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Journal of Knee Surgery

Chukwuweike Gwam, Samuel Rosas, Rashad Sullivan, T David Luo, Cynthia L Emory, Johannes F Plate
The aim of this study was to assess (1) temporal trends, (2) primary indication, (3) patient-level demographics (age, race, gender, health status, and median income quartile), and (4) region and hospital type for all patients receiving primary total knee arthroplasty (TKA) between 2009 and the third quarter of 2015. The National Inpatient Sample Database (NIS) was used to identify all patients who underwent a TKA between 2009 and the third quarter of 2015. Regression analysis was utilized to assess trends. Chi-square analysis was used to explore categorical variables whereas Kruskal-Wallis test was used to explore nonparametric continuous variables...
February 15, 2019: Journal of Knee Surgery
Chao-Hua Fang, Cheng-Kung Cheng, Tie-Bing Qu, Jun-Hui Zhang, Bo Zhang, Qun Hua, Shi-Gui Yan
Rotational malalignment between the femoral and tibial components in total knee arthroplasty (TKA) can affect clinical outcomes, but there is no consensus on how to best determine tibia tray orientation. The posterolateral corner-locked (PLCL) technique may be a new method. This study aims to assess the applicability of this technique in a Chinese population. Forty normal Chinese volunteers were recruited and underwent computed tomography (CT) of the lower limbs. Knee model reconstructions and simulated standard tibial osteotomy were conducted digitally...
February 14, 2019: Journal of Knee Surgery
Michael E Steinhaus, Joshua Buksbaum, Avraham Eisenman, Monal Kohli, Austin T Fragomen, S Robert Rozbruch
Blood loss remains a significant source of morbidity and mortality in orthopaedic surgery, with transfusions associated with an increased risk of infection, length of stay, delayed rehabilitation, and significantly increased hospitalization costs. The purpose of this study was to assess whether the use of tranexamic acid (TXA) is effective in reducing postoperative blood loss in patients undergoing distal femoral osteotomy (DFO). A retrospective review was performed of all patients undergoing DFO by a single surgeon from 2010 to 2017, with a change in protocol occurring in 2014, after which all patients received TXA...
February 12, 2019: Journal of Knee Surgery
Hiba K Anis, Deepak Ramanathan, Nipun Sodhi, Alison K Klika, Nicolas S Piuzzi, Michael A Mont, Carlos A Higuera, Robert M Molloy
The ongoing debate on fixation in total knee arthroplasty (TKA) has become increasingly relevant with its increased use in a younger patient population and the advent of novel cementless prostheses. Recent literature suggests modern cementless implants are comparable to their cemented counterparts in terms of survivorship and functional outcomes. What has not been well-assessed is whether the two modalities differ with respect to infection rates which was the purpose of this study. Specifically, a propensity score matched study population was used to compare: (1) overall infection; (2) prosthetic joint infection (PJI); and (3) surgical site infection (SSI) rates between cementless and cemented TKAs...
February 12, 2019: Journal of Knee Surgery
Joicemar Tarouco Amaro, João Victor Novaretti, Diego Costa Astur, Elton Luiz Batista Cavalcante, Adilson Góes Rodrigues Junior, Pedro Debieux, Camila Cohen Kaleka, Moisés Cohen
The objective of this study was to determine in vivo knee kinematics and clinical outcomes of patients who underwent fixed- and mobile-bearing total knee arthroplasty (TKA) at 1- and 2-year follow-up. This prospective double-blinded randomized controlled trial was performed from November 2011 to December 2012. A total of 64 patients were randomized to fixed- and mobile-bearing TKA groups (32 patients in each group). All patients were evaluated with the following: three-dimensional in vivo knee kinematics analysis during gait, stepping up and stepping down stair steps, and getting up from and sitting on a chair; and knee range of motion and patient-reported outcome measures (Knee Outcome Survey Activities of Daily Living Scale [KOS-ADLS] and pain visual analog scale [VAS]) at 1- and 2-year follow-up...
February 12, 2019: Journal of Knee Surgery
Kelvin Kim, Kevin Chen, Afshin A Anoushiravani, Mackenzie Roof, William J Long, Ran Schwarzkopf
Unsafe opioid distribution remains a major concern among the total knee arthroplasty (TKA) population. Perioperative opioid use has been shown to be associated with poorer outcomes in patients undergoing TKA including longer length of stay (LOS) and discharges to extended care facilities. The current study aims to detail perioperative opioid use patterns and investigate the effects of preoperative chronic opioid use on perioperative quality outcomes in TKA patients. A retrospective analysis was performed on 338 consecutive TKAs conducted at our institution...
February 11, 2019: Journal of Knee Surgery
Adam S Driesman, William Macaulay, Ran Schwarzkopf
Successful arthroplasty of the knee requires a stable foundation for implant placement, adequate mechanical alignment, and durable fixation. In the revision setting, the later may be difficult to obtain, especially in the setting of significant bone loss. While augments, cones, and sleeves have greatly enhanced the modern knee surgeon's ability to gain fixation in metaphyseal bone, stems continue to be a cornerstone tool in revision arthroplasty to bypass deficient or damaged bone surfaces to enhance structural stability of a revision construct...
February 8, 2019: Journal of Knee Surgery
Steffen Schröter, Hiroshi Nakayama, Christoph Ihle, Atesch Ateschrang, Marco Maiotti, Jörg Harrer, Jörg Dickschas
This article provides an overview of symptomatic torsional deformities of the lower extremity, and operative treatment techniques are described in detail. A definition of torsion versus rotation as well as information to physical examination and the relevance of radiological evaluation is given. Based on current literature and the own personal experience of the authors in osteotomies, surgical techniques at the proximal and at the distal femur, as well as at the tibia are presented.
February 8, 2019: Journal of Knee Surgery
Jared M Newman, Nipun Sodhi, Joanne C Dekis, Anton Khlopas, Nicolas S Piuzzi, Assem A Sultan, Jay M Levin, Michael A Mont
The purpose of this meta-analysis was to assess the evidence supporting the use of cementless versus cemented total knee arthroplasties (TKAs). Specifically, we evaluated (1) all-cause survivorship, (2) aseptic survivorship, and (3) functional outcomes (Knee Society Scores [KSS], Oxford Knee Scores, Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] scores, and ranges of motion [ROMs]). A literature search was performed for studies that evaluated cementless versus cemented TKAs published between 2000 and 2017...
February 8, 2019: Journal of Knee Surgery
Michael J McAuliffe, Patrick B O'Connor, Lisa J Major, Gautam Garg, Sarah L Whitehouse, Ross W Crawford
Soft tissue balancing while crucial for a successful total knee arthroplasty (TKA) is incompletely defined and the subject of broad recommendations. We analyzed 69 unilateral computer-assisted surgery posterior stabilized (PS) TKA subjects who postoperatively scored ≥36 out of a possible 40 points on the satisfaction section of the American Knee Society score (2011). We examined a range of postoperative coronal plane laxity parameters and the correlation between preoperative and postoperative laxity. Total postoperative coronal laxity arcs at maximum extension and 20 degrees of flexion varied between 2 and 12 and 3 and 13 degrees, respectively...
February 8, 2019: Journal of Knee Surgery
Hiroshi Inui, Shuji Taketomi, Ryota Yamagami, Kohei Kawaguchi, Keiu Nakazato, Sakae Tanaka
There have been many reports on the clinical outcomes of Oxford unicompartmental knee arthroplasty (UKA); however, none have investigated the influence of flexion angle after UKA on clinical outcomes. The objective of this study was to clarify the relationship between outcomes and the postoperative maximum flexion angle and reveal the necessary factors for maximum flexion angle ≥ 140 degrees which is considered necessary for Asian populations. We categorized 212 UKA patients into the following three groups based on the postoperative maximum flexion angle: group 1 had flexion angle ≥ 140 degrees in 80 patients (38%), group 2 had 130 degrees ≤ flexion angle < 140 degrees in 80 patients (38%), and group 3 had flexion angle < 130 degrees in 52 patients (24%)...
February 8, 2019: Journal of Knee Surgery
Adam I Edelstein, Surabhi Bhatt, Josh Wright-Chisem, Ryan Sullivan, Matt Beal, David W Manning
Up to 20% of total knee arthroplasty (TKA) patients report dissatisfaction with their outcome, especially with weight-bearing in flexion (WBiF) activities. Sagittal plane instability may contribute to dissatisfaction following TKA. We assessed the impact of implant design on TKA sagittal plane stability and clinical satisfaction. We randomized patients to receive one of two TKA implant designs: medial-stabilized (MS) or posterior-stabilized (PS). Sagittal stability was assessed using a KT-1000 arthrometer. Patient-reported outcome measures, including a custom bank of questions targeting patient satisfaction (0-100%) with WBiF activities, were administered to patients 2 years following surgery...
February 8, 2019: Journal of Knee Surgery
B Christian Balldin, Clayton W Nuelle, Thomas D DeBerardino
Increased laxity within the graft construct system can lead to graft failure after anterior cruciate ligament (ACL) reconstruction. Suboptimal cortical device positioning could lead to increased laxity within the system, which could influence the mechanics and function of the graft reconstruction. This study evaluates the benefit of intraoperative fluoroscopy to confirm device position on the femur during ACL reconstruction using cortical suspensory fixation. One hundred consecutive patients who underwent soft tissue ACL reconstruction using a suspensory cortical device for femoral fixation were retrospectively evaluated...
February 8, 2019: Journal of Knee Surgery
Kavin Sundaram, Juan S Vargas-Hernández, Tomas Roca Sanchez, Nestor Moreno Moreu, Michael A Mont, Carlos A Higuera, Nicolas S Piuzzi
Knee osteoarthritis (OA) is a highly prevalent disease and treatment options for early stages of OA are needed. Intraosseous injections of bone substitute and biologic materials have been proposed to expand the therapeutic arsenal by potentially halting OA progression and delaying the need for knee arthroplasty in patients with early/moderate-stage disease. Therefore, the goal of this study was assessed the efficacy and safety of subchondral intraosseous injection for the treatment of knee OA. A systematic review was performed on PubMed-Medline, and the Cochrane Database of systematic reviews...
February 6, 2019: Journal of Knee Surgery
Dimitri M Thomas, James P Stannard, Ferris M Pfeiffer, James L Cook
This study compares bioabsorbable nail to metal screw fixation of shell osteochondral allograft (OCAs) for compression and shear strength. Cadaveric distal femurs ( n  = 5) yielding six 1.5 cm shell grafts ( n  = 30) were used. Three different fixation methods (2.0 and 2.4 mm headed screws, and copolymer absorbable nail) were compared for statistically significant differences ( p  < 0.05) in contact area, contact pressure, and shear load-to-failure. No significant differences in contact areas existed among groups (224 ± 33...
February 6, 2019: Journal of Knee Surgery
Assem A Sultan, Bilal Mahmood, Linsen T Samuel, Kim L Stearns, Robert M Molloy, Joseph T Moskal, Viktor E Krebs, Steven F Harwin, Michael A Mont
Newer generation cementless total knee arthroplasty (TKA) implants continue to develop with demonstrated clinical success in multiple recent reports. The purpose of this study was to investigate (1) survivorship, (2) complications, and (3) clinical outcomes of a newer generation cementless and highly porous titanium-coated base plate manufactured using three-dimensional (3D) printing technology. We reviewed a single-surgeon, longitudinally maintained database of patients who underwent primary TKA using cementless, highly porous titanium-coated base plate implants from July 1, 2013 to December 31, 2016...
February 6, 2019: Journal of Knee Surgery
Kelly M Rogers, Daniel C Berman, Justin W Griffin, Kevin F Bonner
The purpose of this study was to assess potential gender differences in size of the lateral and medial trochlea of the male and female knee as well as the variation within gender of potential osteochondral autograft transfer (OAT) donor site area. Two hundred and twelve skeletally mature patients, 106 males and 106 females, who underwent a 3T magnetic resonance imaging of the knee for a variety of indications were utilized for analysis. Exclusion criteria included degenerative arthritis, trochlear dysplasia, and poor image quality...
February 6, 2019: Journal of Knee Surgery
Anand Padmanabha, Michael T Li, David J Tybor, Eric L Smith
Incidences and risk factors for tibial component oversizing in total knee arthroplasty (TKA) have been well described, predominantly in Caucasian samples. Component oversizing has been linked to variations in proximal tibial shape and morphology, which has been found to be objectively different in African Americans compared with Caucasians. These anthropometric differences may affect the conformity of modern TKA systems to the anatomy of African Americans undergoing TKA. We sought to investigate the incidence and risk factors for tibial baseplate oversizing in an exclusively African American population undergoing TKA with a symmetric tibial baseplate...
February 6, 2019: Journal of Knee Surgery
Hu Li, Danielle Y Ponzio, Alvin Ong, Wei Wei, Baicheng Wang, Zhichang Li, Diange Zhou
Total knee arthroplasty (TKA) for patients with valgus deformity (> 10 degrees) is technically challenging and has produced variable clinical results in terms of deformity correction, instability, and overall outcomes. The lateral parapatellar approach (LPA) is an alternative to the traditional medial parapatellar approach with potential advantages of direct access for release of tight lateral ligamentous structures with preservation of the medial structures, optimized patellar tracking, preserved medial blood supply to the patella, and less use of constrained implants...
February 6, 2019: Journal of Knee Surgery
Sohrab Keyhani, Behzad Hanafizadeh, René Verdonk, Mohammadreza Minator Sajjadi, Mehran Soleymanha
Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding enterprise. Management of widened or previously malpositioned tunnels is challenging and often requires innovative approaches. The purpose of this study was to evaluate the function and clinical results of revision single-stage ACL surgery using an anterolateral tibial tunnel (ALTT). A consecutive series of knees with arthroscopic ACL revision surgery were analyzed prospectively between April 2012 and September 2015. Among the 93 patients presented with revision ACL reconstruction, 25 patients met the study inclusion criteria for the ALTT technique and were followed up for a minimum of 2 years (range: 24-51 months)...
February 6, 2019: Journal of Knee Surgery
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