Colorado Joint Replacement

Mechanical alignment total knee arthroplasty (TKA) in valgus knees requires soft tissue releases and complex techniques that are unnecessary with kinematic alignment (KA). Few studies have evaluated the outcomes of KA in valgus knees, and fewer have studied KA with medial-pivot (MP) implants. This study compared the clinical outcomes of KA-TKA with MP implants (KA/MP-TKA) in patients with preoperative varus versus valgus alignment. We hypothesized that outcomes following KA/MP-TKA would be equivalent. A prospective database was queried to identify patients who underwent primary KA-TKA with MP implants. Patients were included if they had a preoperative hip-knee-ankle angle ≤177° (varus, n = 302) or ≥183° (valgus, n = 51). A total of 353 consecutive patients were identified. The Forgotten Joint Score (FJS), Knee Injury and Osteoarthritis Outcome Score (KOOS-JR), Knee Society Score (KSS), and range of motion were collected preoperatively and at 6-week, 6-month, and 1-year visits. Patients with preoperative valgus alignment had worse KSS Function and KOOS-JR scores preoperatively (p = 0.04 and p = 0.02, respectively); all other baseline outcomes were comparable. Postoperatively, the valgus group demonstrated better KOOS-JR at 6 weeks (p = 0.004), KSS Pain-Motion at 6 months (p = 0.02), and FJS at 1 year (p = 0.03). The varus group showed better KSS Function at all postoperative visits (p < 0.02). There were no statistically significant differences in flexion or extension between the groups. Patients with valgus alignment undergoing KA/MP-TKA achieved postoperative outcomes that were clinically equivalent or superior to those of patients with varus alignment. These findings support KA-TKA using MP implants as an appropriate surgical approach for preoperative valgus alignment.

Complications following total hip arthroplasty (THA) may necessitate a revision and patients who go on to a revision THA may experience depressive symptoms. The objective of this study was to investigate the prevalence of depressive symptoms before and after revision THA for six different failure modes. Patients who underwent a THA revision with minimum 1-year follow-up at a single institution from 2008 to 2022 were retrospectively reviewed. Patients were grouped by failure modes: aseptic loosening, impingement, infection, instability, metallosis, polyethylene wear, and femoral stem pain. Preoperative and postoperative Veterans RAND 12-Item Health Scores and Harris Hip Score were compared. Twenty-four percent of patients in the retrospective cohort review had a previous existing mental health diagnosis, with depression being the most common (18% of all patients). The prevalence of depressive symptoms differed significantly by failure mode both preoperatively (P = .002) and postoperatively (P = .019). Veterans RAND 12 mental component score was significant between mode of failure groups both preoperatively (P < .001) and postoperatively (P = .005). Function significantly improved in all groups from preoperatively to postoperatively. Patients with depressive symptoms had significantly lower physical component score with instability, aseptic loosening, stem pain, and metallosis preoperatively (P < .001) and with instability, aseptic loosening, stem pain, and polyethylene wear postoperatively (P = .002). Nearly 25% of patients with failed THA had a pre-existing mental health diagnosis and depressive symptoms were the most common. Unfortunately, depressive symptoms only improve modestly with revision surgery and can adversely affect a patient's functional outcome.

The aim of this study was to determine whether closed suction drain (CSD) use influences recovery of quadriceps strength and to examine the effects of drain use on secondary outcomes: quadriceps activation, intra-articular effusion, bioelectrical measure of swelling, range of movement (ROM), pain, and wound healing complications. A total of 29 patients undergoing simultaneous bilateral total knee arthroplasty (TKA) were enrolled in a prospective, randomized blinded study. Patients were randomized to receive a CSD in one limb while the contralateral limb had the use of a subcutaneous drain (SCDRN) without the use of suction ('sham drain'). Isometric quadriceps strength was collected as the primary outcome. Secondary outcomes consisted of quadriceps activation, intra-articular effusion measured via ultrasound, lower limb swelling measured with bioelectrical impendence and limb girth, knee ROM, and pain. Outcomes were assessed preoperatively and postoperatively at day two, two and six weeks, and three months. Differences between limbs were determined using paired Student's t-tests or Wilcoxon's signed-rank tests. No significant differences were identified between limbs prior to surgery for the primary or secondary outcomes. No significant differences in quadriceps strength were seen between CSD and SCDRN limbs at postoperative day two (p = 0.09), two weeks (primary endpoint) (p = 0.7), six weeks (p = 0.3), or three months (p = 0.5). The secondary outcome of knee extension ROM was significantly greater in the CSD limb compared with the SCDRN (p = 0.01) at two weeks following surgery, but this difference was absent at all other intervals. Secondary outcomes of quadriceps activation, intra-articular effusion, lower limb swelling, and pain were not found to differ significantly at any timepoint following surgery. The use of CSD during TKA did not influence quadriceps strength, quadriceps activation, intra-articular effusion, lower limb swelling, ROM, or pain. These results have limited drain use by the authors in primary uncomplicated TKA. Cite this article: Bone Joint J 2019;101-B (7 Supple C):84-90.

Background: Up to 20% of total knee arthroplasty (TKA) patients are not satisfied with their outcome, and coronal alignment is considered an important variable in attaining a well-functioning TKA. Neutral mechanical alignment is not necessarily the anatomic norm and has led some surgeons to advocate a shift in defining and attaining the optimal coronal component alignment. Our aim was to review the different coronal alignment paradigms of TKA and summarize the historical and contemporary outcomes of different alignment techniques.Methods: A systematic review was performed in March 2017 via PubMed using the search terms: coronal alignment, kinematic alignment, and total knee replacement using Boolean “and” in-between terms. Relevant results were then reviewed, analyzed and summarized Conclusions: Early clinical outcomes of kinematically aligned TKAs are promising, but long-term clinical results are unknown. Clinical, laboratory, and retrieval studies suggest that mechanical varus in TKA, especially involving the tibial component, may result in earlier failure. Kinematic alignment with boundaries may be an optimal strategy for patients with pre-operative constitutional varus or congenital tibia vara.