Sponsored Issue by Johnson & Johnson MedTech, Open Access.
- 34-3 Table of Contents [PDF]
- 34-3 Editorial [PDF]
Tailored to Fit: A Review of the Role of Custom Implants in Total Knee Arthroplasty - Matthew Stein, MD; David G. Deckey, MD; Crystal Jing, BA; and Thorsten M. Seyler, MD, PhD
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Total knee arthroplasty (TKA) can be performed using either conventional off-the-shelf (OTS) implants or customized individually made (CIM) implants. This study aims to review existing literature and compare clinical outcomes between patients receiving CIM and OTS implants, specifIcally in terms of satisfaction, radiographic/alignment outcomes, revision rates, and costs. A review of literature was conducted using Medline, Cochrane, and Embase to identify articles comparing CIM and OTS implants in TKA patients. Data and outcomes were described qualitatively. Overall, based on the current evidence, custom implants have been shown to yield comparable to improved patient-reported and clinical outcomes, anatomic match, and excellent registry survival outcomes as compared with conventional OTS implants for the general population undergoing TKA. (Journal of Surgical Orthopaedic Advances 34(3):114-118, 2025)
Key words: total knee arthroplasty, custom implants, off-the-shelf implants
Total Hip Arthroplasty: A Surgical Revolution - George A. Shultz, BS; Dana C. Mears, MD, PhD; C. Lowry Barnes, MD; Simon C. Mears, MD, PhD; Benjamin M. Stronach, MD; and Jeff erey B. Stambough, MD
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Total hip arthroplasty (THA) is one of the most successful orthopaedic procedures, off ering signifi cant improvements in pain relief, mobility, and overall quality of life for patients with hip pathology. Since its inception, continuous advancements in implant materials, fi xation techniques, and surgical approaches have contributed to enhanced implant longevity and functional outcomes. THA has evolved from early designs to incorporate modern biomaterials, robotic-assisted surgery with improved precision, and three-dimensional printing for patient-specifi c solutions. Despite its success, challenges such as implant wear, prosthetic joint infection, and the need for revision surgeries remain critical concerns for orthopaedic surgeons. The increasing demand for THA, driven by an aging population and expanded indications, underscores its growing societal impact, including economic benefi ts through improved productivity and reduced healthcare costs. As research and innovation continue to shape the field, THA remains a cornerstone of orthopaedic surgery, with ongoing eff orts to optimize outcomes and address the complexities associated with revision procedures. (Journal of Surgical Orthopaedic Advances 34(3):119-123, 2025)
Key words: total hip arthroplasty, polyethylene, Charnley, bearings, osteolysis
Postoperative Length of Stay: Comparing Kinematic and Mechanical Knee Alignments in Knee Arthroplasties - Mckenna Brownell, BS; Callie Fernandez, BS; Grace Knoer, BS; Kamran Sadr, MD; and Evan Argintar MD
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Unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) can be technically accomplished by either traditional mechanical alignment or by an alternative kinematic alignment. The purpose of this study is to compare postoperative length of hospital stay between these two approaches. A retrospective study at Medstar Washington Hospital Center from 2015 – 2024 identified 167 cases of UKAs, of which 69 were kinematic and 98 were mechanical. During the same period, 420 TKAs were identified where 244 were kinematic and 176 were mechanical. Postoperative length of hospitalization and physical therapy recommendations was then compared with two-sample T-tests and Chi-square tests. Patients undergoing a UKA kinematic procedure were discharged a half day earlier than their mechanical counterparts (p = 0.029), and TKA kinematic patients were discharged nearly a full day earlier (p = 0.0001). Additionally, TKA kinematic patients were more likely to be discharged home with home services rather than to a rehabilitation facility for physical therapy (p < 0.00001). UKA patients of both kinematic and mechanical alignment were recommended to be discharged home (p = 0.312) Postoperative length of stay is significantly decreased by up to a day in patients receiving a knee arthroplasty by kinematic alignment approach. TKA kinematic patients also benefit from a discharge recommendation to home for physical therapy, rather than requiring transfer to a rehabilitative facility. These findings highlight how kinematic alignment may contribute to early improved patient satisfaction, restore early functionality, and decrease disease burden. (Journal of Surgical Orthopaedic Advances 34(3):124-127, 2025)
Key words: unicompartmental knee arthroplasty, total knee arthroplasty, postoperative outcomes, kinematic alignment, hospitalization
Early Clinical Outcomes of the DePuy ACTIS Total Hip Arthroplasty Femoral Implant - Robert J. Teasdall, MD; Hunter B. Yancey, MD; Shane C. Tipton, MD; and Maxwell K. Langfitt, MD
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Early clinical outcomes were assessed for patients who underwent total hip arthroplasty (THA) with the recently released DePuy ACTIS femoral stem for primary osteoarthritis performed through a direct anterior approach. From 2017 to 2018, 226 THAs were retrospectively reviewed on patients with at least one year of postoperative follow-up (average follow-up time was 2.63 years [+/ _ 0.83]). The primary outcome measure was all-cause revision rate (1.91%), observing for failures related to dislocation (0.48%), aseptic loosening (0.48%), pain (0.48%), infection (0.0%), and fracture (0.48%). Mean preoperative Visual Analogue Scale scores were 6.07 (+/ _ 2.37) compared with 0.62 (+/ _ 1.5) postoperatively (p < 0.001). The DePuy ACTIS THA femoral implant demonstrated encouraging early clinical outcomes. Further follow-up and surveillance will evaluate how this stem compares with others in the market, but this study demonstrates reliability in evaluation of short-term outcomes. (Journal of Surgical Orthopaedic Advances 34(3):128-129, 2025)
Key words: total hip arthroplasty, direct anterior approach, DePuy ACTIS, femoral stem, osteoarthritis
Occupational Hazards and Injuries in Total Joint Arthroplasty: Identification and Prevention - Jamie C. Heimroth, MD; Patrick M. Pallitto, MD; Brian A. Klatt, MD; Alan E. Wilson, MD; Malcolm E. Dombrowski, MD; Michael J. O’Malley, MD; Kenneth L. Urish, MD, PhD; and Johannes F. Plate, MD, PhD
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Joint replacements are demanding surgeries that take physical and mental tolls on arthroplasty surgeons. Occupational hazards of joint replacement surgery include musculoskeletal injuries, blood-borne diseases, radiation exposure, noxious chemical exposure, noise exposure, and emotional stress. This article is a review of the available literature surrounding occupational hazards that arthroplasty surgeons face and how they can be prevented. The goal is to address adult reconstruction occupational hazards in order to increase the longevity of arthroplasty surgeons. (Journal of Surgical Orthopaedic Advances 34(3):130- 133, 2025)
Key words: arthroplasty, total knee, total hip, occupational hazards, work injury, mental health
Manipulation and Injection After Total Knee Arthroplasty: Incidence and Outcomes - Maxwell J. Rakutt, MD; Stephen T. Duncan, MD; Mark A. Haimes, MD; Nathaniel J. Nelms, MD; Michael Blankstein, MD; and David C. Landy, MD, PhD
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Following total knee arthroplasty (TKA), stiffness can lead to poor outcomes. Manipulation under anesthesia (MUA) is sometimes combined with corticosteroid injection (CSI). This study sought to describe the incidence of CSI with MUA after TKA, as well as the odds of prosthetic joint infection (PJI). A database was queried to identify 754,421 primary TKA patients. The incidences of MUA, injection, revision, and PJI were investigated, along with patient characteristics before and after matching. Overall, 22,015 (2.9%) underwent MUA alone, and 3,272 (14.9% of MUA procedures) underwent MUA with injection. The odds of all-cause revision (1.0, p = 1.0) and revision with PJI (1.1, p = 0.83) were not significantly higher following injection, even after matching (0.9, p = 0.29 and 0.9, p = 0.77, respectively). Overall, the incidence of MUA following TKA within 90 days of index surgery was low and one in seven underwent injection. Injection during MUA did not increase odds of PJI. (Journal of Surgical Orthopaedic Advances 34(3):134-137, 2025)
Key words: manipulation under anesthesia, total knee arthroplasty, arthrofibrosis, prosthetic joint infection
Complication Rates for Direct Anterior Total Hip Arthroplasty After Fellowship Compared with Switching Approaches Midcareer: A Multicenter Study of the First 100 Cases - Justin A. Magnuson, MD; Ilda B. Molloy, MD, MS; James Messina, MD; Matthew J. Grosso, MD; Matthew B. Sherman, BS; John Hobbs, MS; Yale A. Fillingham, MD; and Chad A. Krueger, MD
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The rate of complications and case complexity were evaluated in the first 100 total hip arthroplasty (THA) procedures in early-career direct anterior approach (DAA)-trained adult-reconstruction surgeons and midcareer surgeons who switched to DAA from a different approach. The study is a multicenter, retrospective analysis that collected data on 500 DAA THAs performed by three early-career surgeons and two midcareer surgeons. The patients of early-career surgeons were older (66.4 vs. 64.1), had a higher body mass index (29.9 vs. 28.4), and increased Charlson Comorbidity Index (2.21 vs. 1.52) compared with midcareer surgeons (p < 0.05). There were no differences in intraoperative complications or 90-day postoperative adverse events (odds ratio 0.45, 95% confidence interval 0.17 – 1.09, p = 0.87). Operative time was significantly greater for the early-career cohort relative to midcareer surgeons (98.1 min vs. 73.8 min, respectively, p < 0.001). Early-career fellowship-trained arthroplasty surgeons have similar complication rates to experienced surgeons switching from a different approach, with higher complexity patients. (Journal of Surgical Orthopaedic Advances 34(3):138-141, 2025)
Key words: direct anterior approach (DAA), total hip arthroplasty, learning curve, arthroplasty fellowship
What Is the Impact of Anti-Estrogen Therapy on Total Joint Arthroplasty Outcomes? A View into Women’s Health After Breast Cancer - Marcus DiLallo, MD; Justin Leal, BS; Thorsten M. Seyler, MD, PhD; William A. Jiranek, MD; Samuel S. Wellman, MD; Michael P. Bolognesi, MD; and Sean P. Ryan, MD
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The purpose of this study is to determine if differences exist in patient-reported outcome measures (PROMs), revision rates, and postoperative health care utilization between individuals that have a history of taking anti-estrogen medication prior to total joint arthroplasty (TJA) and those who have not in matched cohorts. Patients undergoing primary TJA from 2015 to 2023 were reviewed retrospectively. Demographics, history of medication use, PROMs pre- and post-TJA, revision TJA history, and post-TJA hospital utilization were extracted from medical records. Propensity score matching was then performed at 10:1 control to patients with a history of taking anti-estrogen medication prior to TJA accounting for age, race, American Society of Anesthesiologists physical status classification, and body mass index. Patient PROMs, revision rate, and post-TJA hospital utilization were then compared. After applying exclusion criteria, stratifying the groups into total hip arthroplasty (THA) and total knee arthroplasty (TKA), and propensity score matching, the outcomes of 345 THAs and 549 TKAs were analyzed. Patients taking anti-estrogen medications who underwent THA had significantly higher Patient-Reported Outcome Measures Information System (PROMIS) Pain Interference scores; PROMIS Physical Function scores at 6 weeks, lower PROMIS Physical Function at 1 year; and higher rates of readmission at 90 days. There was no difference in PROMs or hospital utilization between groups in patients that underwent TKA. Patients with a history of taking anti-estrogen medications had meaningful improvement after THA and TKA. Although PROMs were similar between groups after TKA, PROMs suggest that patients taking anti-estrogen medication may have worse pain early after THA as well as worse overall function. (Journal of Surgical Orthopaedic Advances 34(3):142-151, 2025)
Key words: patient reported outcome measures, arthroplasty, anti-estrogen, breast cancer, women
Racial Differences in Perioperative Pain Management After Total Knee Arthroplasty -
Kevin Purcell, MD, MPH, MS; Taylor Stauffer, MD; Christopher Holland, MD; Danielle Chun, MD; Nicholas Scarcella, MD; Michael Bolognesi, MD; Samuel Wellman, MD; Thorsten Seyler, MD; and Paul F. Lachiewicz, MD
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Racial differences have been reported in the utilization of total knee arthroplasty (TKA), and there exists differences in pain management between African American and Caucasian patients. There are insufficient data concerning racial differences in perioperative pain management for patients after TKA for osteoarthritis of the knee. This is a retrospective study of 804 African American patients who had primary TKA between 2013 and 2022 at a single academic medical center. Patients were matched, 2:1, to Caucasian patients having TKA using American Society of Anesthesiologists score, age, gender, and body mass index. Demographic data and perioperative variables, including pain scores, morphine equivalents required at multiple time points, operative time, length of stay, and opioid refills were evaluated. A significantly higher proportion of African American than Caucasian patients had opioid medication prescribed within 90 days preoperatively (38% African American vs. 22% Caucasian patients). African American patients had significantly higher preoperative pain scores (3.28 vs. 2.26) than Caucasian patients and received significantly higher doses of morphine equivalents both preoperatively and postoperatively. The proportion of African American patients with opioid medication refills within 90 days postoperatively was significantly higher than Caucasian patients (73% vs. 33%). However, African American patients received significantly less intraoperative morphine equivalents. The reasons for the racial differences in perioperative pain management after TKA at one medical center are unknown and require additional study. However, these results suggest that pain management protocols, including standardized opioid medication, be implemented for patients of all races after primary TKA. (Journal of Surgical Orthopaedic Advances 34(3):152-155, 2025)
Key words: pain, opioid, racial differences, total knee arthroplasty, prescription
Investigating Short-term Outcomes and Healthcare Utilization After Traditional Versus Computer-assisted Total Knee Arthroplasty - Mark A. Plantz, MD; Steven Kurapaty, MD; Michael P. Foy, MD; Erik B. Gerlach, MD; and Kevin Hardt, MD
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The purpose of this study was to compare the incidence of various short-term complications and healthcare utilization between traditional and computer-assisted total knee arthroplasty (CA-TKA). Traditional TKA and CA-TKA cases were extracted from the American College of Surgeons’ National Surgical Quality Improvement Program. Patients were matched using patient and demographic variables. Outcomes were compared between the two patient groups after exact matching. Multivariate logistic regression was performed to identify independent risk factors for various outcome measures. The authors identified 159,521 patients that underwent traditional TKA and 3,464 patients that underwent CA-TKA. After matching, CA-TKA patients were more likely to have a nonhome discharge and a hospital length of stay greater than 2 days. Other outcome measures— readmission, reoperation, mortality, and surgical/medical complications—were comparable between groups. Patients undergoing computer-assisted TKA were more likely to have a nonhome discharge and a hospital length of stay greater than 2 days. (Journal of Surgical Orthopaedic Advances 34(3):156-160, 2025)
Key words: computer-assisted total knee arthroplasty (CA-TKA), short-term outcomes, healthcare utilization, ACS NSQIP