Faculty Bibliography

As quality measures may be increasingly used in knee surgery reimbursement, an important focus in outcome assessment will shift toward minimizing complications and increasing efficiency in knee arthroplasty reconstruction. The purpose of this study was to evaluate the efficacy of barbed, absorbable sutures in closure of the longitudinal surgical incision following knee arthroplasty, using post-operative complication occurrences. In 416 operations, primary outcomes assessed were deep infection, superficial infection, dehiscence, or stitch abscesses. Secondary outcomes included self-limiting eschar, severe effusion, arthrofibrosis, and keloid formation. Evaluation of overall primary outcomes showed a higher rate of wound complications using barbed sutures (P < 0.001). With increased rates of infection and overall closure related complications, this study shows that barbed suture use for superficial closure after knee arthroplasty should be avoided.

Few studies about how heterotopic ossification (HO) affects functional outcome after metal-on-metal total hip resurfacing (MOMHR) have been reported. The purpose of this study was to evaluate the incidence and clinical significance of HO after MOMHR. We retrospectively reviewed 122 consecutive patients, who underwent MOMHR from June 2006 to October 2008, with adequate follow-up information. All patients had four weeks of aspirin (325 mg twice a day) for DVT prophylaxis and two weeks of celecoxib (400 mg once a day) for pain control. All data were collected prospectively including radiographs and functional scores preoperatively, at three months and at one year postoperatively. An independent musculoskeletal radiologist, using the Brooker classification, reviewed radiographs. Unbalanced ANOVA analyses were performed to evaluate the effect of HO on outcome. The overall incidence of HO at three months was 62.1% (grade 1: 39.8%, grade 2: 20.4%, grade 3: 1.9%) and 75% at one year (grade 1: 41.7%, grade 2: 27.8%, grade 3: 5.5%). There were no significant differences in the functional status scores among Brooker grade 0 to 3 groups at three months and one year follow-up. The incidence of HO after MOMHR was 62.1% at three months and 75% at one year despite a post-operative regimen of aspirin and celecoxib. We found no evidence that predominantly Brooker grade 1 or 2 HO affected the clinical outcome at three months or one year when compared across all Brooker classes of patients.

INTRODUCTION/PURPOSE/OBJECTIVE:Cruciate retaining total knee replacement has been shown to effectively improve pain and quality of life. Successful outcomes depend on many factors, including the maintenance of a competent posterior cruciate ligament. This study sought to anatomically analyze the percentage of PCL injured during a full transverse, tibial cut, thus altering normal function. MATERIALS AND METHODS/METHODS:One hundred and thirty five consecutive knee MRIs taken from 2006 to 2011 were selected from a single surgeon's database for this study. Only subjects with non-arthritic knees were considered for this study; the lack of degenerative joint disease (DJD) was confirmed via a radiological report. The optimal view of the PCL's tibial attachment was observed using the sagittal view of the knee, with a T1 signal. One hundred and twenty two usable images were viewed electronically, and measurements were made using the standardized transverse cut implant guidelines. The percentage of PCL remaining following the cut was categorized into five different groups: 0% (no PCL undermined), 1-49%, 50-74%, 75-99% and 100% (PCL undermined entirely). RESULTS:Overall only 9.0% (n=11) would have not endured any damage to the PCL with a transverse tibial saw cut, while 79.6% (n=98) would have had 50% or more of the PCL undermined. Of the 98 patients with more than 50% resected, 52.1% (n=51 patients) presented complete destabilization of the PCL. The percentage of PCL destabilized was not significant across age groups (p=0.280), gender (p=0.586), or operative side (p=0.460). CONCLUSION/CONCLUSIONS:Independent of age, gender, and operative side, a majority of PCLs are more than 50% destabilized following the standard transverse tibial cut. LEVEL OF EVIDENCE/METHODS:II.

Indications for UKA for isolated osteoarthritis of the knee remain controversial. Two hundred twenty-nine UKA that were performed at our institution were evaluated for which factors were associated with a poor outcome. BMI >35 was correlated with lower KSS scores than patients with BMI <35. In contrast to prior reports, patients younger than 60 years old had higher scores than patients 60 years and older at 2 years. Women had an unacceptably high short-term revision rate for any reason of 6.5%. Popularity for UKA has increased, and a more in depth investigation of predictors of poor outcomes demonstrates that younger patients appear to have better results. Obese patients continue to improve up to 2 years after surgery and should not be precluded from undergoing UKA.

Obesity has been shown to be a risk factor for degenerative knee arthritis and its incidence is increasing in epidemic proportions. Obesity has also been shown to be a risk factor for surgical complications associated with total knee replacement (TKR) surgery. There have been no prior investigations examining the relationship between body mass index (BMI) and surgical time during TKR. Two hundred and seventy three patients were evaluated and stratified by BMI. There was a direct linear relationship between BMI and operative time. In addition, the higher the BMI group, the younger the age at surgery, and obese class III patients experienced a higher rate of early post-operative complication. Therefore, patients should be counseled that obesity prior to TKR surgery might lead to a longer operative time and any sequelae associated with further exposure of the operative wound, especially with regard to higher rates of prosthetic joint infection (PJI).

The definitive treatment for advanced joint destruction in the late stages of rheumatoid arthritis can be successfully treated with total joint arthroplasty. Total knee arthroplasty has been shown to be a well-proven modality that can provide pain relief and restoration of mobility for those with debilitating knee arthritis. It is important for rheumatologists and orthopedic surgeons alike to share an understanding of the special considerations that must be addressed in this unique population of patients to ensure success in the immediate perioperative and postoperative periods including specific modalities to maximize success.

OBJECTIVE:Serum albumin has long been used in clinical practice as a marker of protein-energy undernutrition, but very few studies have focused on its relation with dual-energy X-ray absorptiometry-assessed lean mass measurements, which is the current reference method in routine for body composition-related nutritional status. Serum albumin concentration is also affected by non-nutrition-related factors, and there is published evidence on the relation between serum albumin concentration and morbidity/mortality in the elderly. This study was designed to examine the relationship between serum albumin and lean mass and nutrition-related risk of morbidity/mortality in geriatric patients. Our objective was to clarify whether serum albumin in geriatric patients is a marker of body composition-related nutritional status, risk of morbidity/mortality, neither, or both. METHODS:This prospective study enrolled 125 elderly patients hospitalized in a rehabilitation unit [83.8 (SD 7.7) y]. Subjects were evaluated for serum albumin concentration and nutritional status at admission [body mass index, lean mass, appendicular skeletal muscle mass index, and body cell mass index (calculated as the ratio of the mass to the square of the height), evaluated by dual-energy X-ray absorptiometry combined with bioelectrical impedance analysis]. Outcome scores were assessed 6 mo later, taking into account complications (pressure ulcers and/or infections) and 6-mo mortality. RESULTS:Serum albumin concentration was not correlated with the lean mass, appendicular skeletal muscle mass, or body cell mass indexes. Serum albumin concentration was, however, correlated with outcome score (r = 0.22, P = 0.02). CONCLUSION/CONCLUSIONS:This study clearly demonstrates that albumin is not suitable as a marker of body composition in elderly patients.