What’s New in Adult Reconstructive Knee Surgery 2025

Topics of interest in adult reconstructive knee surgery are presented in the new JBJS Guest Editorial What’s New in Adult Reconstructive Knee Surgery. Here, we highlight 5 standout studies, as selected by coauthor Samuel Rosas, MD, PhD, MBA. 

Health-Care Policy and Economics

A recent study published in JBJS evaluated the impact of social determinants of health on outcomes and complications following total knee arthroplasty (TKA). The study utilized the Social Vulnerability Index (SVI), a metric that identifies at-risk communities based on 16 variables from U.S. Census data. In this sample of 19,321 TKA cases, higher SVI was associated with increased length of stay and increased rates of readmission and complications after TKA1. 

Blood Loss Prophylaxis

The efficacy of extended oral tranexamic acid (TXA) use in outpatient TKA was investigated in a double-blinded randomized controlled trial (RCT) that included 40 patients. In addition to the standard dose of TXA during surgery, the treatment group received 1.95 g of oral TXA after ambulation on the day of the surgery and 3 doses on postoperative days 1, 2, and 3. Compared with the placebo group, the treatment group had better knee flexion, better Knee Injury and Osteoarthritis Outcome Scores for Joint Replacement, and decreased pain at 6 weeks postoperatively2. 

Postoperative Complications

In a multicenter RCT of 124 patients with arthrofibrosis after primary TKA, researchers assessed the impact of adjuvant anti-inflammatory medications with manipulation under anesthesia (MUA)3 on range of motion and outcomes. The control group underwent MUA followed by physical therapy, whereas the treatment group received intravenous dexamethasone (8 mg) followed by MUA, physical therapy, and 14 days of oral celecoxib (200 mg). Although range of motion improved in both groups, there was no significant difference between the groups at 6 weeks or 1 year3. 

Technology-Assisted TKA

The cost-effectiveness of computer-assisted vs. conventional TKA was compared using Markov models in a recent JBJS study. Computer-assisted TKA was associated with higher quality-adjusted life-years and lower costs for elderly patients as well as for patients who were not elderly, regardless of the payment program. Additionally, the models estimated that 100% adoption of computer-assisted TKA would result in lifetime cost savings of nearly $1 billion annually for Medicare and commercial payers4. 

Periprosthetic Joint Infection (PJI)

To evaluate the necessity of the additional tests included in the 2018 Musculoskeletal Infection Society criteria for PJI diagnosis, researchers retrospectively reviewed 204 revision TKAs and 158 revision total hip arthroplasties (THAs) that involved a suspected PJI and that had a minimum 2-year follow-up. Without using alpha-defensin or synovial C-reactive protein, the criteria for infection were met in 94.6% of TKA cases and 98.7% of THA cases based on preoperative and intraoperative data and in 88.4% of TKA and THA cases based on preoperative data alone5. These findings “highlight that an algorithmic approach would be both effective and economical for diagnosing PJI,” write Guest Editorial authors Drs. Luo, Rosas, and Lanting. 

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 

  1. Rahman TM, Shaw JH, Mehaidli A, Hennekes M, Hansen L, Castle JP, Kulkarni M, Silverton CD. The impact of social determinants of health on outcomes and complications after total knee arthroplasty: an analysis of neighborhood deprivation indices. J Bone Joint Surg Am. 2024 Feb 21;106(4):288-303. 
  2. Kirwan MJ, Diltz ZR, Dixon DT, Rivera-Peraza CA, Gammage CJ, Mihalko WM, Harkess JW, Guyton JL, Crockarell JR, Ford MC. The AAHKS Clinical Research Award: Extended postoperative oral tranexamic acid in total knee arthroplasty: a randomized controlled pilot study. J Arthroplasty. 2024 Sep;39(9S2):S13-7. 
  3. Abdel MP, Salmons HI, Larson DR, Austin MS, Barnes CL, Bolognesi MP, Della Valle CJ, Dennis DA, Garvin KL, Geller JA, Incavo SJ, Lombardi AV Jr, Peters CL, Schwarzkopf R, Sculco PK, Springer BD, Pagnano MW, Berry DJ. The Chitranjan S. Ranawat Award: Manipulation under anesthesia to treat postoperative stiffness after total knee arthroplasty: a multicenter randomized clinical trial. J Arthroplasty. 2024 Aug;39(8S1):S9: 14.e1. 
  4. Tian Y, Ahmed AG, Hiredesai AN, Huang LW, Patel AM, Ghomrawi HMK. The cost-effectiveness of computer-assisted compared with conventional total knee arthroplasty: a payer’s perspective. J Bone Joint Surg Am. 2024 Sep 18;106(18):1680-7. 
  5. Kreinces JB, Ashkenazi I, Shichman I, Roof MA, Schwarzkopf R, Aggarwal VK. The James A. Rand Young Investigator’s Award: Keeping it simple: are all Musculoskeletal Infection Society tests useful to diagnose periprosthetic joint infection? J Arthroplasty. 2024 Sep;39(9S2):S3: 7.e1. 

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