Incidence of Anterior Knee Pain and Functional Difficulty in a Prospectively Recruited Cohort Following Total Knee Arthroplasty With Selective Patellar Resurfacing.

BACKGROUND: The influence of patellar resurfacing on anterior knee pain, stair climbing, and functional activity outcomes following total knee arthroplasty (TKA) are incompletely understood. This study examined the influence of patellar resurfacing on patient-reported outcome measures (PROMs) relating to anterior knee pain and function. METHODS: The Knee Injury and Osteoarthritis Outcome Score of Joint Replacement (KOOS, JR.) patient PROMs were collected preoperatively and at 12 months follow-up for 950 TKAs performed over 5 years. Indications for patellar resurfacing included Grade IV patello-femoral (PFJ) changes or mechanical PFJ findings during patellar trialing. Patellar resurfacing was performed on 393 (41%) of the 950 TKAs performed. Multivariable binomial logistic regressions were performed, using KOOS, JR. questions assessing pain during stair climbing, standing upright, and function during rising from sitting as surrogates for anterior knee pain. Independent regression models were performed for each of the targeted KOOS, JR. questions, with adjustment for age at surgery, sex, and baseline pain and function. RESULTS: No association was observed between 12-month postoperative anterior knee pain or function with patellar resurfacing (P = .17, .97). Patients who had moderate or greater preoperative pain on stairs had an increased likelihood of postoperative pain and functional difficulty (odds ratio 2.3, P = .013), while males were 42% less likely to report postoperative anterior knee pain (odds ratio 0.58, P = .002). CONCLUSION: Selective patellar resurfacing based on PFJ degeneration and mechanical PFJ symptoms produces similar improvement in PROMs for resurfaced and unresurfaced knees.

What Role Does Patello-Femoral Joint Degeneration Have on Pain and Function After Unicompartmental Knee Arthroplasty? A Prospective Observational Cohort Study.

BACKGROUND: Influences on anterior knee pain, stair climbing limitations, and function such as rising from sitting are poorly understood in unicompartmental knee arthroplasty (UKA). Original indications for UKA excluded patients who had patello-femoral disease, while more recent studies have expanded the indications to include these patients. This study examined the influence of the patello-femoral joint degeneration on patient-reported outcome measures relating to anterior knee pain and function after UKA. METHODS: Between October 2017 and August 2021, Knee Injury and Osteoarthritis Outcome Score of Joint Replacement (KOOS, JR) patient-reported outcome measures were collected preoperatively and at 12 months of follow-up for 678 medial UKAs. Patello-femoral joint status was visually graded intraoperatively. Radiographic or intraoperative medial patellar facet and trochlear patello-femoral arthritis and preoperative anterior knee pain were not considered contraindications for UKA, while grade IV lateral patello-femoral arthritis was considered a contraindication for UKA. Multivariable ordinal logistic regressions were performed, using the KOOS, JR questionnaire assessing pain during stair climbing, standing upright, and function during rising from sitting. Independent regressions were performed for each targeted KOOS, JR question, with adjustments for age at surgery, sex, and baseline pain and function scores. RESULTS: No association was observed between 12-month postoperative anterior knee pain (P = .575) and function (P = .854) with patellar osteoarthritis grading after UKA. When comparing fixed and mobile-bearing UKA designs, no association was observed between bearing type and pain (P = .663) or functional outcomes (P = .758). CONCLUSION: Pain and function improved significantly following medial UKA and was independent of medial patellar and trochlear degenerative status.

Outpatient-Focused Joint Arthroplasty Is the Future: The Midwest Center for Joint Replacement Experience.

BACKGROUND: Perhaps, the most significant developments in joint arthroplasty in the past decade have been in the area of multimodal perioperative management reducing pain, nausea, and length of stay leading to outpatient arthroplasty. METHODS: Over a 2-year period, we performed 1230 arthroplasty cases including partial knee, total hip, total knee, and selected revision cases. RESULTS: Patient satisfaction ranged from 98% to 100% great/good. Ninety-eight percent of patients were discharged the same day. There were no readmissions for pain control and an overall readmission rate of 2%. CONCLUSION: The outpatient program centers on the patient needs, family engagement, essentials of home recovery, preoperative education, efficient surgery, and a surgeon-controlled environment with a highly standardized care. This is a distinct shift in today's health-care environment, which has seen the expansion of regulatory demands; focus on Electronic Health Record, and distractions from real discussions of demonstrated value creation. The future is bright for both ambulatory surgery center and hospital development of successful outpatient joint arthroplasty program for patients and surgeons alike.

Clinical predictors for possible failure after total hip arthroplasty.

INTRODUCTION: With the rising number of total hip arthroplasties (THAs) each year, it is increasingly important for surgeons to have evidence-based information on which to determine how often patients should be examined postoperatively. The purpose of this research was to determine whether it is possible to identify - based on Harris Hip Score (HHS) - early signs or predictors of THA failure so that methods of postoperative follow-up can be scheduled in advance of the time frame indicated by those predictors of failure. METHODS: The HHS of 9,949 primary THAs performed from 1973 to 2012 was reviewed retrospectively to identify the clinical predictors of failure. 1,131 hips were completely lost to follow-up, leaving 8,331 primary THAs in 6,979 patients. Time to failure was recorded with Kaplan-Meier analysis performed with aseptic loosening or revision of any component as the endpoint. RESULTS: Regression analysis revealed that a pain score of 30 or less at any time of follow-up (p<0.0001) was a significant risk and strongly indicative of later failing. A low distance walked score of 5 or less at 6 months (p = 0.0087) and 1 year (p = 0.0167) served as an early predictor of future failure. A lower stairs score of 2 or less was also an early predictor at 1 year (p = 0.0343) and at 3 years (p = 0.0245). A lower limp score of 8 or less was a mid-term predictor at 3 (p = 0.0001), 5 (p = 0.0002), 7 (p = 0.0191) and 10 (0.0028) years postoperative follow-up. CONCLUSIONS: Pain, walk, stairs and limp scores are predictive of THA failure. Surgeons with patients who present with these indicators should optimise postoperative follow-ups to alert their patients.

Midterm Results of the Vanguard SSK Revision Total Knee Arthroplasty System.

Revision total knee arthroplasty (TKA) is becoming increasingly common as the population ages and the number of existing primary TKAs continues to increase. Revision TKA systems use a greater range of component modularity than primary TKA systems, including stems, augments, and varying levels of constraint. The purpose of this study was to retrospectively review the authors' institution's use of one specific revision knee implant system and its midterm results. The Vanguard SSK Revision Knee System (Biomet, Warsaw, Indiana) was implanted 297 times in 272 patients between 2005 and 2013. Average patient age was 67.2 years, average body mass index was 33 kg/m(2), and average follow-up was 4.8 years. The most common diagnoses leading to use of this system were failed previous TKA (45.5%) and periprosthetic infection (23.2%). The SSK system was used in 78 (26.3%) complex primary TKAs at the discretion of the operating surgeon. There were 22 failures: 12 septic and 10 aseptic. Of the 12 infections, 6 occurred after 2-staged treatment of periprosthetic joint infection, with all 6 of these reinfections having a different causative organism. Aseptic failures included aseptic loosening (n=3), periprosthetic fracture (n=2), patellar maltracking (n=2), instability (n=1), arthrofibrosis (n=1), and extensor mechanism disruption (n=1). Aseptic implant survivorship was 97.2%, 95.6%, 93.1%, and 93.1% at 1, 3, 5, and 7 years postoperatively, respectively. The Vanguard SSK demonstrates excellent performance at medium-range follow-up with respect to complications, clinical scores, and prosthesis survivorship. [Orthopedics.2016; 39(5):e833-e837.].

Analysis of the musculoskeletal trauma section of the Orthopaedic In-Training Examination (OITE).

OBJECTIVE: To analyze the musculoskeletal trauma content domain of the Orthopaedic In-Training Examination (OITE) over a 5-year period (2005-2009) to better understand the question content and distribution of references cited. METHODS: The questions, answers, and recommended readings from the musculoskeletal trauma portion (as defined by the American Academy of Orthopaedic Surgeons) of the OITE were reviewed from the five examinations. The total number of questions, presence/modality of images, topics covered, taxonomic classification, and references listed were compiled and analyzed. RESULTS: Two hundred fifty-four of 1351 questions (18.8%) were included in the musculoskeletal trauma domain. Imaging modalities were included with 28% of questions with plain radiographs alone being most common (83%). Fifty-six percent of the questions required the test taker to recall facts directly from the orthopaedic literature (taxonomy 1). The remaining 44% involved the interpretation of data, making a diagnosis, or formulating a treatment plan (taxonomies 2 and 3). No taxonomy 1 question was accompanied by a medical image. Upper extremity injuries were included in 25%, pelvis and acetabulum in 15%, and the lower extremity in 60% of the questions. The Journal of Orthopaedic Trauma was the most frequently cited reference source (24.1%) followed by the Journal of Bone and Joint Surgery, American Volume (20.8%). CONCLUSIONS: The musculoskeletal trauma section of the OITE remains the largest of the 12 content domains. Questions with associated images require a higher cognitive taxonomy. The Journal of Orthopaedic Trauma was the most cited reference. This analysis may help test question writers, future test takers, and faculty involved with resident education to better understand and prepare for this portion of the OITE.