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Osteoarthritis (OA) continues to be a leading cause of disability and healthcare expenditure in the United States (US). This is only expected to rise as the population continues to age (1).

Background: With increased legislative efforts to utilize evidence-based medicine as a guide for clinical practice, orthopaedists feel increasing pressure to publish research in higher-quality journals that reach a larger audience. Impact factor (IF) is used to quantify and rank journal apparent quality, and is the most standardized method for journal appraisal. In this study, we assessed the trends for IF among orthopaedic journals and compared these trends to those of medicine and general surgery journals. Methods: Journal IFs from Journal Citation Reports ( JCR ) between the years 2010 to 2016 were obtained and analyzed for trends. Only journals that were considered primarily orthopaedic journals were included. The top 10 journals by IF in both internal medicine and surgery were also included for comparison. Each journal was analyzed by IF, and trends across time were noted. The differences in mean IF between orthopaedic specialty groups were analyzed using an independent samples t -test. Results: The mean IF of orthopaedic increased from 1.4 (range, 0.0–3.9) in 2010 to 1.9 (range, 0.5–5.7) in 2016. In 2016, the percentage of English journals increased to 87.3% (n=48), while the percentage of journals published in the United States was 47.3% (n=26). There was a significant difference between the IF of journals published in English and those published in other languages (P=0.004). The mean IF of both general and specialized orthopaedic journals increased from 2010 to 2016, but the difference was nonsignificant. The mean IF of the top 10 journals in both surgery and internal medicine also increased from 2010 to 2016, but the increase was also nonsignificant. Conclusions: Overall, the mean IF for peer-reviewed orthopaedic journals has increased in the past years, as has the number of journals. English journals from the United States continue to have the largest impact when compared to non-English journals and journals from outside the United States. Future studies should aim to better qualify journal impact, while limiting confounders such as self-citation.

Total knee arthroplasty (TKA) is among the most common elective procedures performed worldwide. Recent efforts have been made to significantly improve patient outcomes, specifically with postoperative rehabilitation. Despite the many rehabilitation modalities available, the optimal rehabilitation strategy has yet to be determined. Therefore, this systematic review focuses on evaluating existing postoperative rehabilitation protocols. Specifically, this review analyses the study designs, rehabilitation methods, and outcome measures of postoperative rehabilitation protocols for TKA recipients in the past five years. The PubMed, EMBASE, and Cochrane Library databases were queried for studies evaluating rehabilitation protocols following primary TKA. Of the 11,013 studies identified within the last five years, 70 met the inclusion and exclusion criteria. After assessing for relevance and removing duplicates, a final count of 20 studies remained for analysis. Level-of-evidence was determined by the American Academy of Orthopaedic Surgeons (AAOS) classification system. Our findings demonstrated that continuous passive motion and inpatient rehabilitation may not provide additional benefit to the patient or healthcare system. However, early rehabilitation, telerehabilitation, outpatient therapy, high intensity, and high velocity exercise may be successful forms of rehabilitation. Additionally, weight-bearing biofeedback, neuromuscular electrical stimulation, and balance control appear to be beneficial adjuncts to conventional rehabilitation. Postoperative rehabilitation following TKA facilitates patient recovery and improves quality of life. This systematic review analyzed the existing rehabilitation protocols from the past five years. Some studies did not accurately describe the conventional rehabilitation protocols, the duration of therapy sessions, and the timing of these sessions. As such, future studies should explicitly describe their methodology. This will allow high-quality assessments and the conception of standardized protocols.

Background: Despite the success of total knee arthroplasty (TKA), quadriceps strength can fail to recover. Active extension lag [quadriceps lag (Q-lag)] is a function of quadriceps weakness. Q-lag presents itself in patients who maintain a full passive range of motion (ROM), but are limited in active extension ROM. Few studies have evaluated the outcomes of post-TKA patients in the presence of post-operative Q-lag. Thus, this study aims to compare: (I) pain scores; and (II) rates of readmission to physical therapy (PT) in TKA patients with Q-lag of ≥15 degrees to patients without Q-lag. Methods: A retrospective review of primary TKA patients between 2013 and 2015 was performed. A total of 150 patients (mean age 63.0 years) with a mean follow-up of 30.7 months were analyzed. All patients received an evidence-based protocol for PT at our institution. Patient readmission to PT was recorded if the orthopedic surgeon wrote an additional prescription for PT intervention following the standard of care following TKA. An independent samples t -test and chi-square analysis was conducted to assess the continuous and categorical variables, respectively. Results: Fifty-one patients had Q-lag ≥15 degrees and 97 patients had Q-lag vs . 3.9; P=0.043). Chi-square analysis demonstrated no significant difference in rates of PT readmission between patients who presented with Q-lag, and patients without Q-lag (23.5% vs . 13.4%; P=0.118). Conclusions: There was no significant difference in readmission rates; however, patients with Q-lag experienced a clinically significant higher pain level. Since this is the first study of its kind, we suggest further investigations on the effect of Q-lag on patient outcomes following primary TKA.