What’s New in Adult Reconstructive Knee Surgery 2022

Every month, JBJS publishes a review of the most pertinent and impactful studies from the orthopaedic literature during the previous year in 14 subspecialty areas. This month, co-author Jesus M. Villa, MD selected the 5 most clinically compelling findings from among the studies highlighted in the most recent “What’s New in Adult Reconstructive Knee Surgery.” 

Smartphone-Based Care Platform 

–The use of a smartphone-based exercise system was compared with a traditional in-person physiotherapy model in a recent award-winning randomized controlled trial¹. Among patients receiving primary partial and total knee arthroplasty, the investigators found no significant differences between the treatment groups in the 90-day mean knee range of motion, Timed Up and Go (TUG) test score, Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), and need for manipulation under anesthesia. 

Aspirin and IDVT 

–Another award-winning study evaluated the use of aspirin (325 mg twice daily) in a cohort of patients diagnosed with infrapopliteal deep venous thrombosis (IDVT) after total knee arthroplasty². The findings indicated that aspirin was effective in preventing the propagation of IDVT, with resolution of IDVT noted on follow-up Doppler ultrasound in 445 of 459 cases. 

PJI Prevention 

– Extended oral antibiotic prophylaxis for 7 days in high-risk patients undergoing total knee and hip arthroplasty led to a significantly lower rate of periprosthetic joint infection (PJI) within 1 year postoperatively compared with the rate among high-risk patients who did not receive extended antibiotic prophylaxis (0.89% vs. 2.64%; p < 0.001)³. 

– Another recent study evaluated the use of prophylactic intraosseous vancomycin in patients undergoing primary total knee arthroplasty. The authors found a significantly lower incidence of PJI at 90 days when compared with intravenous vancomycin⁴. All patients received an additional dose of first-generation cephalosporin. 

PJI Treatment 

– In a preliminary investigation, plasma D-dimer showed low accuracy and did not appear to anticipate persistent infection after reimplantation in patients who underwent 2-stage revision for PJI5. The authors concluded that, while D-dimer alone might be used to establish that PJI is unlikely, the combination of D-dimer, ESR, and CRP should be considered in confirming the diagnosis of PJI in cases of reimplantation. 

To access the full text of the newest JBJS Guest Editorial, “What’s New in Adult Reconstructive Knee Surgery,” click here.  

A collection of previous ‘What’s New By Subspecialty’ articles can be found here. 

References 

1. Crawford DA, Duwelius PJ, Sneller MA, Morris MJ, Hurst JM, Berend KR, Lombardi AV. 2021 Mark Coventry Award: Use of a smartphone-based care platform after primary partial and total knee arthroplasty: a prospective randomized controlled trial. Bone Joint J. 2021 Jun;103-B(6)(Supple A):3-12. 
2. Omari AM, Parcells BW, Levine HB, Seidenstein A, Parvizi J, Klein GR. 2021 John N. Insall Award: Aspirin is effective in preventing propagation of infrapopliteal deep venous thrombosis following total knee arthroplasty. Bone Joint J. 2021 Jun;103-B(6)(Supple A):18-22. 
3. Kheir MM, Dilley JE, Ziemba-Davis M, Meneghini RM. The AAHKS Clinical Research Award: Extended oral antibiotics prevent periprosthetic joint infection in high-risk cases: 3855 patients with 1-year follow-up. J Arthroplasty. 2021 Jul;36(7S):S18-25. 
4. Park KJ, Chapleau J, Sullivan TC, Clyburn TA, Incavo SJ. 2021 Chitranjan S. Ranawat Award: Intraosseous vancomycin reduces periprosthetic joint infection in primary total knee arthroplasty at 90-day follow-up. Bone Joint J. 2021 Jun;103-B(6)(Supple A):13-7. 
5. Pannu TS, Villa JM, Engh C 3rd, Patel A, Levine BR, Piuzzi NS, Higuera CA, Riesgo AM. Plasma D-dimer does not anticipate the fate of reimplantation in two-stage exchange arthroplasty for periprosthetic joint infection: a preliminary investigation. Clin Orthop Relat Res. 2021 Jul 1;479(7):1458-68.