Kinematic Performance of Medial Pivot Total Knee Arthroplasty.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2023.11.038. 17. J Arthroplasty. 2020 Mar;35(3):725-731. doi: 10.1016/j.arth.2019.10.014. Epub 2019 Oct 15. Intraoperative Practice Variability in Total Knee Arthroplasty. Bosch LC(1), Beger SB(2), Duncan ST(3), Rossi SMP(4), Sculco PK(5), Barnes CL(6), Amanatullah DF(1). Author information: (1)Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, CA. (2)University of Arizona College of Medicine - Phoenix, Phoenix, AZ. (3)Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY. (4)Clinic of Orthopaedics and Traumatology, University of Pavia, Pavia PV, Italy. (5)Hospital for Special Surgery, New York, NY. (6)Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR. BACKGROUND: Considerable practice variability exists among orthopedic surgeons performing total knee arthroplasty (TKA). The purpose of this study is to understand what TKA surgical and perioperative techniques are standard among high-volume academic knee arthroplasty surgeons. METHODS: A written survey with 59 questions regarding management preferences in TKA was distributed by the 2018 John N. Insall Traveling Fellows to all arthroplasty-trained attending physicians at 13 medical centers, with 45 responses recorded. RESULTS: Surveyed surgeons performed unicompartmental knee arthroplasty (88%) and bilateral TKA (87%). Most surveyed surgeons rarely or never performed outpatient primary TKA (71%). Conventional alignment guides and cemented implants were used by 80% of respondents. Most surgeons used posterior-stabilized implants (67%), followed by cruciate-retaining (20%), ultracongruent (20%), and medial congruent or medial pivot designs (17.8%). Surveyed surgeons frequently or always resurfaced the patella (73%), used a tourniquet for the entire case (73%), and used tranexamic acid for all TKAs (91%). The most common locations for intra-articular anesthetic injection were the arthrotomy (91%), the periosteum (84%), and the medial posterior capsule (82%). Saline (62%) and dilute iodine (47%) were the most common irrigation fluids. The arthrotomy was most commonly closed with running barbed suture (60%) followed by interrupted vicryl (40%). Skin closure was predominantly with running monocryl (60%) followed by staples (29%). Anticoagulation for TKA was primarily aspirin 81 mg BID (60%). CONCLUSION: There was considerable variability among surgeons polled although a strong preference for more conventional and less developmental techniques prevailed. Copyright © 2019 Elsevier Inc. All rights reserved. DOI: 10.1016/j.arth.2019.10.014