McLaren MD, Christine Pauken PhD, Henry D. Clarke MD, Ryan McLemore PhD

Local delivery of antifungals is an important modality in managing orthopaedic fungal infection. Voriconazole is a powder antifungal suitable for addition to bone cement that is released from bone cement but the mechanical properties of antimicrobial-loaded bone cement (ALBC) made with voriconazole are unknown.

Is Administratively Coded Comorbidity and Complication Data in Total Joint Arthroplasty Valid?

Kevin J. Bozic MD, MBA, Ravi K. Bashyal MD, Shawn G. Anthony MD, MBA, Vanessa Chiu MPH, Brandon Shulman BS, Harry E. Rubash MD

Administrative claims data are increasingly being used in public reporting of provider performance and health services research. However, the concordance between administrative claims data and the clinical record in lower extremity total joint arthroplasty (TJA) is unknown.

Determinants of Direct Medical Costs in Primary and Revision Total Knee Arthroplasty

Hilal Maradit Kremers MD, MSc, Sue L. Visscher PhD, James P. Moriarty MSc, Megan S. Reinalda, Walter K. Kremers PhD, James M. Naessens ScD, David G. Lewallen MD

TKA procedures are increasing rapidly, with substantial cost implications. Determining cost drivers in TKA is essential for care improvement and informing future payment models.

Complications of Total Knee Arthroplasty: Standardized List and Definitions of The Knee Society

William L. Healy MD, Craig J. Della Valle MD, Richard Iorio MD, Keith R. Berend MD, Fred D. Cushner MD, David F. Dalury MD, Jess H. Lonner MD

Despite the importance of complications in evaluating patient outcomes after TKA, definitions of TKA complications are not standardized. Different investigators report different complications with different definitions when reporting outcomes of TKA.

Surgical Technique: Vastus Medialis and Vastus Lateralis as Flap Transfer for Knee Extensor Mechanism Deficiency

Leo A. Whiteside MD

Loss of the quadriceps tendon, patella, and patellar tendon leaves a major anterior defect that is difficult to close and compromises knee extension strength. Gastrocnemius muscle transfer does not sufficiently cover such major defects. This paper describes a new surgical technique that addresses these defects and the results of eight cases of revision TKA managed with this new technique.

Do Fresh Osteochondral Allografts Successfully Treat Femoral Condyle Lesions?

Yadin D. Levy MD, Simon Görtz MD, Pamela A. Pulido BSN, Julie C. McCauley MPHc, William D. Bugbee MD

Fresh osteochondral allograft transplantation is an increasingly common treatment option for chondral and osteochondral lesions in the knee, but the long-term outcome is unknown.

High Infection Control Rate and Function After Routine One-stage Exchange for Chronically Infected TKA

Jean-Yves Jenny MD, Bruno Barbe MD, Jeannot Gaudias MD, Cyril Boeri MD, Jean-Noël Argenson MD

Many surgeons consider two-stage exchange the gold standard for treating chronic infection after TKA. One-stage exchange is an alternative for infection control and might provide better knee function, but the rates of infection control and levels of function are unclear.

Higher Cefazolin Concentrations with Intraosseous Regional Prophylaxis in TKA

Simon W. Young FRACS, Mei Zhang PhD, Joshua T. Freeman FRCPA, Kelly G. Vince MD, Brendan Coleman FRACS

Prophylactic antibiotics reduce the risk of deep infection after primary TKA. However, conventional systemic dosing may not provide adequate tissue concentrations against more resistant organisms such as coagulase-negative staphylococci. Regional intravenous administration of antibiotics after tourniquet inflation achieves far higher tissue concentrations but requires foot vein cannulation. The intraosseous route may offer a rapid and reliable method of regional administration.

Failure of Irrigation and Débridement for Early Postoperative Periprosthetic Infection

Thomas K. Fehring MD, Susan M. Odum MEd, Keith R. Berend MD, William A. Jiranek MD, Javad Parvizi MD, Kevin J. Bozic MD, Craig J. Della Valle MD, Terence J. Gioe MD

Irrigation and débridement (I&D) of periprosthetic infection (PPI) is associated with infection control ranging from 16% to 47%. Mitigating factors include organism type, host factors, and timing of intervention. While the influence of organism type and host factors has been clarified, the timing of intervention remains unclear.

Predictors of Range of Motion in Patients Undergoing Manipulation After TKA

Harpreet S. Bawa MD, Glenn D. Wera MD, Matthew J. Kraay MS, MD, Randall E. Marcus MD, Victor M. Goldberg MD

Knee stiffness or limited range of motion (ROM) after total knee arthroplasty (TKA) may compromise patient function. Patients with stiffness are usually managed with manipulation under anesthesia (MUA) to improve ROM. However, the final ROM obtained is multifactorial and may depend on factors such as comorbidities, implant type, or the timing of MUA.

Computer-assisted Total Knee Arthroplasty Is Currently of No Proven Clinical Benefit: A Systematic Review

R. Stephen J. Burnett MD, FRCSCC, Robert L. Barrack MD

Navigated total knee arthroplasty (TKA) may improve coronal alignment outliers; however, it is unclear whether navigated TKA improves the long-term clinical results of TKA.

Does Humeral Lengthening With a Monolateral Frame Improve Function?

Abhijit Y. Pawar MD, Thomas H. McCoy MD, Austin T. Fragomen MD, S. Robert Rozbruch MD

Humeral lengthening by distraction osteogenesis historically has relied on bulky circular external fixators. Advances in fixator technology have allowed for the use of monolateral frames. However, it is unclear whether and to what degree function is improved after humeral lengthening.

Is Posterior Synovial Plica Excision Necessary for Refractory Lateral Epicondylitis of the Elbow?

In Hyeok Rhyou MD, Kang Wook Kim MD

Arthroscopic treatments for lateral epicondylitis including débridement of the extensor carpi radialis brevis (ECRB) origin (Baker technique) or resection of the radiocapitellar synovial plica reportedly improve symptoms. However the etiology of the disease and the role of the plica remain unclear.

Do Patients Lose Weight After Joint Arthroplasty Surgery? A Systematic Review

Maria C. S. Inacio MS, Donna Kritz-Silverstein PhD, Elizabeth W. Paxton MA, Donald C. Fithian MD

The ability of patients with a total joint arthroplasty (TJA) to lose weight after surgery has been investigated in a few studies with inconsistent results.

Is the Damage of Cartilage a Global or Localized Phenomenon in Hip Dysplasia, Measured by dGEMRIC?

Andreas Hingsammer MS, Jenny Chan MS, Leslie A. Kalish ScD, Tallal C. Mamisch MD, Young-Jo Kim MD, PhD

The mechanism of damage in osteoarthritis is believed to be multifactorial where mechanical and biological factors are important in its initiation and progression. Hip dysplasia is a classic model of increased mechanical loading on cartilage attributable to insufficient acetabular coverage that leads to osteoarthritis. If the damage is all attributable to direct mechanical damage then one initially would expect only local, not global changes.

Efficacy and Degree of Bias in Knee Injury Prevention Studies: A Systematic Review of RCTs

Nathan L. Grimm BS, Kevin G. Shea MD, Ryan W. Leaver DPT, Stephen K. Aoki MD, James L. Carey MD, MPH

Knee injury prevention programs have been developed to address the epidemic of knee injuries in young athletes. These programs include exercises that focus on balance, proprioception, and neuromuscular control. Some studies have suggested such specialized exercise programs may reduce the risk of knee injury.

Surgical Technique: Repair of Forefoot Skin and Soft Tissue Defects Using a Lateral Tarsal Flap With a Reverse Dorsalis Pedis Artery Pedicle: A Retrospective Study of 11 Patients

Dehao Fu MD, Liyi Zhou MD, Shuhua Yang MD, Baojun Xiao MD

Various authors have proposed flaps to reconstruct traumatic forefoot skin and soft tissue defects, especially with exposure of tendon and/or bone although which is best for particular circumstances is unclear.

Poor Long-term Clinical Results of Saddle Prosthesis After Resection of Periacetabular Tumors

J. A. Jansen MD, M. A. J. Sande PhD, P. D. S. Dijkstra PhD

The saddle prosthesis originally was developed to reconstruct large acetabular defects in revision hip arthroplasty and was used primarily for hip reconstruction after periacetabular tumor resections. The long-term survival of these reconstructions is unclear.

Case Report: Artificial Elevation of Prothrombin Time by Telavancin

Derek F. Amanatullah MD, PhD, Matthew J. Lopez BS, Robert C. Gosselin CLS, Munish C. Gupta MD

Methicillin-resistant Staphylococcus aureus infections are a well-documented risk of surgery and are becoming increasingly difficult to treat owing to continued acquired resistance. A new antibiotic for treatment of Staphylococcus aureus is telavancin.

Letter to Editor: Operating Room Traffic is a Major Concern During Total Joint Arthroplasty

Purnajyoti Banerjee MBBS, DOrth, MSc(orth), MRCSEd, Amin Kheiran MD, MRCSEd (Orthopaedic Core Trainee)
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