What’s New in Adult Reconstructive Knee Surgery DOI Open Access
T. David Luo, Samuel Rosas, Brent A. Lanting

et al.

Journal of Bone and Joint Surgery, Journal Year: 2024, Volume and Issue: unknown

Published: Nov. 20, 2024

In this Guest Editorial, we review and summarize the key findings from most noteworthy impactful studies relating to adult reconstructive knee surgery across different areas of research over past year. This includes various Levels Evidence, but special attention was paid higher Evidence award-winning publications. Health-Care Policy Economics As orthopaedic surgeons strive provide improved patient outcomes, there remains a wide disparity in equity health-care access for vulnerable populations. There is an increased recognition adverse outcomes based on social determinants health (SDOH) need policy system changes bridge gap quality care that they receive1. The International Classification Diseases, Tenth Revision (ICD-10) contains Z code categories (Z55-Z65) document presence SDOH. Although these codes currently lack financial incentives their use, data tracking purposes identify potential targeted interventions1. large database study, were used matched cohorts patients with without After propensity matching 207,844 patients, authors observed disparities SDOH had odds readmissions complications within 90 days rates revision periprosthetic joint infection (PJI) 2 years following total arthroplasty (TKA) compared control group2. One specific socioeconomic metric, Social Vulnerability Index (SVI), uses 16 variables U.S. Census at-risk communities3,4. Two separately demonstrated SVI associated length stay, readmissions, after TKA3, whereas subthemes household composition disability risk factors 90-day TKA4. These encourage broader adoption screening preoperative intervention optimize Treatment Knee Osteoarthritis Biologic interventions treat osteoarthritis prevent progression remain trending topic. randomized controlled trial (RCT), platelet-rich plasma (PRP) injections alone exercise PRP combined treatment symptomatic grade-2 3 osteoarthritis. A commercially available kit prepare injections, which given times at weekly intervals. improvements patient-reported seen all groups 24 weeks, group superior respect pain, function, life. no benefit treating exercise, allowing conclude role mild moderate osteoarthritis5. Unicompartmental Arthroplasty (UKA) Indications Utilization utilization UKA continues increase as compartment-specific American Board Orthopaedic Surgery (ABOS) Part II Oral Examination Case List revealed volume UKAs performed by newly trained more than doubled between 2011 (18.8 per 10,000 cases) 2021 (39.5 cases). UKA, periarticular osteotomy osteoarthritis, significantly lower surgical (7.3% 23.7%; p < 0.001), reoperation (1.9% 5.2%; = 0.002), (1.4% 6.7%; 0.001)6. Similarly, network study 590% 2012 (241 UKAs) 2022 (1,662 UKAs), similar robotic (11 68 [518%])7. Lateral growing interest lateral isolated compartment cohort analysis, comparing causes significant functional Society Score, Forgotten Joint visual analog scale (VAS) pain. Compared primary who underwent meniscectomy less medial thus greater implant survivorship (97.6% 83.3%) mean follow-up 10 years8. Plancher et al.9 grade-3 or 4 chondromalacia patellar facet did not negatively impact scores UKA. Bunyoz al.10 found learning curve approximately 33 cases, duration. Oxford Scores (OKS) reveal during 95.4% revision-free 7 years10. single-surgeon 161 153 97.4% 5 years, 91.3% 15 years11. Registry Data National England, Wales, Northern Ireland Isle Man (NJR) OKS 3,453 cement cementless propensity-matched study. postoperative (39.1 ± 8.7) mobile-bearing (38.5 8.6), although difference below minimum clinically important (MCID). Additionally, 10-year (93.0%) its cemented counterpart (91.3%). differences clinical greater, favor cement, when procedures high-volume (≥30 year)12. New Zealand indicated threshold revise poorly functioning (OKS, ≤25) TKA 6 months (19.6% 5.1%; (12.5% 4.3%; (15.0% 6.4%; 0.024). unknown etiology 2.5 TKA13. Acute PJI presents unique challenge involving prosthetic component well native cartilage. multicenter explored effectiveness debridement, antibiotics, retention (DAIR) scenario. time index diagnosis 11.1 months. eradication rate 1 year 80.8% (42 52 failures proceeding either 1-stage 2-stage TKA. techniques irrigation solutions varied widely institutions, exposure thorough synovectomy eradication14. Primary Antibiotic Prophylaxis Infection Prevention Debate persists regard optimal antibiotic prophylaxis multicenter, double-blinded, placebo-controlled superiority trial, investigators sought evaluate efficacy addition intravenous vancomycin placebo preventing site postoperatively. Over 4,000 known methicillin-resistant Staphylococcus aureus (MRSA) colonization included, including 2,233 Patients received g cefazolin plus weight-based placebo. Sixty-three (5.7%) 1,109 developed 42 (3.7%) 1,124 (relative risk, 1.52 [95% confidence interval (CI), 1.04 2.23]). An additional subgroup analysis safety administration yielded events (1.7%) both groups15. systematic penicillin allergy setting (TJA), true be low (0.7% 3%). allergic reaction cephalosporin 0% 2%, leading perioperative testing can safely usage first-line TJA16. single-blinded RCT undergoing tourniquetless TKA, hour before procedure 500-mg intraosseous incision. Systemic samples prior incision closure showed levels interosseous group. Intraoperative tissue groups, distal femur (61.0 16.0 66.2 12.3; 0.80), proximal tibia (52.8 13.5 57.1 17.0; 0.84), suprapatellar synovial (10.7 5.3 9.0 3.3; 0.80). highlighted while avoiding possible systemic toxicity vancomycin17. Catalan Register TKAs 2020 assessed association antibiotic-loaded bone (ALBC) rates. Their 22,781 (57.6% plain 42.4% ALBC) 3-month ALBC (0.52% 0.78%, 0.04)18. Conversely, 14 national regional registries, >2 million reviewed compare 1-year using cement. reported cumulative <1% (range, 0.21% 0.80%) 0.23% 0.70%). (hazard ratio [HR], 1.16 CI, 0.89 1.52]) (HR, 1.12 1.40]) cement19. Blood Loss winners Association Hip Surgeons (AAHKS) Clinical Research Award, Kirwan al.20, investigated extended oral tranexamic acid (TXA) double-blinded RCT. outpatient center receive 1.95-g TXA day ambulation doses 1, 2, 3. took pills same manner. better flexion (116.05° 106.5°; 0.0308), VAS pain (1.35 2.8; 0.011), Injury Outcome Replacement) (73.33 62.47; 0.0019) weeks becomes universal, use PJI, (OR) 0.63 (95% 0.42 0.96; 0.001) shown recent meta-analysis, it included small number studies. hypothesized prevents reducing transfusions, wound drainage, and/or hematoma formation21. Perioperative Care Pain Management Several new multimodal anesthesia regimens. assessing injection adductor canal block infiltration popliteal artery capsule (IPACK), sham saline-solution noninferior active terms score morphine equivalents22. Maniar al.23 administered surgeon intraoperatively yield relief decreased opioid consumption. described technique avoids specialized equipment anesthesiologist. 106 bilateral 20-mg duloxetine satisfaction placebo24. Sleep disturbance commonly symptom John N. Insall LeBrun al.25, exogenous melatonin subjective sleep quality, usage, 86 each vitamin C arms RCT, Haider al.26 trend toward longer duration taking initial attenuating effects waned thereafter. Wearable devices track have gained popularity. returned baseline metrics, such bed, asleep, minutes REM (rapid eye movement) nicely captured wearable devices, correlation weak may useful objective tool27. Postoperative Complications Chitranjan S. Ranawat Abdel al.28, adjuvant anti-inflammatory medications manipulation under (MUA) arthrofibrosis 124 institutions. 8-mg dexamethasone followed MUA, physical therapy, celecoxib (200 mg) MUA therapy. Range motion but, (101° 99°; 0.35) (108° 108°; 0.98). Implant Design Bearing designs contemporary continue generate substantial debate. meta-analysis function posterior-stabilized, cruciate-retaining, ultracongruent liners, pooled limited paucity RCTs high-quality studies29. evaluating single-radius design, posterior-stabilized cruciate-retaining (median, 120.0° 115°; 0.017), years30. another knees implants maximal (129° 127° 131°]) (120° 121° 124°]) anterior-stabilized (122° 120° 124°]). types liners 2-year follow-up31. 11 RCTs, all-polyethylene metal-backed tibial similarly survivorship. Five radiostereometric (RSA), liftoff (0.3 mm) (0.19 (p 0.03); however, 5-year survivorship32. Cementless garner interest. paired resurfacing anesthetic setting, 40 other At follow-up, knees. implants, early evidence migration radiographs, none required revision33. series, 95.9% 98.9% implant, revisions 0.151) aseptic loosening 0.737)34. Concerns about components, common mode failure polyethylene dissociation metal backing35. held belief osseointegration debunked short-term (≤6 months) cement36. Canadian Replacement >202,000 all-cause 4.49% slightly 3.14% accounting confounders. When confounders taken into consideration, counterparts, 0.66 0.51 0.85], 0.001). Nonetheless, multiple limitations external validity, patient, surgeon, facility variabilities37. Technology-Assisted utility robotic-assisted much unblinded manual computed tomography (CT)-based platform, 46 41 outcomes. Western Ontario McMaster Universities (WOMAC) 0.425) improvement WOMAC 0.037), 0.198). proportion reached MCID (36 [78.3%] [58.5%]; 0.047) (40 [87.0%] 29 [68.3%]; 0.036). satisfied favored (45 [97.8%] 46) [87.8%] 41), finding 0.096)38. (AJRR) 14,216 128,334 conventional (OR, 1.0 0.8 1.3]; 0.92)39. 300 CT scanograms high long-leg radiographs coronal plane alignment knee40. Markov model incorporating parameters obtained literature (costs procedure, episode care, revision, failure; probability complications, 15-year rate), computer-assisted quality-adjusted life-years (QALYs) cost further estimates 100% would result nearly $1 billion annually lifetime savings Medicare commercial payers41. variety topics gain internationally. range published articles categorized summarized next. rotating-hinge studied cases PJI. Total Arthrofibrosis (TKAF) Consortium arc-of-motion 56 patients. arc treated construct (41.3° 19.4°) non-rotating-hinge (18.3° 15.2°); final follow-up. severe (preoperative motion, <70°), 31.1° 20.9° seen42. hinged multistage 79 2010 2018 Despite complex history, good 87.3% free infection43. James A. Rand Young Investigator's Kreinces al.44, evaluated necessity tests Musculoskeletal (MSIS) criteria diagnose retrospectively 204 158 hip (THA) suspected Most (94.6% 98.7% THA met "infected" intraoperative alpha-defensin C-reactive protein. applying only, 88.4% MSIS infection, highlighting algorithmic approach effective economical diagnosing temporal trends York Statewide Planning Cooperative System year-to-year change likelihood among 2006 2013. For 2014 2016, 0.76 0.88]; 0.0002), attributed advances prevention strategies45. Dutch Nosocomial Surveillance Network (PREZIES) primarily involved (39%), coagulase-negative staphylococci (19%), especially epidermidis (11%)46. Polymicrobial rise. single-center frames (2001 2022), involvement Cutibacterium acnes polymicrobial Culture microorganisms frequently coexisted47. 41.7% PJIs overlying sinus tract 29.1% tract48. prevalence, implications unexpected positive cultures presumed revisions. prevalence ≥2 organisms 19.5%, uncommon contaminant organism 4.7%. years49. series 691 TKAs, 7.1% culture, 1.4% organism, 0.2% organisms. Regression microorganism 11.0; culture 4.2; 0.018), constructs 4.1; 0.008) re-revision PJI50. 159 hips 61 fracture 6.8% (10 knees). causative (35%). Re-revision patients51. Special Considerations quantified single-institution grouped basis practice ("inexperienced" [little experience; first years], experience [4 senior [15 17 years]). inexperienced (216.8 minutes) (135.1 (95.0 minutes); similar: 5.3% surgeons, 3.6% 5.0% 0.916)52. Evidence-Based Orthopaedics editorial staff JBJS recently related musculoskeletal Level grade. cited already update, 9 relevant are appended standard bibliography, brief commentary article help guide evidence-based reading subspecialty area. Di Matteo B, Anzillotti G, Gallese A, Vitale U, Gaggia GMMC, Ronzoni FL, Marcacci M, Kon E. Placenta-derived products demonstrate profile overall satisfactory osteoarthritis: evidence. Arthroscopy. 2023 Aug;39(8):1892-904. review, placenta-derived Sixteen augmentation procedures. remaining injectable therapeutic agent. results encouraging, conclusions should approached caution, inclusion only variability preparation methods. Gupta PK, Maheshwari S, Cherian JJ, Goni V, Sharma AK, Tripathy SK, Talari K, Pandey Sancheti Singh Bandyopadhyay Shetty N, Kamath SU, Prahaldbhai PS, Abraham J, Kannan Bhat Parshuram Shahavi Verma NN, Kumar U. Efficacy stempeucel knee: Phase randomized, double-blind, Am J Sports Med. Jul;51(9):2254-66. allogenic mesenchymal stromal cells Kellgren-Lawrence consisted mL medium suspend marrow-derived (BMMSC) experimental Both also 2-mL hyaluronic acid. 12 months, BMMSC group, those Magnetic resonance imaging (MRI) gradual worsening tibiofemoral cartilage However, differ groups. present promising novel strategies. Jawanda H, Khan ZA, Warrier AA, Acuña AJ, Allahabadi Kaplan DJ, Ritz E, Jackson GR, Mameri ES, Batra Dornan Westrick Chahla J. Platelet-rich plasma, marrow aspirate concentrate, outperform corticosteroids intra-articular meta-analysis. 2024 May;40(5):1623-36.e1. 48 9,338 Only Level-I review. Hyaluronic injected 40.9% knees, 26.2%, 21.5%, cortisone 8.8%, concentrate (BMAC) 2.5%. Because heterogeneity studies, surface ranking (SUCRA) highest BMAC, acid, cortisone. nevertheless clinicians consider conservative Jiao Feng Z, Dai T, Huang Liu R, Meng Q. High-intensity progressive rehabilitation versus routine arthroplasty: trial. Arthroplasty. Mar;39(3):665-71.e2. high-intensity training therapy blinded grouping. regimen divided phases (muscle strengthening, rehabilitation, weight-bearing training) process. differed training, standardized instructions, along frequency training. 78 equally satisfaction, scores, shorter stay program recovery, popular. Oeding JF, Varady NH, Fearington FW, Pareek Strickland SM, Nwachukwu BU, Camp CL, Krych AJ. alternative statistical Fragility Index-based trials. Feb 29:3635465231224463. nonoperative treatments. Ten represented evidence, Level-II Outcomes 1,993 evaluated. fragility determine whether fragile robust. Briefly, involves simultaneously adding subtracting outcome × contingency table until significance reversed. If event leads reversal (i.e., 1), then deemed improvement, achieving requiring reintervention injectables, effect 8.67 4.50. Based index, drawn robust physician determining modality Stubnya BG, Kocsis Váncsa Kovács Agócs MP, Suskó Hegyi P, Bejek Z. Subvastus supporting fast-track parapatellar approach: Dec;38(12):2750-8. according approach. 2,895 subvastus mini-subvastus approaches generally (midvastus, mini-midvastus, parapatellar) With 1. general, quadriceps-sparing outperformed Functional approaches, time. main limitation time-reporting sample sizes drastically 365). limitation, supported benefits Tao X, Aw AAL, Leeu Bin Abd Razak HR. Three one dose Dec;39(12):2568-76.e2. single Seven 575 included. ranged grades triple-dose single-dose 12-month doses. interpreted caution because attempted omitted heterogeneity. Wang Q, Jin Cai L, Zhao C, Jia Xu W, Qian Ding Gu Zhang Shi Ma Deng Y, Song Zhou Pei Yang Liang Jiang Li Wu Kang P. diosmin lower-extremity swelling Bone Surg Am. Mar 20;106(6):492-500. Diosmin semisynthetic flavonoid derived hesperidin venous insufficiency. Its mechanism ability improve tone lymphatic drainage. 330 (0.9 twice days) Swelling thigh, patella, calf measured assessor rest, inflammatory markers, complication regarding diosmin's long-term warranted widespread recommended. Yoo JD, Huh MH, Lee SH, D'Lima DD, Shin YS. trials therapies analgesic consumption arthroplasty. May;39(5):1361-73. aimed modalities. Local saphenous nerve produced best (SUCRA, 80.0) lowest 100.0). femoral 90.0). suggest local considered

Language: Английский

The utility of wearable devices in the perioperative period DOI
Alexander Xiang,

J. F. Hu,

Karim S. Ladha

et al.

Current Opinion in Anaesthesiology, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 12, 2025

Purpose of review Improved perioperative patient monitoring is a crucial step toward better predicting postoperative outcomes. Wearable devices capable measuring various health-related metrics represent novel tool that can assist healthcare providers. However, the literature surrounding wearables wide-ranging, preventing clinicians from drawing definitive conclusions regarding their utility. This intends to consolidate recent on and summarize most salient information. Recent findings cardiac output colonic motility have recently been piloted with mixed results. Novel measurement techniques for established also studied, including photoplethysmography heart rate blood pressure along resistance thermometers temperature. Nuanced methods synthesizing data piloted, machine-learning algorithms adverse events trajectory curves count progression. are generally well accepted, although adjuvant support systems improved satisfaction. Summary Perioperative valuable tools tracking health metrics, events, improving Future research removing barriers such as technological illiteracy, artifact generation, false-positive alarms would enable integration into hospital setting.

Language: Английский

Citations

0
A prospective study comparing sleep quality using Pittsburgh Sleep Quality Index at 8 weeks after robotic-assisted versus conventional total knee arthroplasty: a single-center study DOI
Sanjay Bhalchandra Londhe, Ravi Vinod Shah, Nicholas Antao

et al.

Journal of Robotic Surgery, Journal Year: 2025, Volume and Issue: 19(1)

Published: April 30, 2025

Language: Английский

Citations

0
The 2023 Knee Society Members Meeting and 2024 Awards DOI
James I. Huddleston,

William J. Maloney

The Journal of Arthroplasty, Journal Year: 2024, Volume and Issue: 39(8), P. S1 - S1

Published: May 18, 2024

Language: Английский

Citations

0
What’s New in Adult Reconstructive Knee Surgery DOI Open Access
T. David Luo, Samuel Rosas, Brent A. Lanting

et al.

Journal of Bone and Joint Surgery, Journal Year: 2024, Volume and Issue: unknown

Published: Nov. 20, 2024

In this Guest Editorial, we review and summarize the key findings from most noteworthy impactful studies relating to adult reconstructive knee surgery across different areas of research over past year. This includes various Levels Evidence, but special attention was paid higher Evidence award-winning publications. Health-Care Policy Economics As orthopaedic surgeons strive provide improved patient outcomes, there remains a wide disparity in equity health-care access for vulnerable populations. There is an increased recognition adverse outcomes based on social determinants health (SDOH) need policy system changes bridge gap quality care that they receive1. The International Classification Diseases, Tenth Revision (ICD-10) contains Z code categories (Z55-Z65) document presence SDOH. Although these codes currently lack financial incentives their use, data tracking purposes identify potential targeted interventions1. large database study, were used matched cohorts patients with without After propensity matching 207,844 patients, authors observed disparities SDOH had odds readmissions complications within 90 days rates revision periprosthetic joint infection (PJI) 2 years following total arthroplasty (TKA) compared control group2. One specific socioeconomic metric, Social Vulnerability Index (SVI), uses 16 variables U.S. Census at-risk communities3,4. Two separately demonstrated SVI associated length stay, readmissions, after TKA3, whereas subthemes household composition disability risk factors 90-day TKA4. These encourage broader adoption screening preoperative intervention optimize Treatment Knee Osteoarthritis Biologic interventions treat osteoarthritis prevent progression remain trending topic. randomized controlled trial (RCT), platelet-rich plasma (PRP) injections alone exercise PRP combined treatment symptomatic grade-2 3 osteoarthritis. A commercially available kit prepare injections, which given times at weekly intervals. improvements patient-reported seen all groups 24 weeks, group superior respect pain, function, life. no benefit treating exercise, allowing conclude role mild moderate osteoarthritis5. Unicompartmental Arthroplasty (UKA) Indications Utilization utilization UKA continues increase as compartment-specific American Board Orthopaedic Surgery (ABOS) Part II Oral Examination Case List revealed volume UKAs performed by newly trained more than doubled between 2011 (18.8 per 10,000 cases) 2021 (39.5 cases). UKA, periarticular osteotomy osteoarthritis, significantly lower surgical (7.3% 23.7%; p < 0.001), reoperation (1.9% 5.2%; = 0.002), (1.4% 6.7%; 0.001)6. Similarly, network study 590% 2012 (241 UKAs) 2022 (1,662 UKAs), similar robotic (11 68 [518%])7. Lateral growing interest lateral isolated compartment cohort analysis, comparing causes significant functional Society Score, Forgotten Joint visual analog scale (VAS) pain. Compared primary who underwent meniscectomy less medial thus greater implant survivorship (97.6% 83.3%) mean follow-up 10 years8. Plancher et al.9 grade-3 or 4 chondromalacia patellar facet did not negatively impact scores UKA. Bunyoz al.10 found learning curve approximately 33 cases, duration. Oxford Scores (OKS) reveal during 95.4% revision-free 7 years10. single-surgeon 161 153 97.4% 5 years, 91.3% 15 years11. Registry Data National England, Wales, Northern Ireland Isle Man (NJR) OKS 3,453 cement cementless propensity-matched study. postoperative (39.1 ± 8.7) mobile-bearing (38.5 8.6), although difference below minimum clinically important (MCID). Additionally, 10-year (93.0%) its cemented counterpart (91.3%). differences clinical greater, favor cement, when procedures high-volume (≥30 year)12. New Zealand indicated threshold revise poorly functioning (OKS, ≤25) TKA 6 months (19.6% 5.1%; (12.5% 4.3%; (15.0% 6.4%; 0.024). unknown etiology 2.5 TKA13. Acute PJI presents unique challenge involving prosthetic component well native cartilage. multicenter explored effectiveness debridement, antibiotics, retention (DAIR) scenario. time index diagnosis 11.1 months. eradication rate 1 year 80.8% (42 52 failures proceeding either 1-stage 2-stage TKA. techniques irrigation solutions varied widely institutions, exposure thorough synovectomy eradication14. Primary Antibiotic Prophylaxis Infection Prevention Debate persists regard optimal antibiotic prophylaxis multicenter, double-blinded, placebo-controlled superiority trial, investigators sought evaluate efficacy addition intravenous vancomycin placebo preventing site postoperatively. Over 4,000 known methicillin-resistant Staphylococcus aureus (MRSA) colonization included, including 2,233 Patients received g cefazolin plus weight-based placebo. Sixty-three (5.7%) 1,109 developed 42 (3.7%) 1,124 (relative risk, 1.52 [95% confidence interval (CI), 1.04 2.23]). An additional subgroup analysis safety administration yielded events (1.7%) both groups15. systematic penicillin allergy setting (TJA), true be low (0.7% 3%). allergic reaction cephalosporin 0% 2%, leading perioperative testing can safely usage first-line TJA16. single-blinded RCT undergoing tourniquetless TKA, hour before procedure 500-mg intraosseous incision. Systemic samples prior incision closure showed levels interosseous group. Intraoperative tissue groups, distal femur (61.0 16.0 66.2 12.3; 0.80), proximal tibia (52.8 13.5 57.1 17.0; 0.84), suprapatellar synovial (10.7 5.3 9.0 3.3; 0.80). highlighted while avoiding possible systemic toxicity vancomycin17. Catalan Register TKAs 2020 assessed association antibiotic-loaded bone (ALBC) rates. Their 22,781 (57.6% plain 42.4% ALBC) 3-month ALBC (0.52% 0.78%, 0.04)18. Conversely, 14 national regional registries, >2 million reviewed compare 1-year using cement. reported cumulative <1% (range, 0.21% 0.80%) 0.23% 0.70%). (hazard ratio [HR], 1.16 CI, 0.89 1.52]) (HR, 1.12 1.40]) cement19. Blood Loss winners Association Hip Surgeons (AAHKS) Clinical Research Award, Kirwan al.20, investigated extended oral tranexamic acid (TXA) double-blinded RCT. outpatient center receive 1.95-g TXA day ambulation doses 1, 2, 3. took pills same manner. better flexion (116.05° 106.5°; 0.0308), VAS pain (1.35 2.8; 0.011), Injury Outcome Replacement) (73.33 62.47; 0.0019) weeks becomes universal, use PJI, (OR) 0.63 (95% 0.42 0.96; 0.001) shown recent meta-analysis, it included small number studies. hypothesized prevents reducing transfusions, wound drainage, and/or hematoma formation21. Perioperative Care Pain Management Several new multimodal anesthesia regimens. assessing injection adductor canal block infiltration popliteal artery capsule (IPACK), sham saline-solution noninferior active terms score morphine equivalents22. Maniar al.23 administered surgeon intraoperatively yield relief decreased opioid consumption. described technique avoids specialized equipment anesthesiologist. 106 bilateral 20-mg duloxetine satisfaction placebo24. Sleep disturbance commonly symptom John N. Insall LeBrun al.25, exogenous melatonin subjective sleep quality, usage, 86 each vitamin C arms RCT, Haider al.26 trend toward longer duration taking initial attenuating effects waned thereafter. Wearable devices track have gained popularity. returned baseline metrics, such bed, asleep, minutes REM (rapid eye movement) nicely captured wearable devices, correlation weak may useful objective tool27. Postoperative Complications Chitranjan S. Ranawat Abdel al.28, adjuvant anti-inflammatory medications manipulation under (MUA) arthrofibrosis 124 institutions. 8-mg dexamethasone followed MUA, physical therapy, celecoxib (200 mg) MUA therapy. Range motion but, (101° 99°; 0.35) (108° 108°; 0.98). Implant Design Bearing designs contemporary continue generate substantial debate. meta-analysis function posterior-stabilized, cruciate-retaining, ultracongruent liners, pooled limited paucity RCTs high-quality studies29. evaluating single-radius design, posterior-stabilized cruciate-retaining (median, 120.0° 115°; 0.017), years30. another knees implants maximal (129° 127° 131°]) (120° 121° 124°]) anterior-stabilized (122° 120° 124°]). types liners 2-year follow-up31. 11 RCTs, all-polyethylene metal-backed tibial similarly survivorship. Five radiostereometric (RSA), liftoff (0.3 mm) (0.19 (p 0.03); however, 5-year survivorship32. Cementless garner interest. paired resurfacing anesthetic setting, 40 other At follow-up, knees. implants, early evidence migration radiographs, none required revision33. series, 95.9% 98.9% implant, revisions 0.151) aseptic loosening 0.737)34. Concerns about components, common mode failure polyethylene dissociation metal backing35. held belief osseointegration debunked short-term (≤6 months) cement36. Canadian Replacement >202,000 all-cause 4.49% slightly 3.14% accounting confounders. When confounders taken into consideration, counterparts, 0.66 0.51 0.85], 0.001). Nonetheless, multiple limitations external validity, patient, surgeon, facility variabilities37. Technology-Assisted utility robotic-assisted much unblinded manual computed tomography (CT)-based platform, 46 41 outcomes. Western Ontario McMaster Universities (WOMAC) 0.425) improvement WOMAC 0.037), 0.198). proportion reached MCID (36 [78.3%] [58.5%]; 0.047) (40 [87.0%] 29 [68.3%]; 0.036). satisfied favored (45 [97.8%] 46) [87.8%] 41), finding 0.096)38. (AJRR) 14,216 128,334 conventional (OR, 1.0 0.8 1.3]; 0.92)39. 300 CT scanograms high long-leg radiographs coronal plane alignment knee40. Markov model incorporating parameters obtained literature (costs procedure, episode care, revision, failure; probability complications, 15-year rate), computer-assisted quality-adjusted life-years (QALYs) cost further estimates 100% would result nearly $1 billion annually lifetime savings Medicare commercial payers41. variety topics gain internationally. range published articles categorized summarized next. rotating-hinge studied cases PJI. Total Arthrofibrosis (TKAF) Consortium arc-of-motion 56 patients. arc treated construct (41.3° 19.4°) non-rotating-hinge (18.3° 15.2°); final follow-up. severe (preoperative motion, <70°), 31.1° 20.9° seen42. hinged multistage 79 2010 2018 Despite complex history, good 87.3% free infection43. James A. Rand Young Investigator's Kreinces al.44, evaluated necessity tests Musculoskeletal (MSIS) criteria diagnose retrospectively 204 158 hip (THA) suspected Most (94.6% 98.7% THA met "infected" intraoperative alpha-defensin C-reactive protein. applying only, 88.4% MSIS infection, highlighting algorithmic approach effective economical diagnosing temporal trends York Statewide Planning Cooperative System year-to-year change likelihood among 2006 2013. For 2014 2016, 0.76 0.88]; 0.0002), attributed advances prevention strategies45. Dutch Nosocomial Surveillance Network (PREZIES) primarily involved (39%), coagulase-negative staphylococci (19%), especially epidermidis (11%)46. Polymicrobial rise. single-center frames (2001 2022), involvement Cutibacterium acnes polymicrobial Culture microorganisms frequently coexisted47. 41.7% PJIs overlying sinus tract 29.1% tract48. prevalence, implications unexpected positive cultures presumed revisions. prevalence ≥2 organisms 19.5%, uncommon contaminant organism 4.7%. years49. series 691 TKAs, 7.1% culture, 1.4% organism, 0.2% organisms. Regression microorganism 11.0; culture 4.2; 0.018), constructs 4.1; 0.008) re-revision PJI50. 159 hips 61 fracture 6.8% (10 knees). causative (35%). Re-revision patients51. Special Considerations quantified single-institution grouped basis practice ("inexperienced" [little experience; first years], experience [4 senior [15 17 years]). inexperienced (216.8 minutes) (135.1 (95.0 minutes); similar: 5.3% surgeons, 3.6% 5.0% 0.916)52. Evidence-Based Orthopaedics editorial staff JBJS recently related musculoskeletal Level grade. cited already update, 9 relevant are appended standard bibliography, brief commentary article help guide evidence-based reading subspecialty area. Di Matteo B, Anzillotti G, Gallese A, Vitale U, Gaggia GMMC, Ronzoni FL, Marcacci M, Kon E. Placenta-derived products demonstrate profile overall satisfactory osteoarthritis: evidence. Arthroscopy. 2023 Aug;39(8):1892-904. review, placenta-derived Sixteen augmentation procedures. remaining injectable therapeutic agent. results encouraging, conclusions should approached caution, inclusion only variability preparation methods. Gupta PK, Maheshwari S, Cherian JJ, Goni V, Sharma AK, Tripathy SK, Talari K, Pandey Sancheti Singh Bandyopadhyay Shetty N, Kamath SU, Prahaldbhai PS, Abraham J, Kannan Bhat Parshuram Shahavi Verma NN, Kumar U. Efficacy stempeucel knee: Phase randomized, double-blind, Am J Sports Med. Jul;51(9):2254-66. allogenic mesenchymal stromal cells Kellgren-Lawrence consisted mL medium suspend marrow-derived (BMMSC) experimental Both also 2-mL hyaluronic acid. 12 months, BMMSC group, those Magnetic resonance imaging (MRI) gradual worsening tibiofemoral cartilage However, differ groups. present promising novel strategies. Jawanda H, Khan ZA, Warrier AA, Acuña AJ, Allahabadi Kaplan DJ, Ritz E, Jackson GR, Mameri ES, Batra Dornan Westrick Chahla J. Platelet-rich plasma, marrow aspirate concentrate, outperform corticosteroids intra-articular meta-analysis. 2024 May;40(5):1623-36.e1. 48 9,338 Only Level-I review. Hyaluronic injected 40.9% knees, 26.2%, 21.5%, cortisone 8.8%, concentrate (BMAC) 2.5%. Because heterogeneity studies, surface ranking (SUCRA) highest BMAC, acid, cortisone. nevertheless clinicians consider conservative Jiao Feng Z, Dai T, Huang Liu R, Meng Q. High-intensity progressive rehabilitation versus routine arthroplasty: trial. Arthroplasty. Mar;39(3):665-71.e2. high-intensity training therapy blinded grouping. regimen divided phases (muscle strengthening, rehabilitation, weight-bearing training) process. differed training, standardized instructions, along frequency training. 78 equally satisfaction, scores, shorter stay program recovery, popular. Oeding JF, Varady NH, Fearington FW, Pareek Strickland SM, Nwachukwu BU, Camp CL, Krych AJ. alternative statistical Fragility Index-based trials. Feb 29:3635465231224463. nonoperative treatments. Ten represented evidence, Level-II Outcomes 1,993 evaluated. fragility determine whether fragile robust. Briefly, involves simultaneously adding subtracting outcome × contingency table until significance reversed. If event leads reversal (i.e., 1), then deemed improvement, achieving requiring reintervention injectables, effect 8.67 4.50. Based index, drawn robust physician determining modality Stubnya BG, Kocsis Váncsa Kovács Agócs MP, Suskó Hegyi P, Bejek Z. Subvastus supporting fast-track parapatellar approach: Dec;38(12):2750-8. according approach. 2,895 subvastus mini-subvastus approaches generally (midvastus, mini-midvastus, parapatellar) With 1. general, quadriceps-sparing outperformed Functional approaches, time. main limitation time-reporting sample sizes drastically 365). limitation, supported benefits Tao X, Aw AAL, Leeu Bin Abd Razak HR. Three one dose Dec;39(12):2568-76.e2. single Seven 575 included. ranged grades triple-dose single-dose 12-month doses. interpreted caution because attempted omitted heterogeneity. Wang Q, Jin Cai L, Zhao C, Jia Xu W, Qian Ding Gu Zhang Shi Ma Deng Y, Song Zhou Pei Yang Liang Jiang Li Wu Kang P. diosmin lower-extremity swelling Bone Surg Am. Mar 20;106(6):492-500. Diosmin semisynthetic flavonoid derived hesperidin venous insufficiency. Its mechanism ability improve tone lymphatic drainage. 330 (0.9 twice days) Swelling thigh, patella, calf measured assessor rest, inflammatory markers, complication regarding diosmin's long-term warranted widespread recommended. Yoo JD, Huh MH, Lee SH, D'Lima DD, Shin YS. trials therapies analgesic consumption arthroplasty. May;39(5):1361-73. aimed modalities. Local saphenous nerve produced best (SUCRA, 80.0) lowest 100.0). femoral 90.0). suggest local considered

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