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Current Concept Update on Robotic Technology in Arthroplasty- A Narrative review

Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 35-41 | Shobit Deshmukh, Vaibhav Bagaria

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.630


Author: Shobit Deshmukh [1], Vaibhav Bagaria [1]

[1] Department of Orthopedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Vaibhav Bagaria,
Department of Orthopedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India.
E-mail: drbagaria@gmail.com


Abstract

Ensuring precise prosthesis positioning is one of the key elements for improving long-term survival rates in knee arthroplasty. The evolution of Total knee arthroplasty surgeries from Computer assisted navigation to robotic assisted techniques has improved the precision of bone preparation, component positioning and has reduced alignment outliers and surgeon-related errors. The present article gives an overview of the existing robotic arthroplasty systems available.
The present review describes the types of robots, their classification system, comparisons between various robotic assisted devices available in the market. This review highlights the key steps involved in using various systems, current concepts and the future scope of development in this field. This review also proposes the concept of intelligent alignment philosophy which is more patient specific combining different philosophies.
Keywords– Robotic Assisted techniques, current updates, intelligent alignment, total knee arthroplasty


References

1. Nunley RM, Nam D, Berend KR, Lombardi AV, Dennis DA, Della Valle CJ, et al. New total knee arthroplasty designs: Do young patients notice? Clin Orthop Relat Res 2015;473:101-8.
2. Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 2010;468:45-51.
3. McClelland JA, Webster KE, Ramteke AA, Feller JA. Total knee arthroplasty with computer-assisted navigation more closely replicates normal knee biomechanics than conventional surgery. Knee 2017;24:651-6.
4. Figueroa F, Parker D, Fritsch B, Oussedik S. New and evolving technologies for knee arthroplasty-computer navigation and robotics: State of the art. J ISAKOS 2018;3:46-54.
5. St Mart JP, Goh EL. The current state of robotics in total knee arthroplasty. EFORT Open Rev 2021;6:270-9.
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9. Jacofsky DJ, Allen M. Robotics in arthroplasty: A comprehensive review. J Arthroplasty 2016;31:2353-63.
10. Shatrov J, Foissey C, Kafelov M, Batailler C, Gunst S, Servien E, et al. Functional alignment philosophy in total knee arthroplasty-rationale and technique for the Valgus morphotype using an image based robotic platform and individualized planning. J Pers Med 2023;13:212.
11. Shatrov J, Battelier C, Sappey-Marinier E, Gunst S, Servien E, Lustig S. Functional alignment philosophy in total knee arthroplasty-rationale and technique for the varus morphotype using a CT based robotic platform and individualized planning. SICOT J 2022;8:11.
12. MacDessi SJ, Griffiths-Jones W, Harris IA, Bellemans J, Chen DB. Coronal plane alignment of the knee (CPAK) classification. Bone Joint J 2021;103-B:329-37.
13. Kazarian GS, Lawrie CM, Barrack TN, Donaldson MJ, Miller GM, Haddad FS, et al. The impact of surgeon volume and training status on implant alignment in total knee arthroplasty. J Bone Joint Surg Am 2019;101:1713-23.
14. Goh GS, Lohre R, Parvizi J, Goel DP. Virtual and augmented reality for surgical training and simulation in knee arthroplasty. Arch Orthop Trauma Surg 2021;141:2303-12.
15. Jiang H, Xiang S, Guo Y, Wang Z. A wireless visualized sensing system with prosthesis pose reconstruction for total knee arthroplasty. Sensors (Basel) 2019;19:2909.
16. Hazratwala K, Brereton SG, Grant A, Dlaska CE. Computer-assisted technologies in arthroplasty: Navigating your way today. JBJS Rev 2020;8:e0157.
17. Bellemans J, Vandenneucker H, Vanlauwe J. Robot-assisted total knee arthroplasty. Clin Orthop Relat Res 2007;464:111-6.
18. Mancino F, Cacciola G, Malahias MA, De Filippis R, De Marco D, Di Matteo V, et al. What are the benefits of robotic-assisted total knee arthroplasty over conventional manual total knee arthroplasty? A systematic review of comparative studies. Orthop Rev (Pavia) 2020;12 Suppl 1:8657.

How to Cite this article: Deshmukh S, Bagaria V. Current Concept Update on Robotic Technology in Arthroplasty. Journal of Clinical Orthopaedics 2024 January-June;9(1):35-41

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Potpourri – Recent and Relevant Literature in Periprosthetic Fractures Around the Knee

Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 52-56 | Clevio Desouza, Nicholas Antao

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.634


Author: Clevio Desouza [1, 2], Nicholas Antao [2]

[1] Centre for Bone and Joints, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, Holy Spirit Hospital, Andheri, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Clevio Joao Baptista Desouza,
Centre for Bone and Joints, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India.
E-mail: ceviod@gmail.com


Abstract

Knee replacement stands as an effective treatment for alleviating pain and restoring function in cases of degenerative joint conditions. The escalating prevalence of knee replacements reflects their acknowledged success. Despite being a relatively uncommon complication, periprosthetic fractures surrounding total knee arthroplasties present intricate challenges, demanding proficiency in both arthroplasty and trauma reconstructive techniques from treating surgeons. The confluence of increased life expectancy and elevated functional expectations among elderly individuals may contribute to a heightened occurrence of periprosthetic fractures. Among these fractures, supracondylar fractures of the femur emerge as the most prevalent. This comprehensive review delves into the classification and diverse treatment modalities available for addressing periprosthetic fractures around total knee arthroplasties.
Keywords: Total Knee Arthroplasty, Replacement, Femur, Periprosthetic fractures


References

1. Vaidya SV, Jogani AD, Pachore JA, Armstrong R, Vaidya CS. India joining the world of hip and knee registries: Present status-a leap forward. Indian J Orthop 2020;55:46-55.
2. Rorabeck CH, Taylor JW. Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin North Am 1999;30:209-14.
3. Engh GA, Rorabeck CH, editors. Revision Total Knee Arthroplasty. Baltimore, Philadelphia, PA: Williams and Wilkins; 1997. p. 275-95.
4. Kim KI, Egol KA, Hozack WJ, Parvizi J. Periprosthetic fractures after total knee arthroplasties. Clin Orthop Relat Res 2006;446:167-75.
5. Felix NA, Stuart MJ, Hanssen AD. Periprosthetic fractures of the tibia associated with total knee arthroplasty. Clin Orthop Relat Res 1997;345:113-24.
6. Ortiguera CJ, Berry DJ. Patellar fracture after total knee arthroplasty. J Bone Joint Surg Am 2002;84:532-40.
7. Benkovich V, Klassov Y, Mazilis B, Bloom S. Periprosthetic fractures of the knee: A comprehensive review. Eur J Orthop Surg Traumatol 2020;30:387-99.
8. Sayum Filho J, Lenza M, Tamaoki MJ, Matsunaga FT, Belloti JC. Interventions for treating fractures of the patella in adults. Cochrane Database Syst Rev 2021;2:CD009651.
9. Cacciola G, Mancino F, De Meo F, Bruschetta A, De Martino I, Cavaliere P. Current reconstruction options in periprosthetic fractures around the knee. Geriatric Orthop Surg Rehabil 2021;12:21514593211023996.
10. Lombardo DJ, Siljander MP, Sobh A, Moore DD, Karadsheh MS. Periprosthetic fractures about total knee arthroplasty. Musculoskelet Surg 2020;104:135-43.
11. Pellegrino A, Coscione A, Santulli A, Pellegrino G, Paracuollo M. Knee periprosthetic fractures in the elderly: Current concept. Orthop Rev (Pavia) 2022;14:38566.
12. Lari A, Kashif S, AlMukaimi A. Arthroscopic retrograde intramedullary nailing of periprosthetic fractures after total knee arthroplasty-technique, safety, and outcomes. Arthroplast Today 2022;17:47-52.
13. Park YG, Kang H, Song JK, Lee J, Rho JY, Choi S. Minimally invasive plate osteosynthesis with dual plating for periprosthetic distal femoral fractures following total knee arthroplasty. J Orthop Surg Res 2021;16:433.
14. Antao NA, Londhe S, Toor R, Shirishkar R, Aiyer S. Short-term results of a novel management of supracondylar fracture with coexisting osteoarthritis with bifold fixation and total knee arthroplasty. Arthroplasty. 2021 Dec 4;3(1):44.
15. Hassan S, Swamy GN, Malhotra R, Badhe NP. Periprosthetic fracture of the distal femur after total knee arthroplasty; Prevalence and outcomes following treatment. J Bone Joint Surg (Br) 2012;94-B:6.
16. Norrish AR, Jibri ZA, Hopgood P. The LISS plate treatment of supracondylar fractures above a total knee replacement: A case-control study. Acta Orthop Belg 2009;75:642-8.
17. Ebraheim NA, Sochacki KR, Liu X, Hirschfield G, Liu J. Locking plate fixation of periprosthetic femur fractures with and without cerclage wires. Orthop Surg 2013;5:183-7.
18. Hoffman MF, Jones CB, Sietsema DL, Koenig SJ, Tornetta P 3rd. Outcome of periprosthetic distal femoral fractures following knee arthroplasty. Injury 2012;43:1084-9.
19. Ehlinger M, Adam P, Abane L, Rahme M, Moor BK, Arlettaz Y, et al. Treatment of periprosthetic femoral fractures of the knee. Knee Surg Sports Traumatol Arthrosc 2011;19:1473-89.
20. Bezwada HP, Neubauer P, Baker J, Israelite CL, Johanson NA. Periprosthetic supracondylar femur fractures following total knee arthroplasty. J Arthroplasty 2004;19:453-8.
21. Herrera DA, Kregor PJ, Cole PA, Levy BA, Jönsson A, Zlowodzki M. Treatment of acute distal femur fractures above a total knee arthroplasty: Systematic review of 415 cases (1981-2006). Acta Orthop 2008;79:22-7.
22. Bong MR, Egol KA, Koval KJ, Kummer FJ, Su ET, Iesaka K, et al. Comparison of the LISS and a retrograde-inserted supracondylar intramedullary nail for fixation of a periprosthetic distal femur fracture proximal to a total knee arthroplasty. J Arthroplasty 2002;17:876-81.
23. Kilicoglu OI, Akgül T, Sağlam Y, Yazıcıoğlu O. Comparison of locked plating and intramedullary nailing for periprosthetic supracondylar femur fractures after knee arthroplasty. Acta Orthop Belg 2013;79:417-21.
24. Althausen PL, Lee MA, Finkemeier CG, Meehan JP, Rodrigo JJ. Operative stabilization of supracondylar femur fractures above total knee arthroplasty: A comparison of four treatment methods. J Arthroplasty 2003;18:834-9.
25. Ristevski B, Nauth A, Williams DS, Hall JA, Whelan DB, Bhandari M, et al. Systematic review of the treatment of periprosthetic distal femur fractures. J Orthop Trauma 2013;28:307-12.
26. Beris AE, Lykissas MG, Sioros V, Mavrodontidis AN, Korompilias AV. Femoral periprosthetic fracture in osteoporotic bone after a total knee replacement: Treatment with Ilizarov external fixation. J Arthroplasty 2010;25:1168.e9-12.
27. Kuzyk PR, Watts E, Backstein D. Revision total knee arthroplasty for the management of periprosthetic fractures. J Am Acad Orthop Surg 2017;25:624-33.
28. Srinivasan K, Macdonald DA, Tzioupis CC, Giannoudis PV. Role of long stem revision knee prosthesis in periprosthetic and complex distal femoral fractures: A review of eight patients. Injury 2005;36:1094-102.
29. Chalmers BP, Syku M, Gausden EB, Blevins JL, Mayman DJ, Sculco PK. Contemporary distal femoral replacements for supracondylar femoral fractures around primary and revision total knee arthroplasties. J Arthroplasty 2021;36:S351-7.
30. Khan S, Schmidt AH. Distal femoral replacement for periprosthetic fractures around total knee arthroplasty: When and how? J Knee Surg 2019;32:388-91.
31. Cannon SR. The use of megaprosthesis in the treatment of periprosthetic knee fractures. Int Orthop 2015;39:1945-50.
32. Windhager R, Schreiner M, Staats K, Apprich S. Megaprostheses in the treatment of periprosthetic fractures of the knee joint: Indication, technique, results and review of literature. Int Orthop 2016;40:935-43.

How to Cite this article: Desouza C, Antao N. Potpourri – Recent and Relevant Literature in Periprosthetic Fractures Around the Knee. Journal of Clinical Orthopaedics 2024;January-June:9(1):52-56.

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Infection After Total Knee Arthroplasty: Does Timing of Pre-operative Antibiotics Matter?

Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 17-21 | Timothy J Walden, Max L Willinger, Jamie C Heimroth, Adam Strigenz2, Alain Sherman, Jonathan R Danoff

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.624


Author: Timothy J Walden [1,2,3], Max L Willinger [1,2,3], Jamie C Heimroth [1,2,3], Adam Strigenz2, Alain Sherman [1], Jonathan R Danoff [1,2,3]

[1] Northwell Orthopedics, New Hyde Park, New York, USA,
[2] North Shore University Hospital, New York, USA,
[3] Zucker School of Medicine, Hempstead, New York, USA.

Address of Correspondence

Dr. Jonathan R. Danoff,
270-05 76th Ave, New Hyde Park, NY 11040,
E-mail: jdanoff@northwell.edu


Abstract

Background: Since the 2003 NIH consensus statement, the use of prophylactic antibiotics in total knee arthroplasty (TKA) has been the standard of care. Some studies recommend antibiotic administration within 1 h of skin incision, but no specific time frame has been delineated. The objective of this study was to determine if timing of pre-operative antibiotics is associated with post-operative infection after TKA.
Materials and Methods: An institutional database from a multi-center health-care system was queried with ICD-10 codes and reviewed for patients undergoing primary TKA between March 2020 and December 2020. The rate of superficial surgical site infection (SSI) and periprosthetic joint infection (PJI) was compared with pre-operative antibiotic timing. PJIs were defined based on 2018 MSIS criteria and superficial SSIs were other infections that did not meet MSIS criteria. Antibiotic timing was separated into 15-min cohorts from 0 min before skin incision to over 45 min before incision. Further comparison between patients who received antibiotics within 30 min of incision with those who received antibiotics greater than 30 min prior was performed.
Results: Of the 2511 patients who underwent primary TKA, 19 were found to have post-operative infections. There were 7 SSIs, and 12 PJIs, 16 of the post-operative infections occurred when patients received antibiotics <30 min before incision. There was no significant difference in SSIs or PJIs between each 15-min time interval of antibiotic administration (P = 0.45) or between the 30-min time intervals (P = 0.09).
Conclusion: Our study demonstrates no difference in post-operative infection based on pre-operative antibiotic timing. As long as antibiotics are given within 60 min of incision, preferentially 30–60 min before incision, their timing does not have a significant effect on post-operative infection following TKA.
Keywords: Pre-operative antibiotics, periprosthetic joint infection, superficial skin infection, total knee arthroplasty, complications


References

1. Premkumar A, Kolin DA, Farley KX, Wilson JM, McLawhorn AS, Cross MB, et al. Projected economic burden of periprosthetic joint infection of the hip and knee in the United States. J Arthroplasty 2021;36:1484-9.e3.
2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007;89:780-5.
3. Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup, American Academy of Orthopaedic Surgeons, American Association of Critical Care Nurses, American Association of Nurse Anesthetists, et al. Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004;38:1706-15.
4. de Jonge SW, Gans SL, Atema JJ, Solomkin JS, Dellinger PE, Boermeester MA. Timing of preoperative antibiotic prophylaxis in 54,552 patients and the risk of surgical site infection. Medicine 2017;96:e6903.
5. Parvizi J, Tan TL, Goswami K, Higuera C, della Valle C, Chen AF, et al. The 2018 definition of periprosthetic hip and knee infection: An evidence-based and validated criteria. J Arthroplasty 2018;33:1309-14.e2.
6. Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 2013;95-B:1450-2.
7. Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: An evidence-based global perspective. Lancet Infect Dis 2016;16:e276-87.
8. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017;152:784-91. Erratum in: JAMA Surg 2017;152:803.
9. Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281-6.
10. Steinberg JP, Braun BI, Hellinger WC, Kusek L, Bozikis MR, Bush AJ, et al. Timing of antimicrobial prophylaxis and the risk of surgical site infections: Results from the Trial to Reduce Antimicrobial Prophylaxis Errors. Ann Surg 2009;250:10-6.
11. van Kasteren ME, Manniën J, Ott A, Kullberg BJ, de Boer AS, Gyssens IC. Antibiotic prophylaxis and the risk of surgical site infections following total hip arthroplasty: Timely administration is the most important factor. Clin Infect Dis 2007;44:921-7.
12. Wu CT, Chen IL, Wang JW, Ko JY, Wang CJ, Lee CH. Surgical site infection after total knee arthroplasty: Risk factors in patients with timely administration of systemic prophylactic antibiotics. J Arthroplasty 2016;31:1568-73.
13. Badge H, Churches T, Xuan W, Naylor JM, Harris IA. Timing and duration of antibiotic prophylaxis is associated with the risk of infection after hip and knee arthroplasty. Bone Jt Open 2022;3:252-60.
14. American Academy of Orthopaedic Surgeons. Information Statement: Recommendations for the Use of Intravenous Antibiotic Prophylaxis in Primary Total Joint Arthroplasty. Available from: https://www.aaos.org/about/papers/advistmt/1027.asp

How to Cite this article: Walden TJ, Willinger ML, Heimroth JC, Strigenz A, Sherman A, Danoff JR. Infection After Total Knee Arthroplasty: Does Timing of Pre-operative Antibiotics Matter? Journal of Clinical Orthopaedics 2024;January-June:9(1):17-21.

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What is Associated with the Greatest Effect on Lengths of Stay after Total Knee Arthroplasty: The Hospital, the Surgeon, or the Patient

Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 07-11 | Max Willinger, Peter Gold, Luke Garbarino, Hiba Anis, Nipun Sodhi, Jonathan R Danoff

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.580


Author: Max Willinger [1], Peter Gold [1], Luke Garbarino [1], Hiba Anis [2], Nipun Sodhi [1], Jonathan R Danoff [3]

[1] Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York, USA,
[2] Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA,
[3] Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, New York, USA.

Address of Correspondence
Dr. Max Willinger,
Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
E-mail: max.willinger1@gmail.com


Abstract

Introduction: Patient-, hospital-, and surgeon-related factors are each associated with the variable nature of length of stay (LOS) after total knee arthroplasty (TKA). However, there is a paucity of literature regarding these intertwined relationships. This study aimed to determine if the hospital, the surgeon, or the patient has the greatest association with LOS after TKA.
Materials and Methods: A total of 11,402 patients were identified from a multicenter prospectively collected institutional database between January 01, 2017, and April 01, 2019. Surgeons and hospitals were subdivided into three groups: (1) low volume (<10 and <100 cases, respectively), (2) intermediate volume (10–150 and 100–400 cases, respectively), and (3) high volume (>150 and >400 cases, respectively). Patient demographics, comorbidities, hospital academic status, and LOS were identified. Univariate and multivariate analyses were performed to compare hospital-, surgeon-, and patient-related factors.
Results: Neither hospital (P = 0.173) volume nor surgeon (P = 0.413) volume were significantly associated with LOS in multivariate analyses while controlling for patient-, surgeon-, and hospital-related factors. Patient medical factors including diabetes (P < 0.001), congestive heart failure (P < 0.001), peripheral vascular disease (P < 0.001), chronic kidney disease (P < 0.001), chronic obstructive pulmonary disease (P < 0.001), and anemia (P < 0.033), as well as academic teaching hospitals (P < 0.001) were associated with a significant increase in hospital LOS.
Conclusion: Patient’s chronic medical conditions and hospital status as an academic teaching hospital were found to be the most important associated risk factors on post-operative hospital LOS after TKA. This study directs the focus onto pre-operative optimization and patient selection and helps demonstrate where to best allocate resources to successfully decrease LOS.
Keywords: Lengths of stay, Total knee arthroplasty, Pre-operative optimization, Complications, High volume surgeon.


References

1. Hoffmann JD, Kusnezov NA, Dunn JC, Zarkadis NJ, Goodman GP, Berger RA. The shift to same-day outpatient joint arthroplasty: A systematic review. J Arthroplasty 2018;33:1265-74.
2. Burn E, Edwards CJ, Murray DW, Silman A, Cooper C, Arden NK, et al. Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: Evidence from linked primary care and NHS hospital records from 1997 to 2014. BMJ Open 2018;8:e019146.
3. Kreder HJ, Grosso P, Williams JI, Jaglal S, Axcell T, Wal EK, et al. Provider volume and other predictors of outcome after total knee arthroplasty: A population study in Ontario. Can J Surg 2003;46:15-22.
4. Styron JF, Koroukian SM, Klika AK, Barsoum WK. Patient vs provider characteristics impacting hospital lengths of stay after total knee or hip arthroplasty. J Arthroplasty 2011;26:1418- 26.e1.
5. Yasunaga H, Tsuchiya K, Matsuyama Y, Ohe K. Analysis of factors affecting operating time, postoperative complications, and length of stay for total knee arthroplasty: Nationwide web-based survey. J Orthop Sci 2009;14:10-6.
6. Piuzzi NS, Strnad GJ, Sakr Esa WA, Barsoum WK, Bloomfield MR, Brooks PJ, et al. The main predictors of length of stay after total knee arthroplasty: Patient-related or procedure-related risk factors. J Bone Joint Surg Am 2019;101:1093.
7. Bozic KJ, Maselli J, Pekow PS, Lindenauer PK, Vail TP, Auerbach AD. The influence of procedure volumes and standardization of care on quality and efficiency in total joint replacement surgery. J Bone Joint Surg Am 2010;92:2643-52.
8. Prohaska MG, Keeney BJ, Beg HA, Swarup I, Moschetti WE, Kantor SR, et al. Preoperative body mass index and physical function are associated with length of stay and facility discharge after total knee arthroplasty. Knee 2017;24:634-40.
9. Winemaker M, Petruccelli D, Kabali C, de Beer J. Not all total joint replacement patients are created equal: Preoperative factors and length of stay in hospital. Can J Surg 2015;58:160-6.
10. Martino J, Peterson B, Thompson S, Cook JL, Aggarwal A. Day of week and surgery location effects on stay length and cost for total joint arthroplasty: Academic versus orthopaedic-specific hospital. J Knee Surg 2018;31:815-21.
11. Pamilo KJ, Peltola M, Paloneva J, Makela K, Hakkinen U, Remes V. Hospital volume affects outcome after total knee arthroplasty. Acta Orthop 2015;86:41-7.
12. Lavernia CJ, Guzman JF. Relationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty. J Arthroplasty 1995;10:133-40.
13. Hervey SL, Purves HR, Guller U, Toth AP, Vail TP, Pietrobon R. Provider volume of total knee arthroplasties and patient outcomes in the HCUP-nationwide inpatient sample. J Bone Joint Surg Am 2003;85:1775-83.

How to Cite this article: Willinger M, Gold P, Garbarino L, Anis H, Sodhi N, Danoff JR. What is associated with the Greatest Effect on Lengths of Stay after Total Knee Arthroplasty: The Hospital, the Surgeon, or the patient. Journal of Clinical Orthopaedics 2023:8(2);07-11.

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Invasive Non-Arthroplasty Treatment Options for Knee Osteoarthritis: Review

Journal of Clinical Orthopaedics | Vol 8 | Issue 1 |  Jan-Jun 2023 | page: 08-17 | Rohan G Reddy, YuChia Wang, Ryan Scully, Savyasachi C Thakkar

DOI: :10.13107/jcorth.2023.v08i01.549


Author: Rohan G Reddy [1], YuChia Wang [2], Ryan Scully [3], Savyasachi C Thakkar [4]

[1] Orthopaedic Research Collaborative (ORC); Johns Hopkins University, Baltimore, Maryland, United States, ,
[2] Orthopaedic Research Collaborative (ORC);Department of Orthopaedic Surgery, Eastern Virginia Medical School, Norfolk, Virginia, United States,
[3] Orthopaedic Research Collaborative (ORC); Department of Orthopaedic Surgery, Naval Hospital Camp Pendleton, Oceanside, California, United States,

[4] Orthopaedic Research Collaborative (ORC); Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States.

Address of Correspondence
Dr. Rohan G Reddy,

Johns Hopkins University, Baltimore, Maryland, United States.

E-mail: rreddy19@jhu.edu


Abstract

Introduction: Knee osteoarthritis (KOA) is one of the most common joint diseases in the world, such that there exists a variety of treatment methods, ranging from conservative treatments such as physical therapy and weight loss to total replacement of the diseased joint. Invasive non-arthroplasty treatment methods are growing in popularity and this review aims to explore the current literature. Better understanding of these alternatives could allow orthopedic surgeons and primary care providers to offer poor arthroplasty candidates meaningful symptomatic relief.

Materials and Methods: A literature review using PubMed, Google Scholar, and SCOPUS was performed to examine the following invasive non-arthroplasty treatment options: Corticosteroid injections (CS), viscosupplementation, platelet-rich plasma injections, stem cell injections, ozone therapy, prolotherapy, radiofrequency nerve ablation (RFA), arthroscopy, and osteotomy. Articles with complete data on the outcomes following these treatment methods were included in the study.

Results: CSs showed strong efficacy in providing short-term pain relief, while viscosupplementation and platelet-rich plasma have shown to be effective in long-term management as well. Aside from the more common injectable treatment options, newer options such as stem cell injection and ozone therapy have shown clinical efficacy while prolotherapy and RFA are still early-stage treatment options. Still, further studies are required to better assess these emerging therapies. Operatively, arthroscopic surgery has shown to be minimally effective while osteotomy demonstrated effective pain and functional improvement.

Conclusion: Multiple therapeutic options exist for invasive management of KOA to a different degree of effectiveness and efficacy. We have analyzed the outcomes of multiple invasive non-arthroplasty treatment options for KOA. This review can better inform patients and surgeons of the pros and cons of different KOA treatment methods. Newer conservative options may have positive clinical implications but will require further investigation. Operative alternatives to arthroplasty can provide symptomatic relief but may increase the associated risk and complexity should the need for arthroplasty ever arises.

Keywords: Total knee arthroplasty, injections, radiofrequency nerve ablation, arthroscopy, osteotomy.


References

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How to Cite this article: Reddy RG, Wang Y, Scully R, Thakkar SC. Invasive Non-arthroplasty Treatment Options for Knee Osteoarthritis: Review. Journal of Clinical Orthopaedics Jan-Jun 2023;8(1):08-17.

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Peri prosthetic fractures after total knee arthroplasty

Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020   | page: 36-40 | Shubhranshu S. Mohanty, Swapnil A. Keny, Ashwin Sathe


Author: Shubhranshu S. Mohanty [1], Swapnil A. Keny [1], Ashwin Sathe [1]

[1] Department of Orthopaedics, Seth GS Medical College & King Edward Memorial Hospital, Mumbai.

Address of Correspondence
Dr. Shubhranshu S. Mohanty,
Department of Orthopaedics, Seth GS Medical College & King Edward Memorial Hospital, Mumbai.
E-mail: drssmohanty@hotmail.com


Abstract

Background: The risk of periprosthetic fracture following TKA is particularly high because most of the TKA patients are elderly and also have osteoporosis. The management remains challenging as a result of poor bone stock, pre-existing implant and bone cement that may impede fracture reduction and fixation, predisposing to non-union or malunion . This article is a comprehensive review of Periprosthetic fractures following total knee replacement surgery along with their management algorithms.
Keywords: Total knee arthroplasty, Preprosthetic fracture, Review.


References

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How to Cite this article: Mohanty SS, Keny SA, Sathe A| Peri prosthetic fractures after total knee arthroplasty | Journal of Clinical Orthopaedics | January-June 2020; 5(1):36-40.

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Simultaneous Bilateral Total Knee Replacement – Current Evidence Based Management Strategy

Vol 3 | Issue 2 |  July-Dec 2018 | Page 22-29 | Abhishek Patil, Nandan Rao.


Authors: Abhishek Patil [1], Nandan Rao [2].

[1] Department of Joint Replacement and Orthopaedics, Sahyadri Superspeciality Hospital Hadapsar, Pune, Maharashtra, India
[2] Department of Orthopaedics Reliance Hospital, Navi Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Abhishek Patil, Sahyadri Superspeciality Hospital, Survey number 163, Bhosale nagar, Pune-Solapur road, Hadapsar, Pune. 411028
Email- abhipatortho@gmail.com


Abstract

With an ever-increasing geriatric population and associated knee arthritis; the number of patients requiring total knee arthroplasty continues to rise. In India 94% of patients with Kellegren-Lawrence grade 3 or 4 arthritis have bilateral arthritis. As such bilateral knee arthroplasty offers the convenience of single surgery, concomitant recovery and rehab of both knees and significant cost savings. However traditionally simultaneous bilateral knee replacement has been associated with higher mortality- both in hospital and after discharge extending up to 1 year and higher morbidity due to cardio-pulmonary complications, deep vein thrombosis, pulmonary embolism and higher rates of readmissions. With modern day surgical refinements and improved anesthetic practices; recent studies have reported results and complications at par with unilateral and staged bilateral total knee arthroplasty. However controversies do remain over the applicability of doing simultaneous bilateral knee arthroplasty. Ethical considerations and rarity of complications have made it difficult to conduct adequately powered randomized trials to justify or refute the practice of simultaneous bilateral knee arthroplasty. This review tries to amalgamate the views of recent literature to give the present status and best practices in simultaneous bilateral total knee arthroplasty.
Keywords: Total knee arthroplasty, bilateral total knee arthroplasty, bilateral knee replacement, knee arthritis, knee arthroplasty, knee replacement.


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How to Cite this article: Patil A, Rao N. Simultaneous Bilateral Total Knee Replacement – Current Evidence Based Management Strategy. Journal of Clinical Orthopaedics July-Dec 2018; 3(2):22-29.

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