ICJR CASES: Applying Technology to Total Knee Arthroplasty

    Whether a primary total knee arthroplasty (TKA) is routine or more complex, technology may have a role in helping surgeons achieve the optimum outcome for each patient.

    With that in mind, moderator C. Lowry Barnes, MD, presented physical exam and imaging findings for 6 TKA patients during a case-based panel discussion at ICJR’s Inaugural Emerging Technologies in Joint Replacement course and challenged the panel to discuss how they would handle these patients and whether they would use advanced technology intraoperatively.

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    Panel members included Martin W. Roche Jr., MD; Scott M. Sporer, MD, MS; Patrick C. Toy, MD; Stefano Bini, MD; and J. Craig Morrison, MD.

    Here are the cases Dr. Barnes presented:

    Case 1: 79-Year-Old Male Patient

    • History of right knee pain since childhood; knee surgery at age 7
    • Prior surgical history of femoral/popliteal bypass on the right leg
    • Deformity of the right lower extremity
    • Knee pain worse with weight-bearing
    • Arthritis in multiple joints

    Case 2: 50-Year-Old Male Patient

    • Right knee pain for 3 years
    • Fractured right femur while skiing in 2015; underwent open reduction and internal fixation (ORIF) and manipulation under anesthesia
    • Refractured right proximal femur and underwent a second ORIF with an intramedullary (IM) nail
    • Underwent removal of long IM nail, replaced with shorter IM nail
    • Still active and otherwise healthy

    Case 3: 65-Year-Old Female Patient

    • Bilateral knee pain; right and left knee pain equal
    • Medical history significant for psoriatic arthritis; takes sulfasalazine and prednisone
    • Retired anesthesiologist
    • Good range of motion on both knees, but painful

    Case 4: 59-Year-Old Male Patient

    • 20-year history of right knee pain
    • Underwent multiple anterior cruciate ligament reconstructions, most recently in the 1990s
    • Has failed conservative treatment to manage worsening pain
    • Worst pain when standing from a seated position and going up and down the stairs
    • Good range of motion; marked crepitus and medial joint line tenderness

    Case 5: 51-Year-Old Male Patient

    • 10-year of right knee pain
    • Pain progressively worse with activity
    • Has failed conservative treatment
    • Medical history is significant for severe asthma
    • Good range of motion; medial joint line tenderness

    Case 6: 67-Year-Old Male Patient

    • Right knee pain, with limited range of motion (30° to 50°), swelling, and erythema
    • Significant surgical history: Underwent irrigation and debridement, external fixation, and ORIF to manage an open distal femur fracture sustained when a tree fell on leg; subsequent non-union
    • Elevated erythrocyte sedimentation rate and C-reactive protein
    • Knee aspiration positive for Staphylococcus warneri

    Click the image above to watch the presentation and find out how the panel members would manage these cases.