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Background: Although total hip arthroplasty (THA) and total knee arthroplasty (TKA) offer significant cost savings to our health care system, the degree to which the burden of postoperative care has been transferred onto the informal caregiver is often overlooked. We performed a scoping review to identify the characteristics and factors that contribute to the burden of care experienced after outpatient THA and TKA. Methods: We systematically searched electronic literature databases according to scoping review guidelines from inception to June 2021 for articles reporting the experiences of informal caregivers providing care for patients having undergone outpatient THA or TKA. Our review included English-language studies that sought to elucidate the impact on caregivers in the acute postoperative period (up to 6 wk after surgery). Results: Our search yielded 1423 unique articles, which were screened for inclusion. We removed 310 duplicate records and excluded another 1099 articles because they did not meet the inclusion criteria for full-text screening with relevancy. We thus assessed 14 articles for full-text review, and none were found to meet our inclusion criteria. Conclusion: We found no published data pertaining to the burden borne by informal caregivers who provide perioperative care to patients who have undergone ambulatory THA or TKA. Further research is needed to identify, quantify and determine the modifability of the various characteristics and factors that contribute to caregiver burden in the outpatient setting. Contexte : L'arthroplastie totale de la hanche (ATH) et l'arthroplastie totale du genou (ATG) realisees en contexte ambulatoire entrainent des economies considerables pour le systeme de sante, mais la part du fardeau des soins postoperatoires qui est transferee aux aidants naturels est souvent ignoree. Nous avons effectue un examen de la portee pour cerner les caracteristiques et les facteurs contribuant au fardeau des soins apres une ATH ou une ATG ambulatoire. Methodes : Nous avons procede, en suivant la methodologie de l'examen de la portee, a une interrogation systematique des bases de donnees electroniques, de leur mise en service a juin 2021, pour recenser des articles sur les experiences des aidants naturels qui offrent des soins aux patients ambulatoires ayant subi une ATH ou une ATG. Notre examen comprenait des etudes publiees en anglais tentant de mieux comprendre les repercussions sur les aidants naturels durant la periode postoperatoire aigue (jusqu'a 6 semaines apres l'intervention). Resultats : Nos recherches ont repere 1423 articles distincts, ensuite passes en revue pour inclusion. Nous avons retire 310 doublons et exclu 1099 autres articles ne repondant pas aux criteres d'inclusion d'un examen complet du texte pour en evaluer la pertinence. En fin de compte, 14 articles ont ete soumis a l'examen complet du texte et aucun n'a repondu aux criteres d'inclusion. Conclusion : Nous n'avons trouve aucune donnee publiee sur le fardeau assume par les aidants naturels offrant des soins perioperatoires aux patients ayant subi une ATH ou une ATG ambulatoire. D'autres recherches seront necessaires pour cerner, quantifer et determiner la variation des caracteristiques et facteurs contribuant au fardeau assume par l'aidant en contexte ambulatoire., Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are 2 of the most common and successful surgical procedures performed worldwide, with more than 120 000 primary total joint arthroplasty [...]

The article discusses the role of Mesenchymal Stem Cells (MSC) as a part of treatment for degenerative joint disease or knee osteoarthritis. The studies recorded the potential of MSCs to improve function and decrease inflammation in animals. Topics include chondrocyte failure, pharmacological pain control, impact of exogenous hyaluronic acid, role of platelet-rich plasma, sources for MSCs like Synovium and Bone marrow, and magnetic resonance imaging.

Introduction: Periprosthetic joint infection (PJI) that arises following total knee arthroplasty (TKA) can usually be resolved through surgical and antimicrobial therapy. However, in approximately 5% of cases, an infection that is chronic and persistent will require treatment by above-knee amputation (AKA). This study seeks to provide an enhanced understanding of patient functionality and satisfaction following this devastating complication of one of the most commonly performed surgeries in the world., Methods: A retrospective chart review of all patients who underwent an AKA as a result of PJI following TKA at our center between January 2000 and November 2023 was performed. Patients completed a post-TKA AKA functionality and satisfaction questionnaire, as well as the 12-Item Short Form Survey (SF-12). Of 27 eligible patients, 14 were contacted by phone for follow-up, 6 were deceased, 6 could not be reached, and 1 declined participation. The mean age at AKA was 62 years old (range, 43 to 85). Patients had an average of 5.5 procedures (range, 3 to 8) between primary TKA and AKA. The average follow-up time post-AKA was 38.5 months (range, 12 to 102)., Results: Of the patients, 85.7% were satisfied with their AKA, 85.7% would choose AKA again, and 71.4% would have proceeded with AKA earlier in retrospect. Average SF-12 physical and mental component scores were 37.1 and 50.6, respectively., Discussion: Despite important limitations in functional and ambulatory status, the vast majority of patients who underwent an AKA following an infected TKA are satisfied with their amputation and would choose this treatment modality again if necessary, with many indicating they would do so at an earlier time point. In light of these results, the option of amputation should, when medically indicated, be discussed in a sensitive, but timely manner with patients undergoing treatment for recalcitrant PJI., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Previous anterior cruciate ligament (ACL) injury is a risk factor for the development of knee osteoarthritis. Despite advances in ACL reconstruction (ACLR) techniques, many patients with history of ACLR develop end-stage osteoarthritis necessitating total knee arthroplasty (TKA). The purpose of this study was to investigate the impact of prior ACLR on intraoperative and postoperative outcomes of TKA., Methods: This was a single-centre matched cohort study of all patients with prior ACLR undergoing primary TKA from January 2000 to May 2022. Patients were matched 1:1 to patients undergoing TKA with no prior ACL injury based on age, sex, and body mass index. Outcomes investigated included TKA procedure duration, soft-tissue releases, implant design, and complications requiring reoperation., Results: Forty-two ACLR patients were identified and matched to controls. Mean follow-up was 6.8 years and 5.0 years in the ACLR and control cohorts, respectively ( P  = .115). ACLR patients demonstrated longer procedure durations (122.8 minutes vs 87.0 minutes, P < .001) and more frequently required soft-tissue releases (40.5% vs 14.3%, P  = .007), stemmed implants (23.8% vs 4.8%, P  = .013), and patellar resurfacing (59.5% vs 26.2%, P  = .002). There were no significant differences in postoperative clinical or surgical outcomes between groups. Ten-year implant survivorship was 92% and 95% in the ACLR and control cohorts, respectively ( P  = .777)., Conclusions: TKA is an effective procedure for the management of end-stage osteoarthritis with prior ACLR. The care team should be prepared for longer operative times and the utilization of advanced techniques to achieve satisfactory soft-tissue balance and implant stability., (© 2024 The Authors.)

Background: Total knee arthroplasty (TKA) is a commonly performed procedure that has traditionally utilized reproducible steps using a set of mechanical instruments. The number of TKAs performed using robotic assistance is increasing, and augmented reality (AR) navigation systems are being developed. Hierarchical task analysis (HTA) aims to describe the steps of a specific task in detail to reduce errors and ensure reproducibility. The objective of this study was to develop and validate HTAs for conventional, robotic-assisted, and AR-navigated TKA., Methods: The development of HTAs for conventional TKA involved an iterative review process that incorporated the input of 4 experienced arthroplasty surgeons. The HTAs were then adapted for robotic-assisted and AR-navigated TKA by incorporating specific steps associated with the use of these systems. The accuracy and completeness of the HTAs were validated by observing 10 conventional and 10 robotic-assisted TKA procedures., Results: HTAs for conventional, robotic-assisted, and AR-navigated TKA were developed and validated. The resulting HTAs provide a comprehensive and standardized plan for each procedure and can aid in the identification of potential areas of inefficiency and risk. Robotic-assisted and AR-navigated approaches require additional steps, and there are an increased number of instances where complications may occur., Conclusions: The HTAs developed in this study can provide valuable insights into the potential pitfalls of robotic-assisted and AR-navigated TKA procedures. As AR-navigation systems are developed, they should be optimized by critical analysis using the developed HTAs to ensure maximum efficiency, reliability, accessibility, reduction of human error, and costs., (© 2024 The Authors.)