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Journal of Knee Surgery

Taylor M Southworth, Neal B Naveen, Tracy M Tauro, Natalie L Leong, Brian J Cole
With average life expectancy and the rising prevalence of obesity, osteoarthritis (OA) is creating an increasingly large financial and physical burden on the U.S. population today. As the body ages and experiences trauma, articular cartilage surfaces in joints are gradually worn away, leading to OA. Traditionally, treatment options have included lifestyle modifications, pain management, and corticosteroid injections, with joint replacement reserved for those who have exhausted nonsurgical measures. More recently, hyaluronic acid, micronized dehydrated human amniotic/chorionic membrane tissue, and platelet-rich plasma (PRP) injections have started to gain traction...
November 13, 2018: Journal of Knee Surgery
Eleni Pappa, Nikolaos Vergados, Emanouil Spiridakis, George Chountas, Anna Apostolopoulou, Savas Sourmelis
Perioperative blood management is essential to minimize allogeneic blood transfusion in total knee replacement. The effect of preoperative administration of erythropoietin, intraoperative cell saver, tranexamic acid, and restrictive transfusion strategies on allogeneic transfusion is studied in total knee replacement. A retrospective comparative study of 106 patients who underwent total knee replacement in different time periods was performed. Group A ( n 1  = 45) underwent restrictive strategies of transfusion between 2009 and 2010...
November 13, 2018: Journal of Knee Surgery
George L Vestermark, Manoshi Bhowmik-Stoker, Bryan D Springer
Advances in mobile device technology combined with the implementation of surgical simulation have led to the development of novel applications (apps) as a potential learning tool for surgical trainees. Touch Surgery (TS) (Kinosis Limited, London, United Kingdom) is a mobile-based app that combines cognitive task analysis with a virtual reality medium to familiarize the user with a surgical procedure through interactive rehearsal. The purpose of this study was to compare the educational efficacy of the TS app with a traditional paper-based learning program in performing a robotic arm-assisted unicompartmental knee arthroplasty...
November 10, 2018: Journal of Knee Surgery
Yoshinori Inou, Tetsuya Tomita, Dai Kiyotomo, Hideki Yoshikawa, Kazuomi Sugamoto
In this study, the effects of tibial bone cutting on the attachment area of the posterior cruciate ligament (PCL), including both the anterolateral bundle (ALB) and posteromedial bundle (PMB), in cruciate-retaining total knee arthroplasty (CR-TKA) were simulated using a three-dimensional (3D) model of the tibial reconstruction. A total of 40 knees with medial osteoarthritis in patients scheduled for TKA were evaluated. Following surface registration of 3D computed tomography (CT) and 3D magnetic resonance imaging (MRI) models of the tibia with the PCL, the area of PCL attachment was calculated...
November 10, 2018: Journal of Knee Surgery
James E Feng, Afshin A Anoushiravani, Jacob Ziegler, Ran Schwarzkopf, William J Long
Total knee arthroplasty (TKA) has been established as the most effective treatment for end-stage, symptomatic osteoarthritis of the knee. However, improper polyethylene size selection has been proposed to predispose patients to postoperative stiffness following TKA. The aim of this study is to evaluate if there is a correlation between the use of the thinnest tibial implant thickness and implant manufacturer with the likelihood of undergoing manipulation under anesthesia (MUA). A retrospective review of unilateral TKAs performed between January 2012 and November 2015 was performed...
November 10, 2018: Journal of Knee Surgery
Trevor J Shelton, Stephen M Howell, Maury L Hull
We hypothesized that a total knee arthroplasty (TKA) with an intraoperative tibial force greater than the tibial force of the native knee has signs of stiffness as measured by loss of extension and flexion, and anterior translation of the tibia. Intraoperative forces in the medial and lateral tibial compartments were measured during passive motion in 71 patients treated with calipered kinematically aligned TKA. Maximum extension, flexion, and the anterior-posterior position of the tibia with respect to the distal femur at 90 degrees of flexion were measured...
November 9, 2018: Journal of Knee Surgery
Michele Malavolta, Andrea Cochetti, Silvio Mezzari, Alberto Residori, Gianpietro Lista
Intraoperative patellar position (eversion, lateralization, or in situ) influences the ligamentous balancing in knee flexion and thereby the correct positioning of the femoral component during total knee arthroplasty. The correct ligament balancing is crucial when, as in our experience, prostheses with medial pivot design are used. It was shown that the flexion gap in the normal knee is not rectangular and that the lateral compartment is significantly slacker than the medial. Therefore, to obtain a correct kinematics of a medial pivot anatomical prosthesis, it is essential to recreate an anatomical flexion gap slacker in the lateral compartment...
November 9, 2018: Journal of Knee Surgery
Aatif Mahmood, Thomas Fursdon, Viju Peter, Gunasekaran Kumar
Position of the knee may affect the range of movement (ROM) after a total knee replacement (TKR). It has been postulated that wound closure in extension may cause shortening of the extensor mechanism and increased tension on the soft tissues. The aim of this study was to determine effect of wound closure in TKR with the knee in flexion or extension on postoperative ROM and rehabilitation. A consecutive series of 121 patients underwent primary TKR between May 2011 and August 2012. Group A (60 patients) had wound closure in extension...
November 9, 2018: Journal of Knee Surgery
Masahiro Hasegawa, Shine Tone, Yohei Naito, Hiroki Wakabayashi, Akihiro Sudo
The present study aimed to define the prevalence of pain persisting after total knee arthroplasty (TKA) and determine the impact of neuropathic pain. Knee pain after TKA was evaluated in 154 patients (222 knees with osteoarthritis) using a numerical rating scale (NRS) and followed up for a mean of 4.7 years. The patients were classified according to whether they had no or mild pain (NRS ≤ 3), or moderate-to-severe pain (NRS > 3), and then assigned to groups with nociceptive, unclear, or neuropathic pain based on responses to painDETECT questionnaires...
November 9, 2018: Journal of Knee Surgery
Lasun O Oladeji, James L Cook
Knee osteoarthritis (OA) is a common condition associated with pain and physical impairment in a large segment of the population. The traditional treatment algorithm progresses from conservative modalities to nonsurgical options to surgical intervention. Surgical intervention often provides reliable pain relief but not all patients are surgical candidates and there are some patients who prefer not to have surgery. Cooled radio frequency ablation (C-RFA) is a treatment with the potential to provide pain relief for patients who no longer benefit from noninvasive modalities and who desire an alternative to surgery...
November 5, 2018: Journal of Knee Surgery
Yoshinobu Uchihara, Yusuke Inagaki, Mitsuru Munemoto, Yasuhito Tanaka, Nicholas Athanasou
Tissues from a periprosthetic joint infection (PJI) of the knee contain a heavy neutrophil polymorph (NP) infiltrate (> 5 NPs per high-powered field [HPF] by Musculoskeletal Infection Society [MSIS] criteria). PJI of the knee can be treated by a two-stage procedure and our aim was to determine whether the MSIS histological criteria for PJI diagnosis are valid in a second-stage revision knee arthroplasty. Periprosthetic tissues from 45 second-stage revision knee cases were analyzed histologically by hematoxylin-eosin and chloroacetate esterase (CAE) staining for the identification of NPs...
November 5, 2018: Journal of Knee Surgery
Davidson A Sacolick, James C Kirven, Moneer M Abouljoud, Joshua S Everhart, David C Flanigan
We sought to evaluate the effectiveness of autologous chondrocyte implantation (ACI) for the treatment of adult osteochondritis dissecans (OCD) lesions according to patient-reported outcomes, complication rates, and failure rates. A search of MEDLINE, Scopus, and Cochrane Library was performed to identify clinical studies (levels I-IV) reporting outcomes after ACI treatment for OCD in adult knees. Our inclusion criteria included the following: (1) published between January 2000 and April 2017, (2) stable and unstable OCD lesions of the knee, (3) use of ACI in at least one group, (4) subjects ≥18 years old or skeletally mature, (5) inclusion of at least one patient-reported clinical outcome measure, and (6) written in English...
November 5, 2018: Journal of Knee Surgery
Ryutaku Kaneyama, Hidetaka Higashi, Kazuhiro Oinuma, Yoko Miura, Tatsuya Tamaki, Hideaki Shiratsuchi
To provide adequate gaps for knee extension and flexion during total knee arthroplasty, a femoral component placement decreases the extension gap because the posterior capsule tension increases against the protrusion of the posterior part of the femoral component. We thought that the influence of this component on the extension gap depends on the amount of posterior femoral bone resection and the thickness of the posterior femoral components. We hypothesized that less bone resection and a thinner posterior part of the femoral component might avoid these problems...
November 5, 2018: Journal of Knee Surgery
Chukwuweike U Gwam, Nicole E George, Jennifer I Etcheson, Samuel Rosas, Johannes F Plate, Ronald E Delanois
Cemented fixation has been the gold standard in total knee arthroplasty (TKA). However, with younger and more active patients requiring TKA, cementless (press-fit) fixation has sparked renewed interest. Therefore, we investigated differences in (1) patient demographics, (2) inpatient costs, (3) short-term complications, and (4) discharge disposition between patients who underwent TKA with cemented and cementless fixation. The National Inpatient Sample database was queried for TKA patients with cement or cementless fixation between October 1 and December 31, 2015...
November 5, 2018: Journal of Knee Surgery
Tyler Britten, Jonathan D Hughes, Yolanda Munoz Maldonado, Kirby D Hitt
Single-dose long-acting periarticular anesthetics have been shown to be an effective method of postoperative analgesia in total knee arthroplasty (TKA). This study retrospectively compares the efficacy of multimodal periarticular injection consisting of a combination of ropivacaine, duramorph, epinephrine, and toradol (HC) with liposomal bupivacaine (LB) periarticular injection in TKA. This study was a retrospective matched comparative chart review of two cohorts of patients who underwent TKA within a single health care system and cared for by one provider...
November 5, 2018: Journal of Knee Surgery
Grace Schumer, John W Mann, Matthew David Stover, John F Sloboda, Carol Sue Cdebaca, Gina Moss Woods
Liposomal bupivacaine has reportedly been used as an adjunct for perioperative pain management in total knee replacement (TKR). The purpose of our single-blind, prospective study is to show that wound infiltration with long-acting liposomal bupivacaine during TKR will shorten length of stay (LOS) as compared with standard bupivacaine injection and spinal anesthetic with or without spinal narcotic. A total of 195 patients were randomized into three groups: wound infiltration with bupivacaine and a spinal with narcotic (Group 1, N  = 65), wound infiltration with liposomal bupivacaine and a spinal without narcotic (Group 2, N  = 67), and bupivacaine wound infiltration with a spinal without narcotic (Group 3, N  = 64)...
October 29, 2018: Journal of Knee Surgery
Dimitrios S Evangelopoulos, Sufian S Ahmad, Anna M Krismer, Christoph E Albers, Sven Hoppe, Barbara Kleer, Sandro Kohl, Atesch Ateschrang
Revision total knee arthroplasty (RTKA) represents an effective treatment for failed TKA, but with less favorable outcomes. Considering the technical complexity and economic burden of RTKA procedures, it is mandatory to investigate current mechanisms and predictors for RTKA failure. The objective of this study is to evaluate the survivorship and determine the predominant causes of failure of RTKA. A total of 146 patients undergoing RTKA between 2003 and 2013 were identified from the institutional database. Revision was defined as surgery in which the whole prostheses (inlay and both femoral and tibial components) required exchange...
October 18, 2018: Journal of Knee Surgery
Felix Greimel, Günther Maderbacher, Clemens Baier, Timo Schwarz, Florian Zeman, Winfried Meissner, Joachim Grifka, Achim Benditz
In the recent past, numerous studies evaluating local infiltration analgesia (LIA) with controversial results have been reported. Efforts have been made to improve patients' outcome regarding operation techniques and material, as well as pain management and anesthetic methods. In this study, postoperative pain management and patient satisfaction were evaluated in patients undergoing total knee replacement surgery with or without intraoperative LIA. Within the context of the "Quality Improvement in Postoperative Pain Management" (QUIPS) project, parameters were collected on the first postoperative day...
October 6, 2018: Journal of Knee Surgery
Mohamed Omar, Yousif Al Saiegh, Emmanouil Liodakis, Timo Stuebig, Daniel Guenther, David Steimer, Nael Hawi, Christian Krettek, Eduardo M Suero
We aimed to investigate how increased or decreased femoral antetorsion would affect the biomechanics of the knee in an anterior cruciate ligament (ACL)-deficient cadaveric model. We hypothesized that external or internal rotation of the distal femur, achieved through a femoral osteotomy, would affect the magnitude of tibiofemoral translation and rotation. Navigated measurements of tibiofemoral translation and rotation during the anterior drawer, Lachman, and pivot shift tests were performed on six whole-body cadaveric specimens in each of the following four conditions: native, ACL-deficient knee, ACL-deficient knee and 20-degree internal distal femur rotation, and ACL-deficient knee and 20-degree external distal femur rotation...
October 3, 2018: Journal of Knee Surgery
Yoshinori Hiyama, Tsukasa Kamitani, Kazuaki Mori
Life-space mobility describes the spatial areas through which an individual moves, and the frequency and need for assistance. Although patients with knee osteoarthritis (OA) have shown restricted life-space mobility, total knee arthroplasty (TKA) does not improve it beyond preoperative levels. Life-space mobility after TKA was influenced by self-efficacy for walking tasks; thus, an intervention to improve self-efficacy for walking tasks may contribute to better life-space mobility. We provided a walking event including several walking tasks as the intervention...
October 3, 2018: Journal of Knee Surgery
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