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Total joint arthroplasty (TJA) is one of the most common surgeries performed in the United States and is a durable and effective option in managing osteoarthritis of the hip and knee. Recent research regarding the procedure has focused on preoperative optimization and weight loss in particular. Obesity has been shown in prior studies to increase risks associated with TJA, and, as a result, debate has focused on whether a body mass index (BMI) cutoff is a prudent tool for preoperative optimization. This article discusses the ethical dilemma of instituting a BMI cutoff and reviews current literature regarding the topic., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Post-traumatic arthritis (PTA) of the knee is a complex problem, requiring foresight and careful preoperative planning. Each case of PTA is unique, requiring understanding of the altered anatomy, management of any retained hardware, and also the ability to provide the appropriate stability for each affected knee. Successful treatment of PTA with total knee arthroplasty (TKA) requires the creation of stable and well-balanced joint. TKA for PTA provides comparable improvements in pain and function when compared with primary osteoarthritis, however, these patients are at increased risk of post-operative complications, including instability and infection., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This report provides an updated analysis for patients with osteoporosis following total hip arthroplasty (THA). The comorbidities of alcohol abuse, chronic kidney disease, cerebrovascular disease, obesity, and rheumatoid arthritis continue to be significant risk factors for periprosthetic femur fracture (PPFFx) and aseptic loosening in the population with osteoporosis. Patients with dual-energy x-ray absorptiometric (DEXA) scans were at risk for PPFFx regardless of femoral fixation method, and patients with DEXA scans with cementless fixation were at risk of aseptic loosening after THA. The patient population with severe osteoporosis may have higher risks for aseptic loosening and PPFFx than previously recognized., (Copyright © 2024 Elsevier Inc. All rights reserved.)

A review article summarizes the existing literature on intraoperative injury to medial collateral ligament (MCL) during total knee arthroplasty (TKA), methods of fixation, repair, and the outcomes after these injuries. The options for increasing implant constraint and repair of the MCL injury are discussed with the potential indications for each. There is also a review of risk factors for MCL injury during TKA to help anticipate potential issues preoperatively. The proper use of retractors during total knee replacement is also discussed with a focus on careful protection of the MCL during surgery., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The rising number of total knee arthroplasties (TKA's) in the United States increases demand for perioperative pain modalities, which can promote early mobilization and discharge. Over the decades, a focus has shifted from opioid-dominant regimens to motor-sparing multimodal protocols, which have not only improved pain scores and reduced opioid consumption but also improved overall patient outcomes. In this article, we briefly review the evolution of post-operative pain management in patients undergoing TKA and summarize the literature on the most popular modalities currently used including periarticular injections, adductor canal blocks, distal selective nerve blocks, as well as liposomal bupivacaine as part of a multimodal approach., (Copyright © 2023 Elsevier Inc. All rights reserved.)

This review article presents the current state of remote patient monitoring (RPM) in total joint arthroplasty. RPM refers to the use of telecommunication with wearable and implantable technology to assess and treat patients. Several forms of RPM are discussed including telemedicine, patient engagement platforms, wearable devices, and implantable devices. The benefits to patients and physicians are discussed in the context of postoperative monitoring. Insurance coverage and reimbursement of these technologies are reviewed., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Knee pain is among the most common complaints that an orthopedic surgeon may see in practice. It is often worked up with X-rays and MRI, leading to a myriad of potential diagnoses ranging from minimal edema patterns to various types of osteonecrosis. Similarities in certain causes can pose diagnostic challenges. The purpose of this review was to present the 3 types of osteonecrosis observed in the knee as well as additional causes to consider to help aid in the diagnosis and treatment.., Competing Interests: Disclosure M.C. Pearl: None. M.A. Mont: Royalty and Consultant: Stryker. Consultant: Stryker, 3M, Centrexion, CERAS Health, Johnson & Johnson, Kolon Tissuegene, Mirror-AR, NXSCI, Pacira, Peerwell, Pfizer-Lily, Skye Biologics, SOLVED Health, Smith & Nephew. Stock or Stock options: CERAS Health, MirrorAR, Peerwell, USMI. Leadership/Editorial: The Knee Society, The Hip Society, Journal of Arthroplasty, Journal of Knee Surgery, Surgical Technology, International Orthopedics. G.R. Scuderi: Royalty and Consultant: Zimmer Biomet. Consultant: 3M, ROM Tech, EMN. Stock or Stock options: ROM Tech, EMN, Force Therapeutics. Royalties: Springer, Elsevier, Theime Editorial Board: Journal Knee Surgery., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Extensor mechanism disruptions following total knee arthroplasty are devastating injuries with complication rates following surgical intervention ranging from 25% to 45%. Primary repair with and without augmentation is appropriate in certain limited clinical settings. Allograft reconstruction has been a popular option; however, synthetic grafts are showing promise and good results. In this article the authors discuss an algorithm for treating these difficult injuries as well as detail the surgical techniques for each approach., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The purpose of this study was to determine if elevated pre-operative D-dimer levels in patients undergoing revision total knee arthroplasty (rTKA) pose an increased risk of: (1) post-operative venous thromboemboli (VTE); (2) intra-operative blood loss; and (3) need for transfusion of blood products. Eighty-nine patients who underwent rTKA by a single surgeon between January 1, 2017, and December 31, 2019, met the inclusion criteria. Elevated pre-operative D-dimer levels did not pose an increased risk of VTE, blood loss, or transfusion of blood products, demonstrating that elevated pre-operative D-dimer is not a contraindication to the use of tranexamic acid for rTKA., Competing Interests: Disclosure M.A. Mont is a board or committee member for The Knee Society and The Hip Society, receives research support from National Institutes of Health, and is on the editorial board for the Journal of Arthroplasty, Journal of Knee Surgery, Surgical Technology International, and Orthopaedics. He also receives company support from 3M, Centrexion, Ceras Health, Flexion Therapeutics, Johnson & Johnson, Kolon TissueGene, NXSCI, US Medical Innovations, Pacira, Pfizer-Lily, Skye Biologics, SOLVD Health, Smith and Nephew, Stryker, CERAS Health, MirrorAR, Peerwell, US Medical Innovations, Johnson & Johnson, RegenLab, TissueGene, Stryker, MedicusWorks LLC, Up-to Date, Wolters Kluwer Health–Lippincott Williams & Wilkins, Journal of Arthroplasty, Journal of Knee Surgery, Orthopedics, Surgical Techniques International; AAHKS, Knee Society, and Hip Society. Dr Giles R. Scuderi receives royalties and/or is a consultant for Zimmer Biomet, 3M KCI, Elsevier, Springer, Thieme, and World Scientific. He has stock options in Force Therapeutics and ROM Tech. G.R. Scuderi is also on the editorial board for the Journal of Knee Surgery and is a board member for Operation Walk USA. All other authors have no conflicts of interest to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Complications related to the extensor mechanism and patellofemoral joint continue to be the most common cause of pain and indication for surgical revision following total knee arthroplasty. Numerous risk factors related to the patient, implant, and technical performance of the procedure have been identified. The Ortiguera and Berry classification system is widely used for the systematic classification and management of these fractures. Because of the difficult nature of revision surgery for fracture and the high risk of complication, a careful assessment of the fracture and implants is vital to determining the best course of treatment., Competing Interests: Disclosure The authors report no disclosures directly related to the article., (Copyright © 2021 Elsevier Inc. All rights reserved.)

A surgical approach to total knee arthroplasty has been at the forefront of many conversations. Surgeons used the medial parapatellar approach for its familiarity of anatomy, reliability, and ability to convert to a more extensile approach. This article reviews the current literature and information regarding the effect of surgical approach on patients' outcomes. The results of the limited medial parapatellar, subvastus, midvastus, and quadriceps-sparing approaches were analyzed. All techniques can provide adequate exposure with successful outcomes. It is recommended that a surgeon perform the approach with which they are most comfortable, because that will likely yield the best patient outcome., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Postoperative pain control after total knee arthroplasty may be insufficient, resulting in insomnia, antalgic ambulation, and difficulty with rehabilitation. Current strategies, including the use of femoral nerve catheters, may control pain but have been associated with falls, motor blockade, and quadriceps inhibition. Periarticular infiltration using the appropriate technique and knowledge of intraarticular knee anatomy may increase pain control and maximize rehabilitation., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Total knee arthroplasty is a common procedure, and current navigation systems are gradually gaining acceptance for improving surgical accuracy and clinical outcomes. A new navigation system used within the surgical field, iAssist, has demonstrated reproducible accuracy in component alignment. All orientation information is captured by small electronic pods and transmitted via a local wireless network, which directs the surgical workflow automatically to the femoral and tibial resection instruments. This simple and accurate navigation system used completely in the surgical field, without optical trackers or preoperative imaging, seems to be the latest generation of smart instrumentation for total knee arthroplasty., (Copyright © 2014 Elsevier Inc. All rights reserved.)

This article presents the clinical features of crystal arthropathy after knee replacement. The current literature on pseudogout and gout after both total and partial knee replacement is summarized. A case of bilateral pseudogout 8 years after initial total knee arthroplasty (TKA) is used to highlight the clinical characteristics and treatment options for this underrecognized condition. Presentation mimicked a late septic joint arthroplasty with sudden onset of pain and effusion. The patient was treated successfully with an arthrotomy, debridement, synovectomy, polyethylene insert exchange, oral steroids, and nonsteroidal anti-inflammatories. There are no other reported cases of bilateral pseudogout after bilateral TKA., (Copyright © 2012 Elsevier Inc. All rights reserved.)

This article examines whether any new complications were associated with highly cross-linked polyethylene in posterior stabilized total knee arthroplasty (TKA) due to its altered mechanical properties. Average preoperative Knee Society Scores (KSS) were 49.7 and 51.5, with a range of movement (ROM) of 3° to 116°, and average postoperative KSS were 87.7 clinical and 89.7, with ROM of 0° to 123°. Postoperative alignment averaged 3.8° of valgus. There were no cases of polyethylene or post failure. Short-term results of posterior stabilized TKAs using highly cross-linked polyethylene show good functional outcomes with no evidence of loosening or tibial post failure., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The initial therapy for patellofemoral pain remains conservative. Once this treatment plan fails and examination has clearly identified the cause of the patellofemoral dysfunction, surgical treatment is considered. No single procedure corrects all patellofemoral problems, and the patient's age, the causative factor, the condition of the articular surface, and the level of activity should be considered. Surgical options include lateral retinacular release, proximal realignment, distal realignment, and proximal and distal realignment.

Patellofemoral dysfunction may be one of the most common and troublesome maladies to affect a patient. The correct identification of the underlying causes is paramount. Once identified, an effective rehabilitation program should be implemented. The program should include stretching and strengthening as well as several other therapeutic modalities. The most successful rehabilitation program is designed to address the specific needs of the patient.

The posterior stabilized knee prosthesis is a versatile and durable prosthesis with an excellent clinical record. It was designed to increase range of motion, improve stair climbing, and prevent posterior tibial subluxation.