New research in adult reconstructive knee surgery is discussed in the latest JBJS Specialty Update What’s New in Adult Reconstructive Knee Surgery. Here, we summarize the 5 most impactful studies, as selected by coauthor T. David Luo, MD, PhD.
Antibiotic Prophylaxis and Infection Prevention
The safety of cefazolin in patients with documented penicillin anaphylaxis was evaluated in a retrospective study of 8,456 patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Cefazolin was not associated with an increased risk of anaphylaxis, with only 1 patient requiring epinephrine or a rapid response among the 214 patients with a penicillin allergy who received cefazolin1.
In a meta-analysis including 19,153 patients across 18 studies, researchers investigated the benefit of extended oral antibiotic prophylaxis following primary or aseptic revision total joint arthroplasty. Compared with standard prophylaxis, extended oral antibiotic use (>24 hours) was associated with a 35% lower likelihood of developing periprosthetic joint infection (PJI) in the cohort. However, no such benefit was observed for primary TKA or aseptic revision THA specifically2.
Blood Loss Control and Thromboprophylaxis
A large national database study published in JBJS examined the prevalence and efficacy of low-dose (81 mg) aspirin vs. other agents for venous thromboembolism prophylaxis in 126,692 patients who underwent TKA between 2012 and 2022. Low-dose aspirin use increased from 7.65% to 55.29% during this period, whereas the use of other agents decreased. In both high and low-risk patients, low-dose aspirin was associated with lower odds of deep vein thrombosis, pulmonary embolism, bleeding, infection, and hospitalization compared with other agents3.
Alignment Technique
A retrospective study of 2,427 primary TKAs demonstrated that a matching preoperative and postoperative coronal plane alignment of the knee (CPAK) classification was not associated with a difference in patient-reported outcomes at 2 years postoperatively4. This finding suggests that “outcomes depend on multiple surgical and biomechanical factors beyond coronal alignment alone,” write Specialty Update authors Drs. Luo et al.
PJI in Revision TKA
The effect of intraosseous (IO) vs. intravenous (IV) delivery of vancomycin on the incidence of PJI was investigated in a multicenter study of 719 aseptic revision TKAs. Compared with IV administration, IO administration was associated with a lower PJI incidence at 30 days (0.3% vs. 2.1%), 90 days (0.9% vs. 3.1%), and 1 year (1.6% vs. 4.9%). Additionally, the rates of acute kidney injury, deep venous thrombosis, and pulmonary embolism did not differ between the groups5.
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 Basic Science, What’s New in Musculoskeletal Tumor Surgery, and What’s New in Musculoskeletal Infection.
References
- Wagner M, Patel NB, Michaels R, Patel K, Jog A, Prentice AJ, Janney CA, Dailey EA. Safety of perioperative cefazolin in penicillin-anaphylactic patients for total hip and knee arthroplasty. J Arthroplasty. 2025 Jun 13:S0883-5403(25)00742-9.
- Dasari SP, Kanumuri SD, Yang J, Manner PA, Fernando ND, Hernandez NM. Extended prophylactic antibiotics for primary and aseptic revision total joint arthroplasty: a meta-analysis. J Arthroplasty. 2024 Sep;39(9S2):S476-87.
- Lavu MS, Porto JR, Hecht CJ 2nd, Acuña AJ, Kaelber DC, Parvizi J, Kamath AF. Low-dose aspirin is the safest prophylaxis for prevention of venous thromboembolism after total knee arthroplasty across all patient risk profiles. J Bone Joint Surg Am. 2024 Jul 17;106(14):1256-67.
- Kraus KR, Deckard ER, Buller LT, Meding JB, Meneghini RM. The Mark Coventry Award: Does matching the native coronal plane alignment of the knee improve outcomes in primary total knee arthroplasty? J Arthroplasty. 2025 Jul;40(7S1):S3-11.
- McNamara CA, Wininger AE, Sullivan TC, Brown TS, Clyburn TA, Incavo SJ, Park KJ. The AAHKS Best Podium Presentation Research Award: Intraosseous vancomycin reduces the rate of periprosthetic joint infection following aseptic revision total knee arthroplasty. J Arthroplasty. 2025 Sep;40(9S1):S28-32.
