Short-Term (6 Months or Less) Pain in Cemented versus Cementless Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

BACKGROUND: Cementless total knee arthroplasty (TKA) has increased in popularity to potentially improve survivorship. Radiostereometric studies demonstrate increased component migration during the first 3 to 6 months in cementless constructs, generating concern for increased postoperative pain during early osseointegration. The purpose of this study was to evaluate short-term (≤ 6 months) pain and function in cemented versus cementless TKA. We hypothesized that cementless TKA patients report increased pain during the short-term (≤ 6 months) postoperative period. METHODS: The MEDLINE, EMBASE, CINAHL, and Cochrane Libraries were searched for studies evaluating short-term (≤ 6 months) outcomes of cemented versus cementless primary TKA. Studies involving hybrid fixation were excluded. A meta-analysis was performed using standardized mean difference for primary outcomes (early postoperative pain) and weighted mean difference (WMD) for secondary outcomes (early postoperative function). RESULTS: There were eleven studies included. There was no significant difference in acute postoperative pain between cemented and cementless TKA within 6 months of index TKA (standardized mean difference 0.08 in favor of cemented TKA; P = .10). Early postoperative forgotten joint scores (WMD 0.81; P = .81) and knee injury and osteoarthritis outcome scores for joint replacement (WMD 0.80 in favor of cemented TKA; P = .14) were also similar between groups. CONCLUSIONS: There is no difference in short-term (≤ 6 months) pain or early function between patients receiving cemented and cementless TKA. This suggests that surgeons may utilize cementless TKA without fear of increased pain due to micromotion within 6 months of index arthroplasty. However, additional studies with uniform assessment methods are needed to further inform differences in short-term pain and early functional outcomes between cemented and cementless TKA.

Transition to Robotic Total Knee Arthroplasty With Kinematic Alignment is Associated With a Short Learning Curve and Similar Acute-Period Functional Recoveries.

Background Robotic instruments are increasingly being used in total knee arthroplasty (TKA). The adoption of robotics has allowed surgeons a new level of precision and facilitated the adoption of a kinematic approach in TKA. We sought to examine one surgeon's transition from a traditional mechanical alignment technique to a modified kinematic approach by comparing short-term recovery outcomes of robotic TKA patients with those who underwent traditionally instrumented TKAs. Methodology We examined six-week and six-month postoperative data from 99 traditionally instrumented, mechanically aligned and 66 kinematically aligned robotic TKA patients between January 2021-October 2021 and October 2021-April 2022, respectively. Robotic surgery was performed with VELYS™ (DePuy Synthes, Warsaw, IN, USA) a semi-active, imageless, table-affixed, robotic TKA solution. Results Robotic and traditionally instrumented TKAs did not differ significantly in any functional outcome measures examined, including pain scores, use of assistive devices, or range of motion at six weeks postoperatively. Robotic TKA patients had a better range of motion in knee flexion than traditional TKA patients at six months postoperatively. There were no differences in surgical complications or rates of manipulation under anesthesia within one year postoperatively. Robotic surgery tourniquet times exhibited a steep drop off and equaled traditional methods after only two robotic surgeries were performed. Conclusions Transition to a kinematic, semi-active, robotic TKA demonstrated encouraging results by demonstrating acute-period recovery of function consistent with the current standard of care, as well as a better range of motion at six months postoperatively. The learning curve of this new-to-market device was shorter than previous research on the transition to robotic TKA. Clear advantages of transitioning to robotic instrumentation by any specific functional measure are yet to be elucidated. Further randomized trials are necessary to characterize long-term outcomes.

Effects of Acetabular Screws on the Initial Stability of Porous Coated Acetabular Implants in Revision Total Hip Arthroplasty.

INTRODUCTION: Revision total hip arthroplasty in the setting of acetabular bone loss remains a challenging clinical entity. Deficiencies of the acetabular rim, walls, and/or columns may limit the bony surface area and initial acetabular construct stability necessary for osseointegration of cementless components. Press-fit acetabular components with supplemental acetabular screw fixation represent a common technique aimed to minimize implant micromotion and allow for definitive osseointegration. Although acetabular screw fixation is commonly practiced in revision hip arthroplasty, few studies to date have examined the screw properties associated with maximal acetabular construct stability. The purpose of the present report is to examine acetabular screw fixation in a pelvis model mimicking Paprosky IIB acetabular bone loss. METHODS: Measuring bone-implant interface micromotion as a surrogate for initial implant stability, experimental models assessed the effect of screw number, screw length, and screw position on construct stability subject to a cyclic loading protocol designed to replicate joint reaction forces of two common daily activities. RESULTS: Trends towards increasing stability were demonstrated with increasing screw number, increasing screw length, and concentrating screws in the supra-acetabular dome. All experimental constructs yielded micromotion levels sufficient for bone ingrowth, except when screws in the dome were moved to the pubis and ischium. CONCLUSIONS: When using a porous coated revision acetabular implant to treat Paprosky IIB defects, screws should be used, and furthermore, increasing number, length, and position within the acetabular dome may help further stabilize the construct.

Same-Day Outpatient Lower-Extremity Joint Replacement: A Critical Analysis Review.

➢ The economics of transitioning total joint arthroplasty (TJA) to standalone ambulatory surgery centers (ASCs) should not be capitalized on at the expense of patient safety in the absence of established superior patient outcomes. ➢ Proper patient selection is essential to maximizing safety and avoiding complications resulting in readmission. ➢ Ambulatory TJA programs should focus on reducing complications frequently associated with delays in discharge. ➢ The transition from hospital-based TJA to ASC-based TJA has substantial financial implications for the hospital, payer, patient, and surgeon.