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    The Top 10 Clinical Reports of 2019

    More than 1400 clinical reports have been published on ICJR.net since 2013, addressing issues in total knee and total hip arthroplasty. Which ones made our list of the 10 most-accessed clinical reports of 2019? Find out below!

    No. 1: Exploring a New Alignment Paradigm in Total Knee Arthroplasty
    Originally published on January 17, 2019

    Durability of the implanted prosthesis has been the goal of total knee arthroplasty (TKA) since the earliest days of the procedure.

    And, it’s been achieved: At the recent ICJR East ISK Hip & Knee Course, Mark W. Pagnano, MD, from Mayo Clinic in Rochester, Minnesota, reported that combined registry data show about a 1.25% risk of TKA revision per year – which means the vast majority of TKA patients will have a knee that will last them 10 to 30 years.

    Orthopaedic surgeons are now turning their attention to improving function of the knee, hoping to close the “satisfaction gap” between total hip and total knee patients. Some surgeons are looking at solving alignment issues with computer navigation and/or robotics, other are considering whether advanced sensor-tensor devices can help with ligament balancing, and still others are investigating new implants to preserve the anterior cruciate ligament.

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    RELATED: Find more clinical reports on the Reports landing page on ICJR.net

    No. 2: Tips for Preventing Tibial Loosening in Total Knee Arthroplasty
    Originally published on November 4, 2019

    Aseptic tibial loosening is the number 1 cause of failure leading to revision after total knee arthroplasty (TKA).

    That shouldn’t be the case: At the 7th Annual ICJR South Hip & Knee Course, Daniel J. Berry, MD, from Mayo Clinic in Rochester, Minnesota, said that surgeons know more now about how to cement knee implants than they did even 15 years ago and have – theoretically – gotten better at it.

    But the data suggest, he said, that surgeons have actually become worse at cementing knee implants. They’re rushing through the procedure, he said, using the wrong type of cement and the wrong cementing technique.

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    No. 3: Why Leg Length Discrepancy after THA Matters – and How It Can Be Prevented
    Originally published on October 17, 2019

    One of the keys to a successful total hip arthroplasty (THA) is restoration of appropriate leg length and offset.

    Why does this matter? At the 7th Annual ICJR South Hip & Knee Course, Bryan D. Springer, MD, from OrthoCarolina Hip & Knee Center in Charlotte, North Carolina, gave 3 very good reasons:

    • Leg length discrepancy is a common cause of patient dissatisfaction after THA.
    • Leg length discrepancy has been found to cause poorer functional outcomes after THA.
    • Leg length discrepancy is the leading cause of litigation after THA.

    What can the surgeon do to prevent leg length discrepancy? Dr. Springer broke it down into preoperative, intraoperative, and postoperative interventions.

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    No. 4: Extended Antibiotic Prophylaxis Can Reduce PJIs in Revision TKA Patients
    Originally published on June 6, 2019

    In a study published at the end of last year, R. Michael Meneghini, MD, and his colleagues from the Indiana University School of Medicine reported that high-risk primary total knee arthroplasty (TKA) patients who took antibiotics for 7 days after surgery were nearly 5 times less likely to develop a periprosthetic joint infection (PJI) than patients who did not take antibiotics postoperatively.

    They concluded that this protocol of extended antibiotic prophylaxis resulted in a “statistically significant and clinically meaningful reduction in the 90-day infection rate of selected patients at high risk for infection.”

    They also wondered: Would the same be true of revision TKA patients?

    Little is known about the duration and effects of extended antibiotic prophylaxis in revision TKA patients, who are at much higher risk of PJI than primary TKA patients: The PJI rate after revision procedures has been reported as high as 7%.

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    No 5: Stem Selection in Cementless Primary Total Hip Arthroplasty
    Originally published on January 21, 2019

    Most total hip arthroplasty patients in the US undergo a cementless procedure. So, the issue for their surgeons isn’t which type of fixation – cemented or cementless – but rather which type of stem they’re going to use.

    In most cases, the answer will be a proximally porous coated stem, Wayne G. Paprosky, MD, said at the recent ICJR East ISK Hip & Knee Course. Dr. Paprosky, from Rush University Medical Center in Chicago, Illinois, noted that development of this type of stem has grown significantly over the past 10 years compared with development of fully porous coated stems.

    One of the issues with fully porous coated stems is their association with stress shielding in the proximal femur, which can lead to bone resorption. This may not be clinically relevant, Dr. Paprosky said, but it can cause challenging revision surgeries – which is why surgeons have moved away from fully porous coated stems in most situations.

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    No. 6: The Role of Dual Mobility Implants in Reducing Instability in Primary THA
    Originally published on August 29, 2019

    Dual mobility implants are typically thought of as an option for reducing recurrent dislocations in patients undergoing revision total hip arthroplasty (THA).

    But there is a growing list of indications for the dual mobility constructs in primary THA, according to Matthew P. Abdel, MD, who spoke on the topic at ICJR’s 11th Annual Winter Hip & Knee Course.

    Dr. Abdel, from Mayo Clinic, Rochester, Minnesota, will consider dual mobility implants in primary THA patients with at least a 5% risk for recurrent dislocations due to:

    • Femoral neck fractures
    • Conversion THAs
    • Oncologic reconstructions
    • Cognitive impairment
    • Compromised abductors
    • Lumbar fusion

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    No. 7: FEATURED SURGERY: Robotic-Arm Assisted Total Knee Surgery
    Originally published on June 24, 2019

    Watch Jeffrey T. Hodrick, MD, from the Southern Joint Replacement Institute, Nashville, Tennessee, perform a robotic-arm assisted total knee surgery on a 78-year-old male with progressively worsening right knee pain in a procedure broadcast live to attendees at ICJR’s inaugural Emerging Technologies in Joint Replacement meeting.

    The patient has experienced symptoms for several years and has failed conservative management, including non-steroidal anti-inflammatory drugs and 2 corticosteroid injections. The pain, located in his medal and lateral joint line, wakes him up at night and makes it difficult to go up and down the stairs.

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    No. 8: FEATURED SURGERY: Cementless Total Knee Arthroplasty
    Originally published on April 18, 2019

    In a pre-recorded surgery shown to attendees at ICJR’s 11th Annual Winter Hip & Knee Course, R. Michael Meneghini, MD, from IU Health Saxony Hospital in Fishers, Indiana, performs a cementless total knee arthroplasty in an active, 58-year-old female patient. Between 20% and 30% of Dr. Meneghini’s patients are candidates for cementless TKA, which he said registry data and the literature support as a viable option for younger patients with good bone quality who need a long-lasting implant.

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    No. 9: 6 Reasons Why Cemented Stems Still Make Sense in Total Hip Arthroplasty
    Originally published on October 14, 2019

    There’s no reason to abandon cemented femoral components in primary total hip arthroplasty (THA), but there are plenty of reasons – well, at least 6 really good reasons – why cement is still relevant.

    Speaking at Essential Hip Topics: Cradle to Grave, ICJR’s 1-day pre-course for the Mid-American Orthopaedic Association’s annual meeting, Robert T. Trousdale, MD, said that registry data from the American Joint Replacement Registry show a decline in the use of cemented hip designs, while the use of cementless implants has been gradually increasing.

    He also noted that 47% of attendees at a meeting of the American Association of Hip & Knee Surgeons (AAHKS) had never done a cemented THA, while another 47% said they use cemented stems in fewer than 25% of their patients.

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    No. 10: Insights on Stiffness after Total Knee Arthroplasty
    Originally published on January 28, 2019

    Why do some total knee arthroplasty (TKA) patients develop knee stiffness after surgery, and what can be done to manage it?

    Preoperative range of motion (ROM) plays a role: A study published in 2004 found that patients with preoperative stiffness were more likely to have postoperative stiffness.

    But that’s just 1 factor of many possibilities, according to Raymond H. Kim, MD, who reviewed the etiology, diagnosis, and treatment of postoperative knee stiffness at the 6th Annual ICJR South Hip & Knee Course.

    Dr. Kim, from The Steadman Clinic in Vail, Colorado, said a complicating issue is that the definition of “stiffness” is not clear cut. In general, “stiffness” means motion restriction in the operated knee that limits daily function. One study reported a prevalence of 1.3% at 32 months after primary TKA, with stiffness defined for the study as flexion contracture of 15° or more and/or flexion of less than 75°.

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