Surgical Technology International
40th Anniversary Edition
May 2022 - ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions
Optimizing Total Knee Arthroplasty With ROSA® Robotic Technology
Paul W. Knapp, DO, Giles R. Scuderi, MD, Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York, Michael P. Nett, MD, Northwell Health Orthopaedics, South Shore University Hospital, Bayshore, New York
1522
A new robotic platform (ROSA® Knee system, Zimmer Biomet, Warsaw, Indiana) for total knee arthroplasty (TKA) has been created to increase precision of bony resections and knee balancing while maintaining surgeon autonomy. Our aim is to discuss: (1) the background of robotic technology in orthopedics, (2) current literature and potential benefits of the ROSA® Knee system, and the (3) optimal surgical technique for this specific robotic TKA platform. Early literature regarding this robotic system is promising as studies have shown precision of its bony resections, accuracy of overall limb alignment, and low early revision rates. There is a need for continued research on clinical outcomes using this platform, and the intention is to provide a review with insight into the potential advantages of robotics and the ideal surgical technique for successful use of this system.
Order Digital ePrint:
PDF Format - $129.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Technology Review: CT Scan-Guided, 3-Dimensional, Robotic-Arm Assisted Lower Extremity Arthroplasty
Zhongming Chen, MD, Michael A. Mont, MD, Sandeep S. Bains, MD, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, Peter M. Bonutti, MD, Sarah Bush Lincoln Bonutti Clinic, Effingham, Illinois, Wael K. Barsoum, MD, Cleveland Clinic, Weston, Florida, David J. Jacofsky, MD, The CORE Institute, Phoenix, Arizona
1540
Robotic-arm assisted lower extremity arthroplasty using computed tomography scan (CT)-based 3-dimensional (3D) modeling operative technologies has increasingly become mainstream over the past decade with over 550,000 procedures performed between first use in 2006 and November 2021. Studies have demonstrated multiple advantages with these technologies, such as decreased postoperative pain and subsequent decreased narcotic usage, decreased lengths of stay, less complications, reduced damage to soft tissues, decreased readmissions, as well as economic advantages in the form of meaningful cost savings for payors. The purpose of this report was to clearly and concisely summarize the good-to-high methodology peer-reviewed, published literature regarding CT scan-based, 3-dimensional robotically-assisted unicompartmental knee arthroplasty, total knee arthroplasty, and total hip arthroplasty stratified by: (1) prospective randomized studies; (2) database comparison studies; (3) national registry studies; (4) health utility studies; (5) comparison studies; and (6) basic science studies. A literature search was conducted and, after applying inclusion criteria, each study was graded based on the modified Coleman methodology score (“excellent” 85–100, “good” 70–84, “fair” 55–69, “poor” <54 points). A total of 63 of 63 good-to-excellent methodology score reports were positive for this technology, including 11 that demonstrated decreased pain and/or opioid use when compared to traditional arthroplasty techniques. The summary results of these high-quality, peer-reviewed published studies demonstrated multiple advantages of this CT scan-based robotic-arm assisted platform for lower extremity arthroplasty.
Patient-Specific TKA with the VELYS™ Robotic-Assisted Solution
Mark Clatworthy, FRACS, Orthopaedic Knee Surgeon , Auckland Bone and Joint Surgery, Auckland, New Zealand
1561
The VELYS™ Robotic-Assisted Solution (VRAS) (DePuy Synthes, Warsaw, Indiana) utilises new technology to accurately collect the bony anatomy and soft tissue envelope of the knee. This enables surgeons to use this information to intraoperatively plan anatomical placement of a total knee arthroplasty (TKA) with preservation of the soft tissues with the aim of restoring functional knee motion. The robotic-assisted saw delivers precise, accurate, and efficient delivery of this implantation plan.
This article describes the patient-specific TKA technique which maximises the full potential of VRAS; however, all TKA techniques and alignment philosophies can be accommodated with VRAS.
The first case was performed in late 2020. An early outcome study shows an improvement in knee function and pain with activity at discharge and six weeks and a neutral surgical time comparable with the author’s extensive experience with patient-specific balanced TKA with navigation. Only a limited number of patients have one-year results. However, the data of this limited cohort demonstrates favourable outcome scores and high patient satisfaction.
Does Retention of the Posterior Cruciate Ligament Lead to a More “Forgotten Joint” Following Total Knee Arthroplasty?
Thomas Bieganowski, BS, Benjamin Fiedler, BA, Vivek Singh, MD, MPH, Elan Karlin, BS, Utkarsh Anil, MD, Joshua C. Rozell, MD, Assistant Professor, Ran Schwarzkopf, MD, MSc, Professor , NYU Langone Health, New York, NY
1538
Introduction: Posterior cruciate ligament (PCL) retention may impact a patient’s awareness of their artificial joint following primary total knee arthroplasty (pTKA) due to increased proprioception and more native knee kinematics. Therefore, the purpose of this study was to investigate whether cruciate-retaining (CR) or posterior-stabilized (PS) implants influence the Forgotten Joint Score (FJS-12) following pTKA.
Methods: We retrospectively reviewed all patients who underwent pTKA with a CR or PS implant at our institute between October 2017 and March 2021. Of the 6,258 patients identified, 5,587 did not have recorded FJS-12 scores at either three months, one year, or two years postoperatively nor a Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) preoperatively, three months, or one year postoperatively, and these were considered lost to follow up. Thus, a total of 671 cases were identified and subsequently stratified into two cohorts based on whether they received a CR (n=236, 35%) or PS (n=435, 65%) implant. Patients who received PS implants were further divided into constrained (CoN) and non-constrained (NCoN) liner cohorts. Multivariable linear regression analysis was used to compare patient-reported outcome (PRO) scores.
Results: There were no significant differences in PRO scores between CR and PS implants at any time point. Patients in the CoN (n=74) cohort had significantly higher FJS-12 scores at one year (CoN: 56.31 + 25.34 vs NCoN: 42.24 + 27.00, p=0.001) and two years (CoN: 58.52 + 33.71 vs NCoN: 46.97 + 27.44, p=0.013) postoperatively compared to patients in the NCoN (n=361) cohort.
Conclusion: Although our analysis demonstrated significant differences in FJS-12 scores at one and two years postoperatively depending upon the liner constraint, there were no significant differences in FJS-12 scores between CR and PS implants. Therefore, while retention of the PCL does not impact patient awareness of their artificial joint, the level of liner constraint may influence outcomes if the PCL is sacrificed.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Risk of Venous Thromboemboli, Readmissions, and Costs in Opioid Use Disorder Patients Following Revision Total Knee Arthroplasty
Puneet Gupta, BS, Hytham S. Salem, MD, Zhongming Chen, MD, Michael A. Mont, MD, Lenox Hill Hospital, New York, New York, Martin W. Roche, MD, Hospital for Special Surgery, West Palm Beach, Florida
1547
Introduction: Opioid use disorder (OUD) patients have an increased risk of venous thromboembolism (VTE), readmissions, and higher costs following primary elective primary total joint arthroplasty, but these risks have not yet been clarified for other arthroplasty surgeries. Thus, the purpose of this study was to investigate whether OUD patients undergoing revision total knee arthroplasty (RTKA) have higher rates of: VTEs, readmissions, and costs of care.
Materials and Methods: Patients who had a 90-day history of OUD prior to undergoing RTKA were identified and randomly matched to a comparison cohort in a 1:4 ratio by age, sex, Elixhauser-Comorbidity Index (ECI), diabetes mellitus, hyperlipidemia, hypertension, obesity, and tobacco use with a total of 16,851 patients collectively in both groups. The 90-day frequency and odds (OR) of developing VTE, deep vein thrombosis (DVTs), and PEs along with 90-day readmission rates and 90-day costs of care were analyzed. A p-value less than 0.01 was considered statistically significant.
Results: OUD patients undergoing RTKA were found to have a higher incidence and odds of VTE (2.91 vs. 1.88; OR: 1.58, p<0.0001) 90 days following RTKA. Compared to the matched cohort, patients who have OUD had a higher incidence and increased risk of lower extremity DVT (2.61 vs. 1.73; OR: 1.52, p=0.0008) and PE (0.97 vs. 55%; OR: 1.74, p=0.007). Furthermore, the likelihood (25.7 vs. 21.4%; OR: 1.26, p<0.0001) of being readmitted within 90 days was higher in OUD patients. Additionally, OUD was associated with significantly higher total global 90-day episode-of-care costs ($19,289.31 ± $17,378.71 vs. $17,292.87 vs. $11,690.61; p<0.0001).
Conclusion: Patients who have OUD undergoing RTKA have higher rates of thromboembolic complications, readmission rates, and total global 90-day episode-of-care costs. Orthopaedic surgeons should educate OUD patients about these risks and titrate patient opioid consumption through multi-specialty interventions prior to surgery to improve outcomes and reduce costs.
Order Digital ePrint:
PDF Format - $129.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Heterotopic Ossification Prophylaxis Following Operative Fixation of Acetabular Fractures: A Systematic Review
Kevin K. Mathew, BS, Kevin B. Marchand, BS, John M. Tarazi, MD, Zhongming Chen, MD, Michael A. Mont, MD, Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York, Jeffrey A. O’Donnell, MD, Thorsten M. Seyler, MD, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
1543
Introduction: Heterotopic ossification (HO) is a well-recognized complication following operative fixation of acetabular fractures with a range of severity and clinical consequences. The purpose of this review was to: (1) report the incidence of heterotopic ossification (HO) formation following operative fixation of acetabular fractures; (2) determine the effectiveness of prophylactic treatments for HO; and (3) assess the radiographic severity of HO with and without prophylactic treatment.
Materials and Methods: A literature search for peer-reviewed articles was conducted utilizing a variety of research databases. PRISMA guidelines were followed and included in this review were full-length, English language manuscripts published before September 2019, using the following search criteria: “heterotopic ossification AND acetabulum OR acetabular.” Studies that reported HO as one of the reported outcomes were included. Articles were excluded if radiographic HO was not reported and if it was evaluated in surgeries other than those involved in acetabular fractures. Extracted data included, but was not limited to: type of prophylaxis; incidence of HO; severity of HO based on the Brooker classification; and statistical significance. A methodologic quality appraisal of the included studies was also conducted. A total of 54 full-text studies with 5,890 patients with operatively fixed acetabular fractures met inclusion criteria. There were four level I studies, four level II study, 26 level III studies, and 20 level IV studies.
Results: The overall incidence of HO after acetabular fracture surgery was 28.4%. The rate of HO formation was: 34.9% without prophylaxis, 28.3% with non-steroidal anti-inflammatory drugs (NSAID) prophylaxis, and 21.2% with radiation therapy (RT). Patients receiving a combination of both RT and NSAIDs developed HO 21.8% of the time. The rate of radiographic severe HO was 13.9% (range, 0–75%) in patients without prophylaxis, 9.4% (range, 0–50%) with NSAID prophylaxis, 5.7% (range, 0–12.8%) with RT prophylaxis, and 11.7% (range, 0–18.5%) with the combination of RT and NSAIDs.
Conclusion: With the current literature collected in this systematic review, there was a lower incidence and severity of heterotopic bone formation following acetabular fracture fixation using radiation prophylaxis compared to NSAIDs or no treatment. The available literature is heterogeneous in fracture characteristics, surgical approaches, and prophylactic regimens with a general lack of randomized control trials. Further prospective studies are required to make definitive claims on the optimal prophylactic strategy to prevent heterotopic ossification.
Order Digital ePrint:
PDF Format - $129.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Improving Operating Room Efficiency with Single-Use Disposable Instruments for Total Knee Arthroplasty
David A. Crawford, MD, Adolph V. Lombardi Jr., MD, FACS, Clinical Assistant Professor, Keith R. Berend, MD, JIS Orthopedics, New Albany, Ohio
1553
Many strategies have been employed to improve operating room efficiency when performing total knee arthroplasty. The goals of efficiency improvements are to decrease operative time and reduce healthcare expenses while providing patients the best quality surgical care. Single-use disposable instruments are one technique to accomplish efficiency.
The authors describe their experience with a specific implant manufacturer’s disposable single-use instruments for total knee arthroplasty and analyze the cost and time savings compared to traditional instrumentation. Single-use disposable instruments are a viable option to improve OR efficiency, decrease sterile processing burden, and ensure sterile instrumentation for total knee arthroplasty. Furthermore, cost savings can be realized based on an institution’s sterile processing expenses and whether the manufacturer or facility covers the cost of the single-use instruments.
Can We Approach a Zero Percent Infection Rate In Total Knee Arthroplasty? A Program To Achieve This Goal With Antimicrobial Agents
Paul W. Knapp, DO, Zhongming Chen, MD, Michael A. Mont, MD, Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York, Matthew F. Myntti, PhD, Next Science, Jacksonville, Florida
1551
Periprosthetic joint infections (PJIs) are one of the most feared complications in the realm of adult reconstruction due to the substantial morbidity and mortality associated with these cases. Advancements in arthroplasty have been made across a variety of areas of interest including implant surfaces, implant design, material science, etc., but a focus on infection prevention and treatment is of utmost importance. A new technology has been created that targets biofilm and aims to prevent infection in total joint arthroplasty. In this manuscript we aim to describe the benefits of this technology and describe the ideal use in a case scenario format. We believe that with this technology that we can approach the goal of a zero periprosthetic infection rate.
Concept for Minimally Invasive Hook Plate Stabilisation of the Acromioclavicular Joint
Samuel Haupt, MD, Silvan Hess, MD, Christoph Sommer, MD, Christian Michelitsch, MD, Department of Surgery, Kerstin Bütler, MD, Holger Grehn, MD, Department of Orthopedics, Kantonsspital Graubünden, Chur, Switzerland
1555
Aims: Despite the availability of various operative procedures, hook plates are still one of the main implants used for the treatment of acromioclavicular (AC) joint dislocation. The aim of this report is to present a novel minimally invasive operation technique for AC hook plate fixation. The functional outcomes of patients operated upon with this technique are presented.
Patients and Methods: A retrospective analysis was performed for 5 patients who were operated upon with minimally invasive hook plate fixation. The QuickDASH score (QDS) and subjective shoulder value (SSV) were used to express functional outcomes, and the numeric rating scale (NRS) was used to evaluate pain.
Results: The mean (SD) follow-up was 30±7 months. Patients were hospitalized for a mean of 3±1 days and operated upon for a mean of 54±7 minutes. Functional outcomes measured with the QDS showed a median (IQR) of 2.3 (0 - 6.8) and a median SSV relative to the healthy side of 95% (89 - 100). The median NRS was 0 (0 - 0).
Conclusion: Minimally invasive hook plate fixation for acromioclavicular joint dislocation led to excellent functional outcome scores without complications in a small case series of 5 patients.
Schematic visualisation of plate movements for minimal invasive hook plate insertion and final reduction of the acromio-clavicular joint through anterior rotation of the plate.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Clinical and Radiographic Outcomes of Novel 3D-Printed Highly Porous Knee Cone Design
Saad Tarabichi, MD, Luis Grau, MD, Armin Arshi, MD, Zachary Post, MD, Alvin Ong, MD, Associate Professor, William J. Hozack, MD, Professor, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
1563
Introduction: Metaphyseal bone defects seen at revision total knee replacement (TKA) have traditionally been treated with bone graft or cement. Recently, metal augments have surfaced as viable alternatives to conventional methods previously used in these patients. Newer 3D-printed metal cones offer better biological fixation as a means of improving construct stability. This study aimed to determine clinical and radiographic outcomes of the novel 3D-printed titanium cone augments for femoral and tibial metaphyseal bone defects.
Materials and Methods: A retrospective review was undertaken of 72 patients who underwent revision TKA with metaphyseal cones (Stryker) and stemmed implants from 2015–2017. Knee Injury and Osteoarthritis Outcome Scores (KOOS Jr) and VR/SF-12 scores were recorded. Knee Society radiographic scores were calculated at latest follow up to evaluate for radiolucency and biological fixation. Loosening noted on radiographs and reoperation for any reason were the endpoints to determine survivorship.
Results: A total of 68 patients with 78 cones (58 tibial, 20 femoral) met inclusion criteria. Mean follow up was 3.4 years (range 2–5.4 years). The average KOOS Jr score increased from 38 preoperatively to 66 at two years. The average VR/SF-12 PH score increased from 33 preoperatively to 37 at two years. The average VR/SF-12 MH score increased from 46 preoperatively to 54 at two years. Twelve percent of tibial implants and 10% of femoral implants with cones were found to have lucency in at least one radiographic zone. Overall survivorship at latest follow up was 93% with two patients requiring revision for infection, two revised following mechanical complications, and one patient who underwent polyethylene exchange after experiencing mechanical complications. When considering only aseptic loosening, survivorship was 100%.
Conclusion: This 3D-printed titanium femoral and tibial cone augment system showed excellent survivorship, biological fixation, clinical outcomes, and radiographic outcomes in the setting of TKA. Further studies are needed for assessment of long-term survivorship.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Increased In-Hospital Lengths of Stay, Readmission Rates, Complications, and Costs in Patients Who Have Depressive Disorders Following Primary Total Hip Arthroplasty
William M. DeGouveia, MS, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell , Hempstead, New York, , Hytham S. Salem, MD, Zhongming Chen, MD, John M. Tarazi, MD, Joseph O. Ehiorobo, MD, Michael A. Mont, MD, Lenox Hill Hospital, Northwell Health, New York, New York, Rushabh M. Vakharia, MD3, Holy Cross Hospital, Orthopaedic Research Institute, Ft. Lauderdale, Florida
1548
Introduction: Recent studies have shown the prevalence of depressive disorders has increased within the United States. Studies investigating the impact of depressive disorders following primary THA are limited. Therefore, the purpose of this study was to determine whether patients with depressive disorders have higher rates of: 1) in-hospital lengths of stay (LOS); 2) readmission rates; 3) medical complications; and 4) implant-related complications.
Materials and Methods: A retrospective query of the Humana claims database was performed. Patients undergoing primary THA with a history of depressive disorders were identified by International Classification of Disease, Ninth Revision (ICD-9), and Current Procedural Terminology (CPT) codes. Study group patients were matched to controls in a 1:5 ratio by age, sex, and comorbidities. The query yielded 67,245 patients with (n=11,255) and without (n=55,990) depressive disorders. Welch’s t-tests were used to test for significance in LOS between the cohorts; whereas, logistics regression analyses were used for complications and readmissions. A p-value less than 0.003 was statistically significant.
Results: Patients with depressive disorders undergoing primary THA had significantly longer in-hospital LOS (6.59 days vs. 2.96 days, p <0.0001). Additionally, patients with depressive disorders had higher incidence and odds of readmission rates (46.02 vs. 35.43%; OR: 1.55, p <0.0001), medical complications (7.05 vs. 1.84%; OR: 4.04, p <0.0001), and implant-related complications (5.76 vs. 2.75%; OR: 2.16, p <0.0001) compared to patients without depressive disorders.
Conclusion: After matching age, sex, and medical comorbidities, the results of the study demonstrate patients with depressive disorders have longer in-hospital LOS and increased rates of complications and readmission rates. The study is useful as it can allow orthopedic surgeons to properly counsel these patients of the potential complications which may arise following their procedure.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Meniscal Preservation is More Likely When Performed with Acute Anterior Cruciate Ligament Repair Rather Than with Anterior Cruciate Ligament Reconstruction
William T. Wilson, MBChB, BSc (MedSci), MRCS, MFSEM, University of Strathclyde, Glasgow, United Kingdom, Graeme P. Hopper, MBChB, MSc, MRCS, MFST, MD, FRCS, NHS, Lanarkshire University Hospitals, Glasgow, United Kingdom, Chris Hamilton, MBChB, Lucas O’Donnell, MBChB, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom, Mark J G Blyth, MBChB, FRCS, Glasgow Royal Infirmary, Glasgow, United Kingdom, Gordon M Mackay, MD, FRCS (Tr&Orth), FFSEM (UK), Professor, University of Stirling, Stirling, Scotland
1574
Introduction: Rupture of the anterior cruciate ligament (ACL) often occurs in conjunction with meniscal tears. In this study, we investigate the rates and outcomes of meniscal repair surgery performed with ACL reconstruction compared with acute ACL repair surgery.
Materials and Methods: Data was collected for all patients undergoing surgery for ACL ruptures between 2012 and 2018, including ACL reconstruction with hamstring autograft and primary ACL repair augmented with suture tape. Patients undergoing multi-ligament surgery were excluded. Meniscal injury was evaluated intraoperatively and the treatment was determined by type of tear, reducibility, and quality of meniscal tissue. If possible, tears were repaired using all-inside anchors and all others were resected.
Results: There were 272 ACL reconstructions and 134 ACL repairs, and mean age was 28 (±9) and 35 (±14) years, respectively (p<0.01). The mean Tegner activity score was 6.6 in both groups. The mean interval from injury to surgery was longer in the reconstruction group (26.2 vs. 1.3 months, p<0.01). Fifty-five percent of reconstructions and 43% of ACL repairs required meniscal surgery at the time of their ACL procedure. In the reconstruction group, 123 (70%) were meniscectomies and 53 (30%) were meniscal repairs, compared to 31 (50%) of each in the ACL repair group. Meniscal repair was more likely to be possible when carried out as part of acute ACL repair surgery, c2(1, n=238)=7.94, p<0.01. The success rate of meniscal repair was 97% in both groups.
Conclusions: The rate of meniscal repair is 67% higher when performed early with ACL repair. When ACL reconstruction is performed, meniscal resection was more likely. Rates of post-traumatic osteoarthritis are high after ACL reconstruction when performed with meniscal resection. Furthermore, the success rate of meniscal repair in conjunction with ACL surgery is high (97%). Therefore, meniscal repair should be encouraged whenever possible to improve long-term outcomes.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Clinical Outcomes After Computed Tomography-Based Total Knee Arthroplasty: A Surgeon’s First 1,000 Cases
Robert C. Marchand, MD, Department of Orthopaedic Surgery, Ortho Rhode Island, Wakefield, Rhode Island, Manoshi Bhowmik-Stoker, PhD, Reconstructive and Robotics Research and Development, Stryker Orthopaedics, Mahwah, New Jersey, Zhongming Chen, MD, Michael A. Mont, MD, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
1581
Introduction: Computed tomography scan (CT)-based three-dimensional (3D) modeling operative technologies have been shown to improve upon many perioperative results of manual total knee arthroplasties (TKAs). Although patient satisfaction has been reported for CT-based TKAs, studies evaluating large cohorts are limited. The purpose of this study was to compare the clinical outcomes of a surgeon’s first 1,000 CT-based TKAs with manual TKAs during a minimum follow-up time of approximately six months. Specifically, we analyzed: (1) survivorship; (2) functional outcomes; (3) radiographic outcomes (i.e., alignment, progressive radiolucencies); and (4) complications.
Materials and Methods: A total of 1,000 consecutive primary CT-based total knee arthroplasty cases (988 patients) performed by a single surgeon at a single center between July 1, 2016 and July 1, 2021 were compared to a total of 1,000 consecutive manual TKAs (996 patients) completed by the same surgeon between May 18, 2013 and July 1, 2016. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) surveys were collected at approximately six months postoperatively. Subgroup analyses were performed on the physical function and pain scores. Follow-up radiographs were also examined for alignment, progressive radiolucencies, and/or loosenings.
Results: There was 100% survivorship at approximately six months follow up. The mean physical function score for the manual cohort and CT-based cohort were 10 ± 4 (range, 0 to 32) and 5 ± 4 (range, 0 to 22), respectively (p<0.05). The mean pain score for the manual cohort and CT-based cohort were 4 ± 4 (range, 0 to 20) and 3 ± 2 (range, 0 to 15), respectively (p<0.05). The mean total WOMAC score for the manual cohort and CT-based cohort were 13 ± 9 (range, 0 to 44) and 8 ± 7 (range, 0 to 33), respectively (p<0.05). None of the manual or CT-based cases exhibited progressive radiolucencies by final follow up. There were no postoperative medical and/or surgical complications at final follow up in the two cohorts.
Discussion/Conclusions: The 1,000 CT-based TKA clinical outcomes from this study continue to support great survivorship and radiographic outcomes, minimal complications, as well as improved physical function, pain, and total WOMAC scores. Therefore, those who undergo CT-based 3D modeling total knee arthroplasties should have the advantage of superior patient satisfaction.
Order Digital ePrint:
PDF Format - $129.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Medial Patellofemoral Ligament Repair with Suture Tape Augmentation: A Case Series With Five-Year Follow Up
Graeme P. Hopper, MBChB, MSc, MRCS, MFST, MD, FRCS (Tr&Orth), NHS Lanarkshire University Hospitals, Glasgow, Scotland, Ahmer Irfan, BSc (Hons), MBChB, MRCS, University of Alabama, Birmingham, Alabama, William T. Wilson, MBChB, BSc (MedSci), MRCS, MFSEM (UK), University of Strathclyde, Glasgow, Scotland, Gordon M. Mackay, MD, FRCS (Tr&Orth), FFSEM (UK), Professor, University of Stirling, Stirling, Scotland
1558
Introduction: The medial patellofemoral ligament (MPFL) is the main restraining force against lateral patellar displacement in the first 20 degrees of knee flexion and is often disrupted following patellar subluxation or dislocation. MPFL reconstruction is commonly performed to restore patellar stability but requires autograft harvest with associated donor site morbidity. The aim of this study was to assess the five-year outcomes of MPFL repair performed with suture tape augmentation.
Materials and Methods: All patients who underwent isolated MPFL repair for recurrent patellar instability between 2011 and 2017 were included. Patients requiring any additional surgery, such as osteotomy, were excluded. Patient-reported outcomes were measured at two-year follow up using the Knee Injury and Osteoarthritis Outcome (KOOS) Score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Pain Scale (VAS-pain), Veterans RAND 12-Item Health Survey (VR-12), Marx Activity Scale, and an overall satisfaction questionnaire. At the end of the study period, any complications or secondary surgeries were determined.
Results: Eighteen patients underwent MPFL repair with one lost to follow up. There was a significant improvement in all subscales of the KOOS scoring systems, the WOMAC functional score, and the VR-12 physical score. A significant decrease was seen in the VAS-pain score. A non-significant decrease was seen in the Marx activity scale from pre-injury. The majority of patients reported satisfaction with reduction in pain and return to sporting activities. There were no complications with no further instability episodes.
Conclusion: This is the first study that describes the five-year follow-up results of patients treated with MPFL repair and suture tape augmentation. Our results show that this technique is an alternative treatment to traditional MPFL reconstruction with comparable outcomes and avoidance of autograft harvest.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Efficacy of Periarticular Multimodal Analgesic Injection Containing High-Dose Ketorolac versus Triamcinolone in Early Postoperative Total Knee Arthroplasty: A Randomized Controlled Trial
Rit Apinyankul, MD, Assistant Professor, Kittiphon Lilakhunakon, MD, Witchaporn Witayakom, MD, Malinee Vechvitvarakul, MD, Associate Professor, Khon Kaen University, Khon Kaen, Thailand, Stuart B. Goodman, MD, Professor, Stanford University School of Medicine, Stanford, California
1591
Introduction: Periarticular multimodal analgesic injection associates with less postoperative (post-op) pain after total knee arthroplasty (TKA) with less opioid consumption. The combination of additives and dosage are various and controversial. Evidence of ketorolac compared to triamcinolone as an additive is limited in terms of efficacy and safety.
Materials and Methods: Fifty-six patients with unilateral TKA were randomized to receive either 60mg ketorolac or 80mg triamcinolone acetonide as cocktail additives in periarticular injection. Significant threshold was considered if the adjusted mean difference of morphine consumption was greater than 3mg at any timepoint. The primary outcomes were morphine consumptions at immediate post-op, 24 hour (h), 48h, and 72h post-op. Pain visual analogue scale (VAS), knee range of motion, straight leg raising ability, and adverse events were secondary outcomes.
Results: Adjusted mean differences (ketorolac-triamcinolone) in morphine consumption were -0.4, 2.5, 2.6, and 2.3mg at given timepoints without significance. No difference observed in pain VAS at rest and during motion, post-op knee extension, and straight leg raising ability. However, post-op knee flexion was significantly higher in triamcinolone group at any timepoints (mean differences 10.3, 10.6, and 9.7, respectively, p<0.05).
Conclusions: Periarticular analgesic injection containing 60mg ketorolac provided similar analgesic efficacy and early functional recovery compared with 80mg triamcinolone acetonide. However, triamcinolone may benefit over ketorolac in early post-op knee flexion.
Order Digital ePrint:
PDF Format - $129.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
