What’s New in Adult Reconstructive Knee Surgery

“This is a review article from JBJS, a specialty update. These updates are yearly, cover the new developments and often mention consensus opinions. The comments about tibial osteotomy surgery for knee arthritis are important. In the national consensus, an osteotomy is one surgical choice that is not a knee replacement. The surgical technique for tibial osteotomy is significantly improved by the instruments developed by Arthrex, Naples Florida, in my opinion, based on personally performing many tibial osteotomies. If you need arthritis knee surgery, find a surgeon who offers tibial osteotomy as a choice.” Bill Chesnut, MD.

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What’s New in Adult Reconstructive Knee Surgery: Level I and II Studies.                                               OrthoBuzz Feb 26, 2016.

Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopedic literature during the previous year in 13 subspecialties. Here is a summary of selected findings from Level I and II studies cited in January 20, 2016 Specialty Update on adult reconstructive knee surgery:

Nonsurgical Management and Osteotomy

  • A Cochrane database review found that land-based therapeutic exercise programs were modestly beneficial to patients with knee arthritis. Individualized programs were more effective than exercise classes or home-exercise programs.1
  • A study comparing intravenous administration of tanezumab versus naproxen and placebo in patients with hip and knee osteoarthritis found that tanezumab effectively relieved pain and improved function at week 16.2
  • A comparison of platelet-rich plasma (PRP) injections and hyaluronic acid (HA) injections found both treatments to be equally effective in improving knee function and reducing symptoms as measured by the IKDC subjective score.3
  • A study comparing opening-wedge and closing-wedge high tibial osteotomy found that among patients who did not go on to conversion to TKA, there were no between-group differences in clinical or radiographic outcomes at six years of follow-up.

Implants, Instrumentation, and Technique

  • A comparison of highly cross-linked and conventional polyethylene in posterior cruciate-substituting TKA found no differences in pain, function, and radiographic outcomes at a mean of 5.9 years.
  • A randomized study of 140 patients that compared the use of patient-specific instrumentation (PSI) and conventional instrumentation found no differences in clinical, operative, and radiographic results.4
  • In a randomized trial of 200 patients, the use of electromagnetic computer navigation resulted ininsignificantly fewer outliers from the target alignment, compared with the use of conventional instrumentation. There were no between-group differences in clinical outcomes.5
  • In a prospective randomized trial, the use of computer-assisted navigation during TKA resulted in lower systemic embolic loads, compared with TKA performed using conventional intramedullary instrumentation.
  • A randomized controlled trial comparing kinematically and mechanically aligned TKA found that kinematic alignment with patient-specific guides provided better pain relief and restored better function and range of motion than mechanical alignment using conventional instruments.6
  • A randomized study of selective patellar resurfacing in 327 knees followed for a mean of 7.8 years found higher satisfaction among patients with a resurfaced patella.7

Pain and Blood Management:    A randomized controlled trial comparing femoral and adductor canal blocks found that adductor canal blocks decreased time to discharge readiness without an increase in narcotic consumption.8

  • A trial comparing periarticular injections (PAIs) of liposomal bupivacaine with conventional bupivacaine PAI found no between-group differences in VAS pain scores 72 hours postoperatively orin patient narcotic consumption.9
  • A double-blinded randomized trial comparing topical versus intravenous administration of tranexamic acid found no significant differences in estimated blood loss or complications.

Rehabilitation and Complications

  • A randomized trial of 205 post-TKA patients found no differences in WOMAC scores for pain, function, and stiffness in groups thatreceivedtelerehabilitation or face-to-face home therapy.
  • A randomized trial found that Kinesio Taping helped reduce postoperative pain and swelling and improved knee extension during early postoperative rehabilitation.10
  • A trial comparing oral edoxaban and subcutaneous enoxaparin for post-TKA thromboprophylaxis found that edoxaban wasthe more effective agent. The incidence of bleeding events was similar in both groups.11

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