Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 473 | Issue 1 | Jan, 2015

Is Single-stage Revision According to a Strict Protocol Effective in Treatment of Chronic Knee Arthroplasty Infections?

Fares Sami Haddad FRCS (Tr&O), Mohamed Sukeik MRCSEd, Sulaiman Alazzawi MRCSEd

The increasing number of patients experiencing periprosthetic total knee arthroplasty (TKA) infections and the cost of treating them suggest that we seek alternatives to two-stage revision. Single-stage revision is a potential alternative to the standard two-stage procedure because it involves only one surgical procedure, so if it is comparably effective, it would be associated with less patient morbidity and lower cost.

The Mark Coventry Award

Luis Pulido MD, Matthew P. Abdel MD, David G. Lewallen MD, Michael J. Stuart MD, Joaquin Sanchez-Sotelo MD, PhD, Arlen D. Hanssen MD, Mark W. Pagnano MD

Although highly porous metals have demonstrated excellent bone ingrowth properties and so are an intriguing option for fixation in total knee arthroplasty (TKA), some surgeons are skeptical about the durability of uncemented tibial fixation and the potential for soft tissues to adhere to these porous metals and perhaps cause knee stiffness or pain.

The Chitranjan Ranawat Award: Periarticular Injections and Femoral & Sciatic Blocks Provide Similar Pain Relief After TKA: A Randomized Clinical Trial

Mark J. Spangehl MD, Henry D. Clarke MD, Joseph G. Hentz MS, Lopa Misra MD, Joshua L. Blocher PA-C, David P. Seamans MD

Two of the more common methods of pain management after TKA are peripheral nerve blocks and intraarticular/periarticular injections. However, we are not aware of any study directly comparing the commonly used combination of a continuous femoral block given with a single-shot sciatic block with that of a periarticular injection after TKA.

The John Insall Award: Morbid Obesity Independently Impacts Complications, Mortality, and Resource Use After TKA

Michele R. D’Apuzzo MD, Wendy M. Novicoff PhD, James A. Browne MD

The importance of morbid obesity as a risk factor for complications after total knee arthroplasty (TKA) continues to be debated. Obesity is rarely an isolated diagnosis and tends to cluster with other comorbidities that may independently lead to increased risk and confound outcomes. It is unknown whether morbid obesity independently affects postoperative complications and resource use after TKA.

Does Operative Time Affect Infection Rate in Primary Total Knee Arthroplasty?

Sameer Naranje MD, Lisa Lendway PhD, Susan Mehle BS, Terence J. Gioe MD

Prolonged operative time may increase the risk of infection after total knee arthroplasty (TKA). Both surgeon-related and patient-related factors can contribute to increased operative times.

The KSS 2011 Reflects Symptoms, Physical Activities, and Radiographic Grades in a Japanese Population

Naoya Taniguchi MD, Shuichi Matsuda MD, PhD, Takahisa Kawaguchi MS, Yasuharu Tabara PhD, Tome Ikezoe PhD, Tadao Tsuboyama MD, PhD, Noriaki Ichihashi PhD, Takeo Nakayama MD, PhD, Fumihiko Matsuda PhD, Hiromu Ito MD, PhD

Cultural and ethnic differences are present both in subjective and objective measures of patient health, but scoring systems do not always reflect these differences, and so validation of outcomes tools in different cultural settings is important. Recently, a revised version of The Knee Society Score(KSS 2011) was developed, but to our knowledge, the degree that this tool evaluates clinical symptoms, physical activities, and radiographic grades in the general Japanese population is not known.

Preoperative Pain and Function Profiles Reflect Consistent TKA Patient Selection Among US Surgeons

David C. Ayers MD, Wenjun Li PhD, Leslie Harrold MD, MPH, Jeroan Allison MD, MS, Patricia D. Franklin MD, MBA, MPH

As the number of primary total knee arthroplasties (TKAs) performed in the United States increases, policymakers have questioned whether the indications and timing of TKA have evolved so that surgery is offered earlier.

Intraoperative Angiography Provides Objective Assessment of Skin Perfusion in Complex Knee Reconstruction

Cody C. Wyles BS, Michael J. Taunton MD, Steven R. Jacobson MD, Nho V. Tran MD, Rafael J. Sierra MD, Robert T. Trousdale MD

Wound necrosis is a potentially devastating complication of complex knee reconstruction. Laser-assisted indocyanine green angiography (LA-ICGA) is a technology that has been described in the plastic surgery literature to provide an objective assessment of skin perfusion in the operating room. This novel technology uses a plasma protein bound dye (ICG) and a camera unit that is calibrated to view the frequency emitted by the dye. The intention of this technology is to offer real-time visualization of blood flow to skin and soft tissue in a way that might help surgeons make decisions about closure or coverage of a surgical site based on blood flow, potentially avoiding soft tissue reconstruction while preventing skin necrosis or wound breakdown after primary closures, but its efficacy is untested in the setting of complex TKA.

The Risk of Revision After TKA Is Affected by Previous HTO or UKA

Otto Robertsson MD, PhD, Annette W-Dahl RN, PhD

High tibial osteotomy (HTO) and unicompartmental arthroplasty (UKA) are reconstructive surgeries advocated for younger patients. In case of failure or progression of osteoarthritis, they can both be converted to a total knee arthroplasty (TKA).

What Can Be Learned From Minimum 20-year Followup Studies of Knee Arthroplasty?

John J. Callaghan MD, Christopher T. Martin MD, Yubo Gao PhD, Andrew J. Pugely MD, Steve S. Liu MD, Devon D. Goetz MD, Scott S. Kelley MD, Richard C. Johnston MD

Long-term evaluation of knee arthroplasty should provide relevant information concerning the durability and performance of the implant and the procedure. Because most arthroplasties are performed in older patients, most long-term followup studies have been performed in elderly cohorts and have had low patient survivorship to final followup; the degree to which attrition from patient deaths over time in these studies might influence their results has been poorly characterized.

New Total Knee Arthroplasty Designs: Do Young Patients Notice?

Ryan M. Nunley MD, Denis Nam MD, Keith R. Berend MD, Adolph V. Lombardi MD, Douglas A. Dennis MD, Craig J. Della Valle MD, Robert L. Barrack MD

Although the volume of total knee arthroplasties (TKAs) performed in the United States continues to increase, recent reports have shown the percentage of patients who remain “unsatisfied” is as high as 15% to 30%. Recently, several newer implant designs have been developed to potentially improve patient outcomes.

Cruciate-retaining TKA Is an Option in Patients With Prior Patellectomy

Keith R. Reinhardt MD, Stephen J. Huffaker MD, PhD, Thomas S. Thornhill MD, Richard D. Scott MD

The recommendation for using posterior-stabilized (PS) implants in patellectomy patients undergoing total knee arthroplasty (TKA) is based on older case series with heterogeneous patient populations. The use of cruciate-retaining implants in these patients has not been evaluated with more contemporary implant designs.

How Precise Is Computer-navigated Gap Assessment in TKA?

James B. Stiehl MD, David A. Heck MD

Methods to improve gap balancing in total knee arthroplasty (TKA) include the development of calibrated distractors and various devices to determine the distances of the gaps. However, few studies have validated the accuracy or precision of computer navigation to determine these measurements, especially gaps created after bone cuts have been made; doing so would be important, because optimal surgical technique relies on appropriate gap spacing.

Infrapatellar Saphenous Neuralgia After TKA Can Be Improved With Ultrasound-guided Local Treatments

Steven Clendenen MD, Roy Greengrass MD, Joseph Whalen MD, PhD, Mary I. O’Connor MD

Current opinion suggests that in some patients, chronic pain after total knee arthroplasty (TKA) has a neuropathic origin. Injury to the infrapatellar branch of the saphenous nerve (IPSN) has been implicated as a cause of medial knee pain; however, local treatments for this condition remain controversial.

A New Method for Calculating Femoral Anterior Cortex Point Location and Its Effect on Component Sizing and Placement

Mohamed R. Mahfouz PhD, Emam ElHak Abdel Fatah PhD, Lyndsay Bowers MSc, Giles Scuderi MD

Variation in anterior femoral cortex morphology can cause improper component placement and alignment. When surgical inaccuracies occur, the mechanical properties of the distal femur may be altered, which could result in lower surgical success rates and an increased chance of postoperative complications.

How Do Knee Implants Perform Past the Second Decade? Nineteen- to 25-year Followup of the Press-fit Condylar Design TKA

Shantanu Patil MD, Julie C. McCauley MPHc, Pamela Pulido BSN, Clifford W. Colwell MD

At 14- to 17-year followup, we reported successful outcomes of the Press-fit Condylar total knee arthroplasty (TKA) system in 160 TKAs performed between 1986 and 1989. However, there are few published reports on TKA survivorship and patient function that include patients evaluated into the third decade after surgery.

Do Various Factors Affect the Frequency of Manipulation Under Anesthesia After Primary Total Knee Arthroplasty?

Kimona Issa MD, Aiman Rifai MD, Matthew R. Boylan ScB, Sina Pourtaheri MD, Vincent K. McInerney MD, Michael A. Mont MD

One of the most important goals of primary total knee arthroplasty (TKA) is to achieve a functional range of motion (ROM). However, up to 20% of patients fail to do so, which can impair activities of daily living.

Systematic Review of Patient-specific Instrumentation in Total Knee Arthroplasty: New but Not Improved

Adam Sassoon MD, Denis Nam MD, Ryan Nunley MD, Robert Barrack MD

Patient-specific cutting blocks have been touted as a more efficient and reliable means of achieving neutral mechanical alignment during TKA with the proposed downstream effect of improved clinical outcomes. However, it is not clear to what degree published studies support these assumptions.

What Is the Role of Mental Health in Primary Total Knee Arthroplasty?

Carlos J. Lavernia MD, Jesus M. Villa MD, David A. Iacobelli MD

Psychological distress has been associated with inferior scores for pain after total knee arthroplasty (TKA). However, its relationships with scores and arthrofibrosis after TKA remain unclear.

Correlation of Knee and Hindfoot Deformities in Advanced Knee OA: Compensatory Hindfoot Alignment and Where It Occurs

Adam A. Norton BA, John J. Callaghan MD, Annunziato Amendola MD, Phinit Phisitkul MD, Siwadol Wongsak MD, Steve S. Liu MD, Catherine Fruehling-Wall BA

Many patients undergoing TKA have both knee and ankle pathology, and it seems likely that some compensatory changes occur at each joint in response to deformity at the other. However, it is not fully understood how the foot and ankle compensate for a given varus or valgus deformity of the knee.

Is Potential Malnutrition Associated With Septic Failure and Acute Infection After Revision Total Joint Arthroplasty?

Paul H. Yi MD, Rachel M. Frank MD, Elliott Vann MD, Kevin A. Sonn MD, Mario Moric MS, Craig J. Della Valle MD

Although malnutrition has been hypothesized to increase the risk of periprosthetic joint infection (PJI), strong evidence linking the two is lacking.

A 30-mm Cemented Stem Extension Provides Adequate Fixation of the Tibial Component in Revision Knee Arthroplasty

Paul F. Lachiewicz MD, Elizabeth S. Soileau BSN

The optimal stem length and method of fixation for the tibial component in revision knee arthroplasty remains controversial. The use of a cemented 30-mm stem extension provides certain advantages compared with other methods of fixation, but there are few published results.

Perioperative Morbidity and Mortality of Same-admission Staged Bilateral TKA

Lazaros A. Poultsides MD, Stavros G. Memtsoudis MD, Huong T. Do MA, Thomas P. Sculco MD, Mark P. Figgie MD

Controversy continues regarding the optimal timing of surgery for patients with symptomatic bilateral degenerative knee arthritis who are not considered eligible for same-day bilateral TKA (BTKA).

The Alpha-defensin Test for Periprosthetic Joint Infection Outperforms the Leukocyte Esterase Test Strip

Carl Deirmengian MD, Keith Kardos PhD, Patrick Kilmartin MS, Alexander Cameron BS, Kevin Schiller BS, Robert E. Booth MD, Javad Parvizi MD, FRCS

Synovial fluid biomarkers have demonstrated diagnostic accuracy surpassing the currently used diagnostic tests for periprosthetic joint infection (PJI).

High Degree of Accuracy of a Novel Image-free Handheld Robot for Unicondylar Knee Arthroplasty in a Cadaveric Study

Jess H. Lonner MD, Julie R. Smith PhD, Frederic Picard MD, Brian Hamlin MD, Philip J. Rowe PhD, Philip E. Riches PhD

Surgical robotics has been shown to improve the accuracy of bone preparation and soft tissue balance in unicondylar knee arthroplasty (UKA). However, although extensive data have emerged with regard to a CT scan-based haptically constrained robotic arm, little is known about the accuracy of a newer alternative, an imageless robotic system.

Are Revisions of Patellofemoral Arthroplasties More Like Primary or Revision TKAs

Sébastien Parratte MD, PhD, Alexandre Lunebourg MD, Matthieu Ollivier MD, Matthew P. Abdel MD, Jean-Noël A. Argenson MD, PhD

Patellofemoral arthroplasty (PFA) can be considered in patients with patellofemoral disease. However, the use of partial arthroplasty often causes concern among clinicians and patients that revision to total knee arthroplasty (TKA) will be needed and, if so, whether this revision will be straightforward or more complicated.

Does Increased Topside Conformity in Modular Total Knee Arthroplasty Lead to Increased Backside Wear?

Ran Schwarzkopf MD, MSc, Richard D. Scott MD, Evan M. Carlson MSc, John H. Currier MSc

Modular metal-backed tibia components allow surgeons intraoperative flexibility. Although it is known that modular tibia components introduce the possibility for backside wear resulting from relative motion between the polyethylene insert and the tibial baseplate, it is not known to what degree variability in the conformity of the tibial polyethylene liner itself might contribute to backside wear.

Muscle Fibers are Injured at the Time of Acute and Chronic Rotator Cuff Repair

Max E. Davis BA, Patrick L. Stafford BS, Matthew J. Jergenson, Asheesh Bedi MD, Christopher L. Mendias PhD, ATC

Rotator cuff tears are a common source of shoulder pain and disability. Even after surgical repair, some patients continue to have reduced function and progression of fatty degeneration. Because patients with chronic cuff tears often experience muscle shortening, it is possible that repairing the tendon to its anatomic footprint induces a stretch-induced muscle injury that could contribute to failures of the repair and perhaps ongoing pain.

Does Sequence of Graft Tensioning Affect Outcomes in Combined Anterior and Posterior Cruciate Ligament Reconstructions?

Sung-Jae Kim MD, PhD, Sung-Hwan Kim MD, Min Jung MD, Jong-Min Kim MD, Se-Won Lee MD

Controversy persists regarding the protocol for tensioning and securing the grafts in one-stage reconstruction of combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries. Many authors have reported stability examinations and functional results after reconstruction for this relatively rare injury, and the best sequence for tensioning the grafts is not known.

Abnormal Quantitative Sensory Testing is Associated With Persistent Pain One Year After TKA

Anthony Wright PhD, Penny Moss PhD, Karen Sloan MSc, Richard J. Beaver FRACS, Jarle B. Pedersen MClinPhysio, Gerard Vehof MClinPhysio, Henrik Borge MClinPhysio, Luca Maestroni MClinPhysio, Philip Cheong MManipTher

Up to 15% of patients report at least moderate persistent pain after TKA. Such pain may be associated with the presence of widespread hyperalgesia and neuropathic-type pain.

Patients With Knee Osteoarthritis Have a Phenotype With Higher Bone Mass, Higher Fat Mass, and Lower Lean Body Mass

Magnus K. Karlsson MD, PhD, Håkan Magnusson MD, PhD, Maria Cöster MD, Caroline Karlsson MD, PhD, Björn E. Rosengren MD, PhD

Although knee osteoarthritis (OA) is common, its etiology is poorly understood. Specifically, it is not known whether knee OA is associated with abnormal anthropometric and musculoskeletal characteristics known to be associated with OA in general. We recently studied this topic for patients with hip arthritis; however, it is important to evaluate it for knee OA separately, because there are reports indicating that patients with primary OA in different joints may have a different phenotype.

Do Laterally Wedged Insoles or Valgus Braces Unload the Medial Compartment of the Knee in Patients With Osteoarthritis?

Tijs Duivenvoorden MD, Tom M. Raaij MD, PhD, Herwin L. D. Horemans PhD, Reinoud W. Brouwer MD, PhD, P. Koen Bos MD, PhD, Sita M. A. Bierma-Zeinstra PhD, Jan A. N. Verhaar MD, PhD, Max Reijman PhD

The results of conservative treatment of knee osteoarthritis (OA) are generally evaluated in epidemiological studies with clinical outcome measures as primary outcomes. Biomechanical evaluation of orthoses shows that there are potentially beneficial biomechanical changes to joint loading; however, evaluation in relation to clinical outcome measures in longitudinal studies is needed.

Is There Material Loss at the Backside Taper in Modular CoCr Acetabular Liners?

Matthias T. Agne, Richard J. Underwood PhD, Sevi B. Kocagoz BS, Daniel W. MacDonald MS, Judd S. Day PhD, Javad Parvizi MD, Matthew J. Kraay MS, MD, Michael A. Mont MD, Gregg R. Klein MD, Harold E. Cates MD, Steven M. Kurtz PhD

Metal wear and corrosion products generated by hip replacements have been linked to adverse local tissue reactions. Recent investigations of the stem/head taper junction have identified this modular interface as another possible source of metal debris; however, little is known regarding other modular metallic interfaces, their ability to produce metal debris, and possibly to provide insight in the mechanisms that produce metal debris.

Patient Factors Are Associated With Poor Short-term Outcomes After Posterior Fusion for Adolescent Idiopathic Scoliosis

Bryce A. Basques BS, Daniel D. Bohl MPH, Nicholas S. Golinvaux BA, Brian G. Smith MD, Jonathan N. Grauer MD

Posterior spinal fusion (PSF) is commonly performed for patients with adolescent idiopathic scoliosis (AIS). Identifying factors associated with perioperative morbidity and PSF may lead to strategies for reducing the frequency of adverse events (AEs) in patients and total hospital costs.

Has the Incidence of Thoracolumbar Spine Injuries Increased in the United States From 1998 to 2011?

Andrea N. Doud MD, Ashley A. Weaver PhD, Jennifer W. Talton MS, Ryan T. Barnard MS, J. Wayne Meredith MD, Joel D. Stitzel PhD, Preston Miller MD, Anna N. Miller MD

While most motor vehicle crash (MVC)-related injuries have been decreasing, one study showed increases in MVC-related spinal fractures from 1994 to 2002 in Wisconsin. To our knowledge, no studies evaluating nationwide trends of MVC-related thoracolumbar spine injuries have been published. Such fractures can cause pain, loss of functionality or even death. If the incidence of such injuries is increasing, it may provide a motive for reassessment of current vehicle safety design.

Does Expression of Glucose Transporter Protein-1 Relate to Prognosis and Angiogenesis in Osteosarcoma?

Tadahiko Kubo MD PhD, Shoji Shimose MD PhD, Jun Fujimori MD PhD, Taisuke Furuta MD, Koji Arihiro MD PhD, Mitsuo Ochi MD PhD

The survival of patients who present with nonmetastatic extremity osteosarcoma has dramatically improved, but there are some patients who do not respond to chemotherapy. The ability to identify patients with a poorer prognosis might allow us to target different therapy for these patients. Glucose transporter protein-1 (Glut-1), one of the key factors in glucose metabolism, has been reported to be an independent prognostic factor in various tumors. However, little is known about the role of the Glut-1 pathway in osteosarcoma.

The PROMIS Physical Function Correlates With the QuickDASH in Patients With Upper Extremity Illness

Celeste L. Overbeek BSc, Sjoerd P. F. T. Nota MD, Prakash Jayakumar MD, Michiel G. Hageman MD, David Ring MD, PhD

To assess disability more efficiently with less burden on the patient, the National Institutes of Health has developed the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function—an instrument based on item response theory and using computer adaptive testing (CAT). Initially, upper and lower extremity disabilities were not separated and we were curious if the PROMIS Physical Function CAT could measure upper extremity disability and the Quick Disability of Arm, Shoulder and Hand (QuickDASH).

Does the Subtalar Joint Compensate for Ankle Malalignment in End-stage Ankle Arthritis?

Bibo Wang MD, Charles L. Saltzman MD, Ornusa Chalayon MD, Alexej Barg MD

Patients with ankle arthritis often present with concomitant hindfoot deformity, which may involve the tibiotalar and subtalar joints. However, the possible compensatory mechanisms of these two mechanically linked joints are not well known.

Osteodesis for Hallux Valgus Correction: Is it Effective?

Daniel Y. Wu MD, K. F. Lam PhD

Although the etiology of hallux valgus is contested, in some patients it may be failure of the stabilizing soft tissue structures around the first ray of the foot. Because there is lack of effective soft tissue techniques, osteotomies have become the mainstream surgical approach to compensate for the underlying soft tissue deficiency; osteodesis, a soft tissue nonosteotomy technique, may be a third alternative, but its efficacy is unknown.

Local Gentamicin Delivery From Resorbable Viscous Hydrogels Is Therapeutically Effective

Derek Overstreet PhD, Alex McLaren MD, Francis Calara BSE, Brent Vernon PhD, Ryan McLemore PhD

Local delivery can achieve the high antimicrobial concentrations necessary to kill biofilm-related microbes. Degradation times for resorbable carriers are too long. Hydrogels (gels of hydrophilic polymer in water) can degrade faster but release antimicrobials too quickly. We previously developed hydrogels based on the copolymer poly(N-isopropylacrylamide-co-dimethyl-γ-butyrolactone acrylate-co-JeffamineM-1000 acrylamide) (PNDJ) with delivery times of several days with complete degradation in less than 6 weeks.

Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites?

Thomas Sherman MD, Joseph Ferguson MD, William Davis MD, Matthew Russo MD, Evan Argintar MD

Therapeutic musculoskeletal injections require a clean or sterile skin preparation to minimize the risk of infections. Ultrasound guidance for this procedure requires the use of transmission gel in proximity to the injection site, and its effect on maintaining sterility is unknown.

Sex-specific Differences of the Infraacetabular Corridor: A Biomorphometric CT-based Analysis on a Database of 523 Pelves

Florian Gras PD Dr med, Heiko Gottschling Dr rer nat, Manuel Schröder Dipl Inf, Ivan Marintschev DM, Nils Reimers MBE, Rainer Burgkart PD Dr med

An infraacetabular screw path facilitates the closure of a periacetabular fixation frame to increase the plate fixation strength in acetabular fractures up to 50%. Knowledge of the variance in corridor sizes and axes has substantial surgical relevance for safe screw placement.

Can Therapy Dogs Improve Pain and Satisfaction After Total Joint Arthroplasty? A Randomized Controlled Trial

Carl M. Harper MD, Yan Dong PhD, Thomas S. Thornhill MD, John Wright MD, John Ready MD, Gregory W. Brick MD, George Dyer MD

The use of animals to augment traditional medical therapies was reported as early as the 9century but to our knowledge has not been studied in an orthopaedic patient population. The purpose of this study was to evaluate the role of animal-assisted therapy using therapy dogs in the postoperative recovery of patients after THA and TKA.

The Burden of Musculoskeletal Disease in Sierra Leone

Iain S. Elliott MD, Reinou S. Groen MD, MIH, Thaim B. Kamara MD (5), Allison Ertl MS, Laura D. Cassidy PhD, MS, Adam L. Kushner MD, MPH, Richard A. Gosselin MD, MPH, MSc

Musculoskeletal disease is a major cause of disability in the global burden of disease, yet data regarding the magnitude of this burden in developing countries are lacking. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey was designed to measure the incidence and prevalence of surgically treatable conditions, including musculoskeletal conditions, in patients in low- and middle-income countries, and was administered in the West African nation of Sierra Leone in 2012.

Erratum to: Are Quadrilateral Surface Buttress Plates Comparable to Traditional Forms of Transverse Acetabular Fracture Fixation?

Brian J. Kistler MD, Ian R. Smithson MD, Seth A. Cooper MD, Jacob L. Cox MD, Aniruddh N. Nayak MS, Brandon G. Santoni PhD, H. Claude Sagi MD
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