Faculty Bibliography

Improvements in pain management techniques over the past decade have had a significant impact on the outcomes of total knee arthroplasty. Of these techniques, multimodal approaches have shown potential. The purpose of this study was to compare the results of periarticular injection (PAI) to a combination of patient-controlled epidural analgesia and femoral nerve block (PCEA/FNB). Ninety patients undergoing primary unilateral total knee arthroplasty between June 2010 and March 2011 were randomized into 2 groups. The first group received the PCEA/FNB protocol, whereas the second group received the PAI. Mean patient age was 66.1 +/- 8.7 years. All patients were operated on using a similar standard medial parapatellar approach, and all received preemptive analgesia and postoperative pain protocols. All patients were interviewed twice daily for the first 3 days postoperatively, once on day 7, and once in month 6. The 2 groups had similar readiness for discharge (PCEA/FNB group, 3.3 +/- 1.2 days; PAI group, 3.2 +/- 1.9 days). The results indicated no statistical difference between the 2 groups in 3 of 4 categories (rest in the morning, rest in the evening, and ambulation in the morning). Pain on ambulation was the only category that was statistically lower in the PCEA/FNB group than in the PAI group.Although the study demonstrates similar results between the 2 groups, PAI can play a major role in postoperative pain control in institutions that may not have appropriately trained individuals, equipment, and resources for PCEA/FNB. It also reduces many of the side effects and complications associated with regional anesthesia.

The Patient Administered Questionnaires (PAQ) incorporate physical and psychological symptoms into one scale and permit more comprehensive self-reports for hip and knee disorders. We tested the psychometric properties of the PAQ-Hip and PAQ-Knee. Correlations between baseline PAQ-Hip and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were .39 to .72 (n = 102), .39 to .69 for score change (n = 68 post-total hip arthroplasty), and most kappa values > .60 (n = 50). Correlations between baseline PAQ-Knee and WOMAC were .35 to .64 (n = 100), .62 to .79 for score change (n = 43 post-total knee arthroplasty), and most kappa values >.60 (n = 51). For both scales, effect sizes were higher than for the WOMAC, and there was modest correlation between physical and psychological questions, indicating these concepts are not completely interchangeable. Thus, the PAQ scales have strong psychometric properties and are unique compared with existing scales by including physical and psychological symptoms.

BACKGROUND: The rotating-platform, posterior-stabilized knee was designed to decrease polyethylene wear and to address challenges associated with Low Contact Stress mobile-bearing knees. The purpose of the present prospective study was to investigate the long-term clinical and radiographic results and the survival rate for this implant. METHODS: From January 2000 to October 2001, 117 consecutive patients (138 knees) underwent rotating-platform posterior-stabilized total knee arthroplasty with cement. All patients were followed prospectively. At a mean of 10 +/- 0.4 years (range, 9.5 to eleven years) of follow-up, twenty patients had died and eight had been lost to follow-up, leaving eighty-nine patients (106 knees) for analysis. RESULTS: A good to excellent result according to the Knee Society pain score, which improved from an average of 44 to 94 points, was achieved in 96% (eighty-five) of the eighty-nine patients in the final cohort. The mean knee motion improved from 111 degrees to 119 degrees . The prevalence of postoperative pain was 14%. The prevalence of asymptomatic crepitation was 9.4%, and the prevalence of painful crepitation requiring scar excision was 3.8%. Radiographic analysis revealed no malalignment, aseptic loosening, or osteolysis. There were three revisions: one for the treatment of infection and two for the treatment of traumatic supracondylar fractures. Kaplan-Meier analysis revealed that the ten-year survival rate was 100% with revision due to mechanical failure as the end point, 97.7% with revision for any reason as the end point, and 95% with any reoperation as the end point. CONCLUSIONS: The ten-year follow-up of the rotating-platform, posterior-stabilized total knee arthroplasty demonstrated excellent clinical results and survival rates with no failures due to osteolysis or loosening.

The purpose of this study was to analyze wear rates of highly cross-linked polyethylene comparing the Martell and the Roman methods in 112 total hip arthroplasties in patients 65 years and younger, with a mean follow-up of 5.7 years. The mean wear rates in the Martell and Roman methods were 0.014 +/- 0.05 mm/y and 0.011 +/- 0.04 mm/y when including all values and 0.043 +/- 0.028 mm/y and 0.038 +/- 0.02 mm/y when negative values were assumed to be zero, respectively. Both Roman and Martell methods showed similar low wear rates with negative values. The Roman method had higher precision and was more user friendly because it required less steps to measure wear, especially when comparing with the manual feature of Martell method.

Our hypothesis was that a high-flexion rotating-platform posterior stabilized (RP-PS) design could maximize range of motion (ROM) and improve deep-flexion activities. Eighty-seven consecutive patients (109 knees) with high-flexion RP-PS design were prospectively followed up for a minimum of 3 years. Radiographic and clinical outcomes were analyzed using Knee Society Score criteria and Western Ontario and McMaster Universities Osteoarthritis Index. Good to excellent clinical scores were achieved in 96% of the knees. There were no cases of infection, malalignment, loosening, osteolysis, or spinout. The mean preoperative ROM improved from 110.7 degrees to 124 degrees postoperatively. High-flexion activities such as squatting and kneeling were achieved in 62% and 60% of patients, respectively. High-flexion knee implant is safe and improves ROM and deep-flexion activities. Persistent pain is an important cause of dissatisfaction after total knee arthroplasty.

This is a long-term follow-up report of all-polyethylene tibial components in 60 years and younger, active patients. At the mean follow-up of 12.4 +/- 2.7 (range, 10-18 years), no more patients were deceased or lost to follow-up, leaving 32 patients (44 knees) for final analysis. Good to excellent results were achieved in 96% of patients. The mean Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score were 31 and 97, respectively. Sixty-two percent of patients were participating in sport activities such as running, gym exercises, and playing tennis or golf, with a mean UCLA score of 7.2. There were no cases of malalignment, aseptic loosening, excessive wear, or osteolysis. Seven patients (9 knees) had incomplete, nonprogressive demarcation at the zone 1 tibial interface. Kaplan-Meier survivorship at 10 years for revision due to mechanical reasons and for all failures was 97.7% and 95.5%, respectively.