Surgeons participating in the Insall Scott Kelly Adult Reconstruction Fellowship at NYU Langone Health in New York review the evidence for various aspects of total hip and total knee arthroplasty management, summarizing what is known – and what still need to be known – about these practices.

Current Articles

Evaluating the Direct Anterior Approach to the Hip
The direct anterior approach has experienced a resurgence in utilization in the past decade due to potential advantages over other approaches for total hip arthroplasty and a desire to perform hip reconstruction through a smaller incision with tissue-sparing techniques. What does the literature say about the direct anterior approach?
By Akash K. Shah MD, Dionisio Ortiz III MD, James Slover MD MSc, Ran Schwarzkopf MD MSc - Posted 26 Jul 2021

Is Medial Pivot Design a Major Advancement in Total Knee Arthroplasty?
Manufacturers began incorporating the “medial pivot” into knee implants in the late 1990s to mimic native knee kinematics. The goal: A relatively stable medial compartment through flexion and extension, with evidence of femoral rollback in the lateral compartment. What does the literature say about outcomes with these designs?
By Akash K. Shah MD, Dionisio Ortiz III MD, James Slover MD MSc, Ran Schwarzkopf MD MSc - Posted 15 Apr 2021

Treatment of Early-Stage Osteonecrosis of the Femoral Head
A review of literature providing insights into one of the head-sparing surgical treatments for this multifactorial disease process: core decompression with the addition of bone marrow aspirate concentrate, which has significantly improved long-term outcomes and has become a powerful tool in treating early-stage osteonecrosis of the femoral head.
By Akash Shah MD, Christopher Skeehan MD, James Slover MD MSc, Ran Schwarzkopf MD MSc - Posted 18 Feb 2021

The Use of Dual Mobility Implants in Total Hip Arthroplasty
Mid-term data show that today’s dual mobility constructs can provide excellent stability and range of motion in primary and revision total hip arthroplasty when patients are at a higher risk for dislocation. Modern implant designs have successfully mitigated several major failure mechanisms in older systems.
By Eric Chen MD, James Slover MD, Jeremy Loloi MD, Ran Schwarzkopf MD - Posted 03 Dec 2020

Current Controversies in Stem Fixation for Total Hip Arthroplasty
Cementless fixation has become the most common form of femoral fixation in the US. However, cemented fixation with modern techniques has demonstrated excellent outcomes and may be particularly advantageous in older adults with osteoporotic bone. In this article, surgeons from NYU Langone Health review the literature on cemented and cementless femoral stem fixation in total…
By Charles Lin MD MS, James Slover MD MS, Noah Kirschner MD, Nury Yim MD, Ran Schwarzkopf MD MSc, Tyler Luthringer MD - Posted 28 Sep 2020

How Does the Direct Anterior Approach Compare with Other Surgical Approaches to THA?
To help surgeons provide patients with a balanced overview of the literature surrounding surgical approaches to total hip arthroplasty, the authors review studies on the reported benefits and potential complications of the direct anterior approach versus other approaches.
By Alex Gaukhman MD, James Slover MD MS, Ran Schwarzkopf MD MSc, Simon Garceau MD - Posted 23 Jul 2020

Obesity and Its Effect on Outcomes in Total Joint Arthroplasty
Understanding how obesity may influence outcomes in total hip and total knee arthroplasty patients is important in order to lower the risk of complications in this population. Does that also mean there should be a BMI cutoff for total joint arthroplasty patients?
By Alex Gaukhman MD, James Slover MD MS, Jenna Bernstein MD, Ran Schwarzkopf MD MSc - Posted 21 May 2020

Core Decompression With or Without Bone Marrow Aspirate Concentrate
This article outlines the evidence and history behind the use of core decompression to manage osteonecrosis of the femoral head and discusses its modern evolution to include bone marrow aspirate concentrate.
By James Slover MD MS, Paul Enns MD, Ran Schwarzkopf MD MSc, Simon Greenbaum MD - Posted 17 Mar 2020

Pain Management in TKA: Periarticular Injections and Peripheral Nerve Blocks
Most multimodal pain control regimens for total knee arthroplasty patients include a combination of oral medications, periarticular injection of anesthetics and/or analgesics, and selective motor-sparing nerve blocks. What is the evidence for this approach?
By Alexander Gaukhman MD, James Slover MD MS, Ran Schwarzkopf MD MSc, Simon Garceau MD - Posted 23 Jan 2020

Are Smoking Cessation Programs Effective for Total Joint Arthroplasty Patients?
The authors examine the literature on the effects of smoking on primary and revision hip and knee replacement and discuss research on the potential health and cost benefits of implementing a smoking cessation program.
By Fernando Nussenbaum MD, Charity Jacobs MD, Ran Schwarzkopf MD, Jonathan Vigdorchik MD - Posted 29 Nov 2018

Antibiotics for Perioperative Prophylaxis in Total Joint Arthroplasty
The authors review what’s known – and unknown – about issues with the use of antibiotics to prevent surgical site infections, including current standards, recent recommendations, and dental prophylaxis, in patients undergoing total hip and total knee arthroplasty.
By Lewis Moss MD, Jonathan M. Vigdorchick MD, Andrew M. Pepper MD - Posted 17 Jul 2018

Perioperative Pain Management in TJA: What Should Be in the Mix?
Adequate pain control has been correlated with faster rehabilitation following joint replacement surgery and improved measures of patient satisfaction. This article reviews the evidence for multimodal therapy in the preoperative, intraoperative, and postoperative periods.
By John J. Mercuri MD MA, Omar A. Behery MD MPH, Andrew M. Pepper MD, Jonathan M. Vigdorchik MD - Posted 22 Mar 2018

Evaluating the Evidence for Gap Balancing, Measured Resection, and Kinematic Alignment
There is a renewed focus on understanding optimal soft tissue balancing techniques that may help improve patient satisfaction with total knee arthroplasty. In this article, the authors describe these techniques and review the literature on their use in knee replacement procedures.
By Jordan A. Werner MD, John J. Mercuri MD MA, Andrew M. Pepper MD, Jonathan M. Vigdorchik MD - Posted 19 Dec 2017

Metal Hypersensitivity in Total Joint Arthroplasty
In this review article, the authors describe the current understanding of metal hypersensitivity, discuss diagnostic methodologies used to identify hypersensitivity reactions, and review current treatment approaches and alternatives.
By Daniel Wiznia MD, William J. Long MD FRCSC, Nima Eftekhary MD, Richard Iorio MD, Nicholas Shepard MD, Jonathan Vigdorchik MD - Posted 24 Oct 2017

Infection Prevention for Total Joint Arthroplasty: Pros and Cons
The authors closely examine the evidence for measures that can be taken to reduce the risk of infection during the preoperative, intraoperative, and postoperative periods.
By Ran Schwarzkopf MD MSc, Kevin Chen MA, Samir Nayyar MD, Ameer Elbuluk BA, Duke Hasson MD, Jonathan Vigdorchik MD - Posted 13 Apr 2017

What Is the Role of Robotics and Navigation in THA?
Navigation and robotics systems are intended to help improve accuracy of component positioning and reduce outliers in total hip arthroplasty. The authors review the evidence for and against using these systems.
By Amy S. Wasterlain MD, Jonathan M. Vigdorchik MD - Posted 15 Dec 2016

Does Computer-Assisted Surgery Improve Outcomes of TKA?
A review of the evidence for using computer-assisted navigation, handheld navigation, robotic surgery, and patient-specific instrumentation in total knee arthroplasty.
By John Buza MD, Jonathan Vigdorchik MD - Posted 05 Oct 2016

Osteonecrosis: Is Conservative Management an Option?
In this Evidence-Based Controversies article, the authors examine the literature on the viability of pharmacologic and biophysical modalities for non-operative treatment of patients with osteonecrosis of the hip or knee.
By Savyasachi Thakkar MD, Feroz Osmani BS, Jonathan Vigdorchik MD - Posted 03 Aug 2016

The Hip-Spine Relationship: What Hip Surgeons Need to Know
Spinal deformities such as excessive kyphosis and degenerative lumbar spine disease and even prior lumbar fusion can have an impact on the success of a total hip arthroplasty. Here’s what surgeons need to keep in mind when planning and performing hip replacement in patients with spinal pathology.
Posted 06 Jun 2016

Examining Orthopaedic Applications for 3D Printing
As the technology of 3D printing improves, it has the potential to revolutionize the practice of orthopaedic surgery. An institution's investment in this technology, the authors say, can allow its surgeons to preoperatively plan complex cases, develop implant designs, and enhance education of residents and fellows.
By Jonathan Vigdorchik - Posted 07 Apr 2016

Is Simultaneous Bilateral TKA as Safe as Staged Bilateral TKA?
The authors examine the literature on VTEs and other complications following bilateral total knee arthroplasty, with the goal of establishing an institution-wide set of criteria for performing simultaneous bilateral procedures.
Posted 06 Aug 2015