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Journal of Knee Surgery

Morad Chughtai, Anil Bhave, Sabahat Z Khan, Anton Khlopas, Osman Ali, Steven F Harwin, Michael A Mont
The use of a pneumatic unloader brace has been shown in pilot studies to decrease pain and increase muscle strength in patients with knee osteoarthritis (OA). Therefore, we analyzed patients who had knee OA, and either received a pneumatic unloader brace and conventional treatment or conventional treatment alone. Specifically, we assessed: (1) use of pain relieving injections; (2) opioid consumption; and (3) the eventual need for total knee arthroplasty (TKA) in the above-mentioned cohort. We performed an analysis of a longitudinally maintained database of patients from a prospective, randomized, single center study...
October 17, 2016: Journal of Knee Surgery
Anton Khlopas, Michael A Mont, Morad Chughtai, Robert Molloy, Prem N Ramkumar, Steven F Harwin
Revision total knee arthroplasty (TKA) can be challenging in the setting of bone loss. Previously, severe bone loss was managed with impaction grafting and structural allografts; however, these had limited success. Recently, metaphyseal cones have been developed as useful adjuncts with good early outcomes. Presently, there are no published guidelines on how to preoperatively predict the need for metaphyseal cone implantation radiographically. Therefore, the purpose of this study was to evaluate how well preoperative radiographs were able to predict the use of cones in a small series of patients undergoing revision TKA...
October 17, 2016: Journal of Knee Surgery
Nirav K Patel, Eric G Kim, Morad Chughtai, Anton Khlopas, Randa D K Elmallah, Steven F Harwin, Ronald E Delanois, Michael A Mont
Highly porous metaphyseal cones are used for the management of large bone defects in revision total knee arthroplasty. These cones fill defects and allow bony ongrowth while providing several sizing and offset options. In this case series, we evaluated three patients who received these latest generation metaphyseal cones. Specifically, these cases will be explored in detail with respect to history, indications, operative technique, and short-term outcomes. Overall, these newer generation porous coated cones are excellent options for large contained bone loss in the absence of infection, and they have demonstrated good clinical and radiological outcomes at short-term follow-up...
October 6, 2016: Journal of Knee Surgery
Jonathon Spanyer, Jay Patel, Eric Emberton, Langan S Smith, Arthur L Malkani
The purpose of this study was to evaluate the efficacy and safety profiles of topical tranexamic acid (TXA) in patients undergoing elective total knee arthroplasty (TKA) with comorbid conditions precluding them from intravenous (IV) TXA use. A total of 104 patients were divided into two groups: 47 in the normal-risk group and 57 in the high-risk group, with the latter representing those with one or more risk factors for venous thromboembolism (VTE). Demographics were similar between groups, and there were no differences with regard to postoperative changes in hemoglobin (- 3...
October 5, 2016: Journal of Knee Surgery
Genya Mitani, Takashi Maeda, Tomonori Takagaki, Kosuke Hamahashi, Kenji Serigano, Yutaka Nakamura, Masato Sato, Joji Mochida
Many groups have reported good to excellent clinical outcomes of the Elmslie-Trillat (ET) procedure for recurrent dislocation of the patella. However, the mean follow-up period of these studies was no more than 5 years. We hypothesized that the long-term postoperative outcomes of the modified ET procedure for recurrent dislocation of the patella would be acceptable compared with those of other procedures. The long-term postoperative outcomes of patients treated with the modified ET procedure were examined. A total of 31 knees in 27 patients with recurrent dislocation of the patella who underwent a modified ET procedure (without medial capsular plication) were evaluated...
October 3, 2016: Journal of Knee Surgery
Renn-Chia Lin, Ko-Huang Lue, Ko-Hsiu Lu
To evaluate whether arthroscopic lateral retinacular release and the modified Elmslie-Trillat operation improve osteoarthritis (OA) progression and clinical outcomes in patients with severe isolated lateral patello-femoral OA. Nine women (11 knees) and one man (one knee) with isolated late-stage lateral patello-femoral OA underwent surgery. The severity of patello-femoral OA was recorded using the Merchant method, while the level of pain and anterior knee function were scored using the visual analogue scale (VAS) and Kujala knee scores, respectively...
October 3, 2016: Journal of Knee Surgery
Jessica L Churchill, Kathleen E Puca, Elizabeth Meyer, Matthew Carleton, Michael J Anderson
Multiple studies have shown tranexamic acid (TXA) to reduce blood loss and transfusion rates in patients undergoing total knee arthroplasty (TKA). Accordingly, TXA has become a routine blood conservation agent for TKA. In contrast, ε-aminocaproic acid (EACA), a similar acting antifibrinolytic to TXA, has been less frequently used. This study evaluated whether EACA is as efficacious as TXA in reducing postoperative blood transfusion rates and compared the cost per surgery between agents. A multicenter retrospective chart review of elective unilateral TKA from April 2012 through December 2014 was performed...
October 3, 2016: Journal of Knee Surgery
Jason Scalise, Michael Dunbar, David Jacofsky
Given the increasing emphasis in health care on improving outcomes, reproducible results, and creating value for the patient, orthopedic surgery in particular must necessarily continue to progress away from an individualized and a surgeon-specific technical craft and toward a highly automated and computer-integrated process in which surgeon and digitized systems interact to provide the most reproducible and consistent outcomes possible. In doing so, orthopedic surgery would follow the same path that every other highly reliable and safety conscious industry has adopted by absolute necessity...
September 29, 2016: Journal of Knee Surgery
Yunus İmren, Süleyman Semih Dedeoğlu, Murat Çakar, Haluk Çabuk, Tahsin Olgun Bayraktar, Hakan Gürbüz
Partial or total resection of the infrapatellar fat pad (IPFP) helps surgeon improve access to lateral tibial plateau for better placement of the knee prosthesis. We aimed to investigate the effect of IPFP excision on clinical and radiologic outcomes including patellar tendon length (PTL), range of motion, and functional scores after total knee arthroplasty (TKA) at 5-year follow-up. We retrospectively evaluated postoperative first X-rays (day 0) and postoperative final 5-year control views of 228 knees in patients with primary osteoarthritis who underwent TKA between September 2006 and December 2009 in our hospital...
September 29, 2016: Journal of Knee Surgery
Vincenzo Giordano, Joseph Schatzker, Mauricio Kfuri
High-energy fractures of the proximal tibia with extensive fragmentation of the posterior rim of the tibial plateau are challenging. This technique aims to describe a method on how to embrace the posterior rim of the tibial plateau by placing a horizontal precontoured one-third tubular plate wrapped around its corners. This method, which we named "hoop plating," is mainly indicated for cases of crushed juxta-articular rim fractures, aiming to restore cortical containment of the tibial plateau. Through a lateral approach with a fibular head osteotomy (Lobenhoffer approach), both anterolateral and posterolateral fragments are directly reduced and supported by a one-third tubular plate of adequate length...
September 29, 2016: Journal of Knee Surgery
Juan Diego Ayala-Mejias, Benjamin Garcia-Gonzalez, Luis Alcocer-Perez-España, Jorge Hugo Villafañe, Pedro Berjano
To evaluate the relationship between tunnel position and widening and long-term clinical results in anterior cruciate ligament (ACL) reconstruction, a retrospective cohort of 30 patients undergoing ACL reconstruction with double semitendinous plus double gracilis (SAC technique) with longer than 10-year follow-up was selected. CT scans in the first 3 months and at final follow-up was evaluated. Position, angle, and widening of tunnels including Nebelung criteria were recorded in all CT scans. Physical, KT-1000, and clinical evaluation were performed at final follow-up...
September 29, 2016: Journal of Knee Surgery
Marcelo B P Siqueira, Paul Jacob, John McLaughlin, Alison K Klika, Robert Molloy, Carlos A Higuera, Wael K Barsoum
The purpose of this study was to estimate the survivorship of the varus-valgus constrained (VVC) knee implants in primary, aseptic, and septic revision total knee arthroplasty (TKA); determine functional outcomes; main modes of failure; and variables associated with increased mechanical failures. In this study, 685 consecutive cases of primary (n = 247), aseptic (n = 315), and septic revision (n = 123) TKAs with VVC implants were performed between 1999 and 2008; 533 knees (78%) had a mean follow-up of 8...
September 28, 2016: Journal of Knee Surgery
Hiroshi Higuchi, Atsushi Kobayashi, Keiko Ikeda, Kazuhisa Hatayama, Sinya Yanagisawa, Kazuo Kato
This prospective pilot study investigated whether grafting β-tricalcium phosphate (B-TCP) into the bone-patellar tendon-bone (BPTB)-harvesting site after anterior cruciate ligament reconstruction would accelerate bone and tendon regeneration in the grafted site. Overall, 19 patients agreed prospectively to undergo regular morphological and histological examinations of the B-TCP-grafted site. Postoperative radiographic, ultrasonographic, and magnetic resonance imaging (MRI) examinations were performed to evaluate the grafted site at 1, 3, 6, and 12 months...
September 28, 2016: Journal of Knee Surgery
Gregory M Freisinger, Laura C Schmitt, Andrea B Wanamaker, Robert A Siston, Ajit M W Chaudhari
The purpose of this study was to systematically review and synthesize the literature measuring varus-valgus laxity in individuals with tibiofemoral osteoarthritis (OA). Specifically, we aimed to identify varus-valgus laxity differences between persons with OA and controls, by radiographic disease severity, by frontal plane knee alignment, and by sex. We also aimed to identify if there was a relationship between varus-valgus laxity and clinical performance and self-reported function. We systematically searched for peer-reviewed original research articles in PubMed, Scopus, and CINAHL to identify all existing literature regarding knee OA and objective measurement of varus-valgus laxity in vivo...
September 28, 2016: Journal of Knee Surgery
Chang-Wan Kim, Chang-Rack Lee, Seung-Suk Seo, Heui-Chul Gwak, Jung-Han Kim, Jun-Woo Jeong
Few studies have identified the effects of arthroscopic surgery on the clinical outcomes when open wedge high tibial osteotomy (OWHTO) and arthroscopic surgery were performed together. The purpose of this study was to evaluate the clinical efficacy of arthroscopic surgery in patients who had varus osteoarthritic knee and were treated with OWHTO combined with arthroscopic surgery. Among the 98 knees (88 patients) who underwent OWHTO between January 2008 and March 2013, 79 knees (71 patients) with more than 2 years of follow-up were reviewed retrospectively...
September 21, 2016: Journal of Knee Surgery
William J Cundy, Annika Theodoulou, Chi Meng Ling, Jeganath Krishnan, Christopher J Wilson
Patients undergoing total knee arthroplasty (TKA) have expected blood loss during and after surgery. The morbidity associated with blood loss and the burden of blood transfusions in adult arthroplasty necessitates preoperative optimization as routine practice. Current literature remains inconclusive on which TKA surgical instrumentation techniques are effective in minimizing perioperative blood loss, and consequently lower transfusion rates. The primary objective of this retrospective review, of a prospective randomized cohort study, was to compare surgical and patient factors, and their influence on blood loss and transfusions rates, between one type of patient-specific instrumentation (PSI), navigated computer-assisted surgery (CAS), and conventional TKA surgical techniques...
September 21, 2016: Journal of Knee Surgery
Morad Chughtai, Tanner McGinn, Anil Bhave, Sabahat Khan, Megha Vashist, Anton Khlopas, Michael A Mont
Manipulation under anesthesia (MUA) is performed for knee stiffness following a total knee arthroplasty (TKA) when nonoperative treatments fail. It is important to develop an optimal outpatient physical therapy protocol following an MUA, to avoid a repeat procedure. The purpose of this study was to evaluate and compare: (1) range of motion and (2) the rate of repeat MUA in patients who either underwent innovative multimodal physical therapy (IMMPT) or standard-of-care physical therapy (standard) following an MUA after a TKA...
September 21, 2016: Journal of Knee Surgery
Eric G Kim, Nirav K Patel, Morad Chughtai, Randa D K Elmallah, Ronald E Delanois, Steven F Harwin, Michael A Mont
The best strategy to address large bony defects in revision total knee arthroplasty has yet to be determined. The relatively recent development of porous tantalum cones and their use to address massive bone loss in knee arthroplasty has shown promising short- and intermediate-term results. The purpose of this review is to present the current literature on: (1) basic science of porous tantalum, (2) classification and treatment for bone loss, (3) clinical results, and (4) evolution of newer generation cones.
September 20, 2016: Journal of Knee Surgery
Christopher V Nagelli, James L Cook, Kei Kuroki, Chantelle Bozynski, Richard Ma, Timothy E Hewett
Complications following anterior cruciate ligament (ACL) injury and reconstruction that include chronic dysfunction, second ACL injury, and posttraumatic osteoarthritis (OA) may be interrelated and stem from the inability to fully restore native ACL integrity and function. The loss of ACL sensory input following injury may significantly contribute to joint dysfunction. We developed a novel preclinical animal model to assess the contributions of ACL sensory afferents to knee joint function and health. We hypothesized that ACL sensory denervation would manifest in knee joint dysfunction and development of early OA...
September 20, 2016: Journal of Knee Surgery
Guenther Maderbacher, Clemens Baier, Hans-Robert Springorum, Hermann Maderbacher, Anne-Maria Birkenbach, Achim Benditz, Joachim Grifka, Armin Keshmiri
Correct rotational implant alignment is associated with increased postoperative function and implant survival in total knee arthroplasty (TKA). Due to conformity between tibial and femoral implants, particularly in full extension, we assumed a mutual interference of femoral and tibial component rotations. We, therefore, hypothesized that different rotational alignments of the tibial or femoral components change the rotational postures between the tibia and femur after TKA. In 10 healthy knees of whole body cadavers, TKA was performed...
September 19, 2016: Journal of Knee Surgery
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