The optimal alignment technique for total knee replacement (TKR) remains controversial. We previously reported six-month and two-year results of a randomized controlled trial comparing kinematically (KA) versus mechanically (MA) aligned TKR. In the present study, we report 12-year results from this trial. The original cohort included 88 TKRs (44 KA using Shape Match patient-specific guides and 44 MA using conventional instrumentation), performed from 2008 to 2009. After IRB approval, the health record of the original 88 patients were queried. Revisions, re-operations, and complications were recorded. The non-deceased patients were contacted via phone. Reoperation and complications were documented via the patient's history. Further, a battery of patient-reported outcome measures (including patient satisfaction, WOMAC, Oxford, KOOS Jr, Forgotten Joint Score, and M-SANE) were obtained.Abstract
Introduction
Methods
Adverse reactions to pain medication and pain can delay discharge after outpatient knee arthroplasty (TKA). Pharmacogenomics is an emerging tool that might help reduce adverse events by tailoring medication use based on known genetic variations in the CYP genes determining drug metabolism. This study was undertaken to evaluate whether pre-operative pharmacogenomic testing could optimize peri-operative pain management in patients undergoing total knee arthroplasty (TKA). This prospective, randomized study was performed in adults undergoing primary TKA. Patients in the experimental group underwent pre-operative pharmacogenomic evaluation and medication adjustments. Medications were not optimized for control patients. The Overall Benefit of Analgesic Score (OBAS) at 24 hours post-op was the primary outcome. Postoperative pain scores (VAS scale), total opioid use, time in recovery, and time to discharge were also compared.Abstract
Introduction
Methods
Minimum clinically important differences (MCIDs) are critical to understanding changes in patient-reported outcome measure (PROM) scores after total joint arthroplasty (TJA). The usage and adoption of MCIDs not been well-studied. This study was performed to IDENTIFY trends in PROM and MCID use after TJA over the past decade. All articles published in the calendar years of 2010 and 2020 in CORR, JBJS, and the Journal of Arthroplasty were reviewed. Articles relating to clinical outcomes in primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) were included. For each article, all reported PROMs and (if present) accompanying MCIDs were recorded. The use of PROMs and MCIDs were compared between articles published in 2010 and 2020.Abstract
Introduction
Methods
Periprosthetic joint infection (PJI) is a common cause of revision total knee surgery. Although debridement and implant retention (DAIR) has lower success rates in the chronic setting, it is an accepted treatment for acute PJI. There are two broad DAIR strategies: single debridement or a planned double debridement performed days apart. The purpose of this study is to evaluate the cost-effectiveness of single versus double DAIR with antibiotic beads for acute PJI in total knee arthroplasty (TKA). A decision tree using single or double DAIR as treatment strategies for acute PJI was constructed. Quality Adjusted Life Years (QALYs) and costs associated with the two treatment arms were calculated. Treatment success rates, failure rates, and mortality rates were derived from the literature. Medical costs were derived from both the literature and Medicare data. A cost-effectiveness plane was constructed from multiple Monte Carlo trials. A sensitivity analysis identified parameters most influencing the optimal strategy decision.Abstract
Introduction
Methodology
Patellar resurfacing is performed in more than 90% of primary total knee arthroplasties (TKAs) in the United States, yet far fewer patellae are resurfaced internationally. Multiple randomized controlled trials have shown decreased revision rates in patients with resurfaced patellas (RP) vs. non-resurfaced (NR). However, most of these studies showed no difference in patient satisfaction, anterior knee pain, or knee society scores. (Figure 1) Given uncertain benefits, the purpose of this study was to determine if the rates of patellar resurfacing have changed over the past 10 years worldwide. Data was obtained via direct correspondence with registry administrators or abstracted from the annual reports of six national joint registries: Australia, Denmark, England, New Zealand, Norway, and Sweden. Rates of patellar resurfacing between 2003 and 2013 were collected. Where data was available, subgroup analysis was performed to examine revision rates among RP and NR TKAs.Introduction
Methods
The original Charnley-type negative pressure body exhaust suit reduced infection rates in randomized trials of total joint arthroplasty decades ago. Modern positive pressure surgical helmet systems (SHS) have not shown similar benefit, and several recent studies have shown a trend towards increased wound contamination and infection with SHS use. The gown glove interface may be one source of particle contamination. The purpose of this study was to compare particle contamination at the gown glove interface in several modern SHS vs. a conventional gown.Introduction
Objectives
Serological tests including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are frequently used in the preoperative workup to screen for periprosthetic infection (PPI) in total hip arthroplasty (THA). The cut-off points reported in the literature are arbitrarily chosen by investigators. Similarly, the values used in laboratories to distinguish elevated results vary from one institute to another. Therefore, we intended to define the appropriate cut-off points of ESR and CRP that can be used to differentiate infection from aseptic failure of THA. A review of our joint registry database revealed that 515 THA revisions (131 infected cases) were performed during 2000–2005. Intraoperative samples for culture were taken in all cases. The criteria used for diagnosis of infection were a positive intraoperative culture on solid media, presence of an abscess or sinus tract that communicated with the joint, positive preoperative aspiration culture, and/or elevated fluid cell count and neutrophil differential of the aspirated fluid. Non-infected patients with confounding factors that can elevate ESR and CRP including collagen vascular disease, inflammatory arthropathy, malignancy, and urinary tract infection were excluded. Receiver operator curves were used to determine the ideal cut-off point for both ESR and CRP. The mean value of ESR in the infected group (77mm/ hr) was significantly higher compared to that of the non-infected cohort (29mm/hr) (p=0.0001). Similarly, infected patients presented with a greater mean CRP (9.8 mg/dl) than their non-infected cohort (1.48 mg/ dl) (p=0.0001). The infection threshold for ESR was 45mm/hr with a sensitivity of 85% and specificity of 79%, while the optimal cut-off value for CRP was defined as 1.6 mg/dl which yielded a sensitivity of 86% and specificity of 83%. The optimal threshold values we determined are higher than the arbitrarily chosen values cited in the literature for ESR (30mm/hr) and CRP (1mg/dl). Although it has been previously reported that the sensitivity and specificity of CRP are far greater than that of ESR, we found that the two tests have comparable diagnostic value.
