Findings from high-level and award-winning studies on topics such as unicompartmental and total knee arthroplasty (TKA), among others, are featured in the new JBJS Guest Editorial What’s New in Adult Reconstructive Knee Surgery. Here, we highlight the 5 most impactful studies, as selected by co-author Jesus M. Villa, MD.
Primary TKA: Perioperative Care
The effects of tourniquet use on early recovery following primary TKA were investigated in a randomized controlled trial (RCT) that utilized a smartphone application with wrist-based activity monitoring. A total of 107 patients with osteoarthritis were included. Tourniquet use had no significant impact on pain scores and opioid consumption during the first 30 days postoperatively, nor did it have an impact on function scores or physical therapy performance within 90 days postoperatively1.
Primary TKA: Implant Design
The risk of revision following mobile-bearing vs. fixed-bearing TKA was examined in an analysis of American Joint Replacement Registry data from 2012 to 2019, which included 452,199 fixed-bearing and 32,825 mobile-bearing TKAs performed in patients >65 years old. The investigators found that mobile-bearing TKAs had an increased risk of all-cause revision (hazard ratio, 1.36; p < 0.0001). However, mobile-bearing TKAs were not associated with an increased risk of revision for infection2.
Implant survivorship at a mean of 10 years was reported in a Level I RCT that investigated 3 different TKA implant designs: a traditional modular cemented tibia, a hybrid monoblock tibia, and a cementless monoblock tibia. The hybrid and cementless groups each had 96% implant survivorship. Notably, the cemented group had a significantly greater rate of revision for aseptic tibial loosening (7%; p = 0.003) than the hybrid group (0%) and the cementless group (0%)3.
Primary TKA: Outcomes
A review of patient-reported outcome measures (PROMs) following 1,093 primary TKAs was conducted to determine whether clinically meaningful improvements in PROMs occurred between follow-up at 1 year and a minimum of 2 years. Patient-reported pain, function, activity level, and satisfaction were evaluated. For most of the PROMs, improvements between the 1 and minimum 2-year time points did not reach the minimal clinically important difference. The study authors concluded that it is “reasonable to question the currently accepted 2-year minimum follow-up requirement” by journals for PROM-related research4.
Revision TKA: Infection
A study of synovial fluid obtained from 65 knees demonstrated a distinct microbiome in the knee. Normal knees, osteoarthritic knees, and knees that underwent septic or aseptic revision were included. The most species were found in native osteoarthritic knees. Osteoarthritic knees had a high amount of Proteobacteria, whereas native nonosteoarthritic knees had a large presence of Cutibacterium, Staphylococcus, and Paracoccus. Guest Editorial authors Dr. Villa et al. note that these findings merit further research on the role of the knee microbiome in osteoarthritis and periprosthetic joint infection5.
What’s New in Adult Reconstructive Knee Surgery is freely available at JBJS.org.
What’s New by Subspecialty
Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org.
Recent OrthoBuzz posts include: What’s New in Musculoskeletal Tumor Surgery, What’s New in Musculoskeletal Basic Science, and What’s New in Orthopaedic Rehabilitation.
References
- Lawrie CM, Hannon CP, Jo S, King J, Riegler V, Nunley RM, Barrack RL. Chitranjan S. Ranawat Award: Tourniquet use does not impact trajectory of total knee arthroplasty early recovery: a prospective, randomized controlled trial. J Arthroplasty. 2023 Jun;38(6S):S7-13.
- Hegde V, Kendall J, Schabel K, Pelt CE, Yep P, Mullen K, De A, Kagan R. The James A. Rand Young Investigator’s Award: Increased revision risk with mobile bearings in total knee arthroplasty: an analysis of the American Joint Replacement Registry. J Arthroplasty. 2023 Jul;38(7)(Suppl 2):S3-8.
- Gibon E, Lewallen DG, Larson DR, Stuart MJ, Pagnano MW, Abdel MP. John N. Insall Award: Randomized clinical trial of cementless versus cemented tibial components: durable and reliable at a mean 10-years follow-up. J Arthroplasty. 2023 Jun;38(6S):S14-20.
- Seetharam A, Deckard ER, Ziemba-Davis M, Meneghini RM. The AAHKS Clinical Research Award: Are minimum two-year patient-reported outcome measures necessary for accurate assessment of patient outcomes after primary total knee arthroplasty? J Arthroplasty. 2022 Aug;37(8S):S716-20.
- Fernández-Rodríguez D, Baker CM, Tarabichi S, Johnson EE, Ciccotti MG, Parvizi J. Mark Coventry Award: Human knee has a distinct microbiome: implications for periprosthetic joint infection. J Arthroplasty. 2023 Jun;38(6S):S2-6.