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Article ; Online: Cementless versus Cemented Total Knee Arthroplasty Using the Same Implant Design: A Mean 5-Year Follow-up Study.

Miller, Adam J / Nadar, Arun C / Granade, Charles M / Smith, Langan S / Yakkanti, Madhusudhan R / Malkani, Arthur L

2024

Abstract: Cementless implant use continues to increase primarily due to increased numbers of younger and obese patients opting for primary total knee arthroplasty (TKA). Given the increased use of cementless implants, the purpose of this study was to evaluate the ... ...

Abstract	Cementless implant use continues to increase primarily due to increased numbers of younger and obese patients opting for primary total knee arthroplasty (TKA). Given the increased use of cementless implants, the purpose of this study was to evaluate the midterm clinical performance of cementless TKA using a highly porous tibial baseplate compared with its cemented counterpart of the same system. We conducted a retrospective case-control study of 400 patients undergoing primary TKA that included 200 patients with cementless components matched for age and body mass index (BMI) to 200 patients with cemented implants of the same implant design with a 5-year follow-up. We evaluated clinical results, complications, revisions, and overall survivorship between the cohorts. Statistical analysis was performed using student
Language	English
Publishing date	2024-03-29
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2075354-8
ISSN	1938-2480 ; 1538-8506 ; 0899-7403
ISSN (online)	1938-2480
ISSN	1538-8506 ; 0899-7403
DOI	10.1055/s-0044-1785192
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Zs.A 3867: Show issues

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Jg. 1995 - 2021: Lesesall (2.OG)
ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Results of Primary Total Knee Arthroplasty in Patients on Chronic Psychotropic Medications.

Smith, Nolan S / Abhari, Sarag / Smith, Langan S / Altman, Kyle M / Yakkanti, Madhusudhan R / Malkani, Arthur L

The Journal of arthroplasty

2024

Abstract: Background: Psychotropic medications are commonly used to treat several mental health conditions. The aim of this study was to determine the impact of psychotropic medications in patients undergoing primary total knee arthroplasty (TKA) with respect to ... ...

Abstract	Background: Psychotropic medications are commonly used to treat several mental health conditions. The aim of this study was to determine the impact of psychotropic medications in patients undergoing primary total knee arthroplasty (TKA) with respect to postoperative opioid use, complications, patient-reported outcome measures, and satisfaction. Methods: This is a retrospective cohort study of 514 consecutive patients undergoing primary TKA. There were 120 patients (23.3%) who were excluded due to preoperative opioid usage. The remaining 394 patients had a minimum 1-year follow-up. Of those, 133 (34%) were on psychotropic medications preoperatively and were compared to the remaining 261 (66%) patients who were not on psychotropics. Clinical data, satisfaction, Knee Society (KS) scores, Western Ontario McMaster Universities Arthritis Index, Patient-Reported Outcomes Measurement Index Score, Forgotten Joint Scores, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, postoperative opioid medication usage, and complications were compared. Results: The study cohort (psychotropic medications) had significantly lower postoperative KS Function, KS Knee, Forgotten Joint Scores, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Western Ontario McMaster Universities Arthritis Index, and Patient-Reported Outcomes Measurement Index Score compared to the control group. The study group had a lower overall satisfaction score (Likert scale 1 to 5) and a lower percentage of patients either satisfied or very satisfied (4.55 versus 4.79, P < .001; 92.0 versus 97.24%, P = .03, respectively). Postoperative opioid usage was significantly greater in the study group at both 6.4 weeks (range, 4 to 8) and 12-month follow-up (52.76 versus 13.33%, P < .001; 5.51 versus 0.39%, P = .002, respectively). There were no differences in complications and revisions between the groups. Conclusions: Patients on psychotropic medications should be educated on the risk of increased opioid consumption, diminished satisfaction, and patient-reported outcome measures following primary TKA. Given the large number of patients on psychotropic medications undergoing TKA, additional studies are needed to further improve clinical outcomes in this group.
Language	English
Publishing date	2024-02-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2024.02.037
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Zs.A 2134: Show issues

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Article ; Online: Does Preoperative Opioid Consumption Influence Patient Satisfaction following Total Knee Arthroplasty?

Smith, Austin F / Smith, Nolan S / Smith, Langan S / Yakkanti, Madhusudhan R / Malkani, Arthur L

The journal of knee surgery

2022 Volume 36, Issue 13, Page(s) 1374–1379

Abstract: Chronic opioid use prior to total knee arthroplasty (TKA) has been implicated in adverse outcomes. The purpose of this study was to evaluate clinical outcome measures and patient satisfaction in patients with a history of preoperative chronic opioid use ... ...

Abstract	Chronic opioid use prior to total knee arthroplasty (TKA) has been implicated in adverse outcomes. The purpose of this study was to evaluate clinical outcome measures and patient satisfaction in patients with a history of preoperative chronic opioid use undergoing primary TKA. A retrospective cohort study was performed on 296 consecutive patients undergoing primary TKA. Seventy-four (25%) patients were identified with chronic preoperative opioid use (study group; 22 males, 52 females). A 3:1 matched cohort ratio of control versus study group was utilized resulting in a control group consisting of 222 patients (97 males, 125 females) without chronic opioid use prior to surgery. There was no statistically significant difference in age, BMI, or follow-up. Average follow-up was 23.4 months in the control group and 23.6 months in the study group (
MeSH term(s)	Male ; Female ; Humans ; Arthroplasty, Replacement, Knee/adverse effects ; Patient Satisfaction ; Analgesics, Opioid/therapeutic use ; Retrospective Studies ; Opioid-Related Disorders ; Knee Joint/surgery ; Osteoarthritis, Knee/surgery ; Treatment Outcome
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2022-09-18
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2075354-8
ISSN	1938-2480 ; 1538-8506 ; 0899-7403
ISSN (online)	1938-2480
ISSN	1538-8506 ; 0899-7403
DOI	10.1055/a-1946-6217
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Zs.A 3867: Show issues

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ab Jg. 2022: Lesesaal (EG)

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Article: Is There a Difference in PROMs Between Morbidly Obese Patients and Nonobese Patients Following Primary Total Knee Arthroplasty?

Abhari, Sarag / Rhea, Evan B / Arrington, Derek D / Smith, Langan S / Yakkanti, Madhusudhan R / Malkani, Arthur L

Arthroplasty today

2023 Volume 22, Page(s) 101169

Abstract: Background: Patient satisfaction and patient-reported outcome measures (PROMs) are important for patients, surgeons, and payers in the current healthcare climate. Morbidly obese patients (body mass index [BMI] >40) have demonstrated higher incidence of ... ...

Abstract	Background: Patient satisfaction and patient-reported outcome measures (PROMs) are important for patients, surgeons, and payers in the current healthcare climate. Morbidly obese patients (body mass index [BMI] >40) have demonstrated higher incidence of complications after total knee arthroplasty (TKA) and can have difficulty obtaining access for their surgical care. The purpose of this study was to evaluate PROMs and patient satisfaction in morbidly obese patients undergoing primary TKA. Methods: A total of 75 patients with BMI >40 kg/m Results: The patients of the BMI >40 cohort were less likely to be discharged home ( Conclusions: Morbidly obese patients are less likely to be discharged directly to home and may have functional differences after primary TKA. However, morbidly obese patients have similar PROMs and are as satisfied as nonobese patients at 2 years. Morbidly obese patients with end-stage knee osteoarthritis should also be able to enjoy the benefits of primary TKA following medical and surgical optimization.
Language	English
Publishing date	2023-07-22
Publishing country	United States
Document type	Journal Article
ISSN	2352-3441
ISSN	2352-3441
DOI	10.1016/j.artd.2023.101169
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Article ; Online: Results of a Highly Porous Metal-Backed Cementless Patella Implant: A Minimum 5-Year Follow-Up.

Baker, James F / Smith, Nolan S / Likine, Elive F / Smith, Langan S / Yakkanti, Madhusudhan R / Malkani, Arthur L

The journal of knee surgery

2023 Volume 37, Issue 4, Page(s) 267–274

Abstract: Initial design cementless metal-backed patellar implants failed due to multiple reasons including implant design, use of first-generation polyethylene, and surgical technique. This study evaluates clinical outcomes and survivorship of total knee ... ...

Abstract	Initial design cementless metal-backed patellar implants failed due to multiple reasons including implant design, use of first-generation polyethylene, and surgical technique. This study evaluates clinical outcomes and survivorship of total knee arthroplasty (TKA) using a current generation highly porous metal-backed patellar component. One-hundred twenty-five consecutive primary cementless TKAs with a compression molded highly porous metal-backed patella were reviewed. One-hundred three TKAs (82.4%) with 5-year clinical and radiographic follow-up were available for review. These were matched with 103 consecutive TKAs using a cemented patella of the same implant design. The cementless cohort had a mean age of 65.5 years, body mass index (BMI) of 33.0, and follow-up of 64.4 months. Indications for cementless TKA were based on multiple factors including age, BMI, and bone quality. There were no revisions for loosening or mechanical failure of the cementless patella compared with two cemented patellae revised for aseptic loosening. Eight patients required revisions in the cementless cohort: three for prosthetic joint infection (PJI), two for instability, one periprosthetic femur fracture, one for patella instability, and one for extensor mechanism rupture. Five patients required revisions in the cemented cohort: two for aseptic patellar loosening, one for aseptic femoral loosening, one for PJI, and one for instability. All-cause survivorship at 5 years was 92.2 and 95.1% for the cementless metal-backed implant and cemented implant cohorts, respectively. Use of a compression molded highly porous metal-backed patella component demonstrated excellent clinical and radiographic results at 5-year follow-up. Longer follow-up is required to evaluate the ability of highly porous cementless patella implants to provide durable long-term fixation.
MeSH term(s)	Humans ; Aged ; Patella/diagnostic imaging ; Patella/surgery ; Knee Prosthesis ; Follow-Up Studies ; Porosity ; Arthroplasty, Replacement, Knee/methods ; Metals ; Reoperation ; Prosthesis Design ; Treatment Outcome ; Prosthesis Failure
Chemical Substances	Metals
Language	English
Publishing date	2023-04-11
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2075354-8
ISSN	1938-2480 ; 1538-8506 ; 0899-7403
ISSN (online)	1938-2480
ISSN	1538-8506 ; 0899-7403
DOI	10.1055/s-0043-56997
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 3867: Show issues

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Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Cementless metal-backed patellar components in primary total knee arthroplasty using an implant of modern design.

Baker, James F / Nadar, Arun C / Jouflas, Alex C / Smith, Langan S / Sachdeva, Shikha / Yakkanti, Madhusudhan R / Malkani, Arthur L

The bone & joint journal

2023 Volume 105-B, Issue 12, Page(s) 1279–1285

Abstract: Aims: The use of cementless total knee arthroplasty (TKA) components has increased during the past decade. The initial design of cementless metal-backed patellar components had shown high failure rates due to many factors. The aim of this study was to ... ...

Abstract	Aims: The use of cementless total knee arthroplasty (TKA) components has increased during the past decade. The initial design of cementless metal-backed patellar components had shown high failure rates due to many factors. The aim of this study was to evaluate the clinical results of a second-generation cementless, metal-backed patellar component of a modern design. Methods: This was a retrospective review of 707 primary TKAs in 590 patients from a single institution, using a cementless, metal-backed patellar component with a mean follow-up of 6.9 years (2 to 12). A total of 409 TKAs were performed in 338 females and 298 TKAs in 252 males. The mean age of the patients was 63 years (34 to 87) and their mean BMI was 34.3 kg/m Results: A total of 24 TKAs (3.4%) in 24 patients failed and required revision surgery, of which five were due to patellar complications (0.71%): one for aseptic patellar loosening (0.14%) and four for polyethylene dissociation (0.57%). A total of 19 revisions (2.7%) were undertaken in 19 patients for indications which did not relate to the patella: four for aseptic tibial loosening (0.57%), one for aseptic femoral loosening (0.14%), nine for periprosthetic infection (1.3%), one for popliteus impingement (0.14%), and four for instability (0.57%). Knee Society knee and function scores, and ROM, improved significantly when comparing pre- and postoperative values. Survival of the metal-backed patellar component for all-cause failure was 97.5% (95% confidence interval 94.9% to 100%) at 12 years. Conclusion: The second-generation cementless TKA design of metal-backed patellar components showed a 97.5% survival at 12 years, with polyethylene dissociation from the metal-backing being the most common cause of patellar failure. In view of the increased use of TKA, especially in younger, more active, or obese patients, these findings are encouraging at mean follow-up of seven years.
MeSH term(s)	Male ; Female ; Humans ; Middle Aged ; Arthroplasty, Replacement, Knee/methods ; Patella/surgery ; Knee Prosthesis ; Prosthesis Design ; Reoperation ; Metals ; Polyethylene ; Prosthesis Failure ; Follow-Up Studies ; Treatment Outcome
Chemical Substances	Metals ; Polyethylene (9002-88-4)
Language	English
Publishing date	2023-12-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2697156-2
ISSN	2049-4408 ; 2049-4394
ISSN (online)	2049-4408
ISSN	2049-4394
DOI	10.1302/0301-620X.105B12.BJJ-2023-0670.R1
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Zs.A 6989: Show issues

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Article ; Online: Cementless Metal-Backed Patellar Components in Primary Total Knee Arthroplasty: An Average 10-Year Follow-Up.

Jouflas, Alex C / Nadar, Arun C / Royster, Brett W / Smith, Langan S / Ziegele, Michael J / Yakkanti, Madhusudhan R / Malkani, Arthur L

The Journal of arthroplasty

2023 Volume 38, Issue 6S, Page(s) S137–S144

Abstract: Background: Historically, 1st generation metal-backed cementless patellar implants demonstrated high failure rates due to multiple factors. The 2nd generation cementless implants were developed with purported improvements in component design and ... ...

Abstract	Background: Historically, 1st generation metal-backed cementless patellar implants demonstrated high failure rates due to multiple factors. The 2nd generation cementless implants were developed with purported improvements in component design and polyethylene wear characteristics. This study evaluated clinical results of a current generation cementless metal-backed patellar implant with a minimum 5-year follow-up. Methods: One hundred and thirty-six primary total knee arthroplasties (TKAs) with metal-backed cementless patellae were compared to 183 cemented patellae with the same implant design. The cementless group mean age was 61 years (range, 40 to 81), mean body mass index (BMI) of 34.9 (range, 22.6 to 64.5), and mean follow-up of 10 years (range, 5 to 13). The cemented group mean age was 65 years (range, 32 to 89), mean BMI of 32.5 (range, 18.2 to 56.6), and mean follow-up of 10 years (range, 5 to 12). Significant demographic differences of age (P < .001), BMI (P < .01), and sex (P < .001) were found, with cementless patients being younger, heavier, and with more men. Results: There were no statistical differences in non-revision procedures (P = .214), TKA revisions (P = .639), patellar revisions (P = .151), and patellar aseptic loosening (P = .737). The 10-year survivorship of the cementless metal-backed patella was 95.9% with all-cause failure as the endpoint. The 10-year survivorship of the cemented patellar component was 98.9%. Conclusion: This study demonstrated noninferiority of a 2nd generation HA-coated cementless metal-backed patellar implant in primary TKA compared to cemented patellae with 10-year survivorship of 95.9%. Advances in implant design and polyethylene wear properties have led to improved clinical results with metal-backed patellar components in primary TKA.
MeSH term(s)	Aged ; Humans ; Male ; Middle Aged ; Arthroplasty, Replacement, Knee/methods ; Follow-Up Studies ; Knee Prosthesis ; Metals ; Patella/surgery ; Polyethylene ; Prosthesis Design ; Prosthesis Failure ; Reoperation ; Treatment Outcome
Chemical Substances	Metals ; Polyethylene (9002-88-4)
Language	English
Publishing date	2023-02-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2023.02.010
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Zs.A 2134: Show issues

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ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Incidence of Instability Following Primary Total Hip Arthroplasty Continues to Decline in the Medicare Population.

Sirignano, Michael N / Nessler, Joseph M / Rhea, Evan B / Ong, Kevin L / Watson, Heather N / Yakkanti, Madhusudhan R / Malkani, Arthur L

The Journal of arthroplasty

2023 Volume 38, Issue 7S, Page(s) S89–S94.e1

Abstract: Background: Instability has been the primary cause of failure following primary total hip arthroplasty (THA) leading to revision hip surgery. The purpose of this study was to determine if instability rates have further declined following advances in ... ...

Abstract	Background: Instability has been the primary cause of failure following primary total hip arthroplasty (THA) leading to revision hip surgery. The purpose of this study was to determine if instability rates have further declined following advances in primary THA, including dual mobility articulations, direct anterior approaches, advanced technologies, and improved knowledge of the hip-spine relationships. Methods: Using the 5% Medicare Part B claims data from 1999 to 2019, we identified 81,573 patients who underwent primary THA for osteoarthritis. Patients who experienced instability at 3 months, 6 months, 1 year, and 2 years were identified. Multivariate cox regression analyses evaluated the effect of patient and procedure characteristics on the risk of instability. Results: Instability at 1 year following primary THA declined from approximately 4% in 2000 to 2.3% in 2010 and 1.6% in 2018. The leading cause of revision surgery was infection (18.6%), followed by periprosthetic fracture (14%), mechanical loosening (11.5%), and instability (9.4%). High-risk groups for instability continue to include increased age, higher Charlson index, obesity, lumbar spine pathology, and neurocognitive disorders. Conclusion: Instability is no longer the leading etiology of failure following primary THA with a decline of approximately 40% over the past decade. Infection, periprosthetic fracture, mechanical loosening, and then instability are now the leading causes of failure. Multiple factors may play a role in the decline of instability, including increased use of dual mobility articulations, direct anterior approaches, improved knowledge of the hip-spine relationships, and use of advanced technologies.
MeSH term(s)	Humans ; Aged ; United States/epidemiology ; Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Hip/methods ; Periprosthetic Fractures/complications ; Incidence ; Prosthesis Failure ; Medicare ; Reoperation/adverse effects ; Risk Factors ; Hip Prosthesis/adverse effects ; Retrospective Studies ; Hip Dislocation/etiology
Language	English
Publishing date	2023-04-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2023.04.035
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 2134: Show issues

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ab Jg. 2022: Lesesaal (EG)

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Article: Cementless versus Cemented Total Knee Arthroplasty Using the Same Implant Design: A Mean 5-Year Follow-up Study

Miller, Adam J. / Nadar, Arun C. / Granade, Charles M. / Smith, Langan S. / Yakkanti, Madhusudhan R. / Malkani, Arthur L.

The Journal of Knee Surgery

2024

Abstract	Cementless implant use continues to increase primarily due to increased numbers of younger and obese patients opting for primary total knee arthroplasty (TKA). Given the increased use of cementless implants, the purpose of this study was to evaluate the midterm clinical performance of cementless TKA using a highly porous tibial baseplate compared with its cemented counterpart of the same system. We conducted a retrospective case-control study of 400 patients undergoing primary TKA that included 200 patients with cementless components matched for age and body mass index (BMI) to 200 patients with cemented implants of the same implant design with a 5-year follow-up. We evaluated clinical results, complications, revisions, and overall survivorship between the cohorts. Statistical analysis was performed using student t -test and chi-square analysis. There was no statistical difference in age (64.3 vs. 64.3 p = 0.81), BMI (34 vs. 33.1 p = 0.19), preoperative Knee Society Score (KSS) function (41 vs. 32.3 p = 0.22), and preoperative KSS knee score (39.2 vs. 38.3 p = 0.54) between the cementless and cemented cohorts, respectively. The cementless group had seven revisions, while the cemented group had nine revisions ( p = 0.609). The cementless group had one revision due to aseptic loosening versus five in the cemented group ( p = 0.09). Postoperative 5-year KSS knee scores were 92.84 versus 91.75 ( p = 0.386) and function scores were 81.81 versus 69.65 ( p = 0.00004) in the cementless and cemented groups, respectively. The cementless group had survivorship of 96.5% for all-cause revision compared with 95.5% in the cemented group at 5-year follow-up ( p = 0.60). Cementless TKA using a highly porous tibial baseplate showed excellent midterm results with one case of aseptic loosening at 5-year follow-up and with similar Knee Society outcome scores and survivorship compared with the cemented group. Cementless TKA demonstrated noninferiority to cemented TKA and could be used as an alternative mode of fixation in patients opting for primary TKA. Additional long-term follow-up is needed to determine if cementless TKA can demonstrate improved survivorship over cemented TKA.
Keywords	primary total knee arthroplasty ; cementless TKA ; cemented TKA ; outcomes ; complications ; aseptic loosening
Language	English
Publishing date	2024-03-29
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2075354-8
ISSN	1938-2480 ; 1538-8506 ; 0899-7403
ISSN (online)	1938-2480
ISSN	1538-8506 ; 0899-7403
DOI	10.1055/s-0044-1785192
Database	Thieme publisher's database

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Zs.A 3867: Show issues

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Article ; Online: Cementless Total Knee Arthroplasty Using a Highly Porous Tibial Baseplate in Morbidly Obese Patients: Minimum 5-Year Follow-Up.

King, Bradley A / Miller, Adam J / Nadar, Arun C / Smith, Langan S / Yakkanti, Madhusudhan R / Harwin, Steven F / Malkani, Arthur L

The journal of knee surgery

2022 Volume 36, Issue 9, Page(s) 995–1000

Abstract: Morbidly obese patients undergoing cemented primary total knee arthroplasty (TKA) can pose a challenging problem with implant survivorship due to greater stress at the cement-bone interface. With the advent of additive manufacturing (three-dimensional ... ...

Abstract	Morbidly obese patients undergoing cemented primary total knee arthroplasty (TKA) can pose a challenging problem with implant survivorship due to greater stress at the cement-bone interface. With the advent of additive manufacturing (three-dimensional printing), highly porous implants are now readily available. The purpose of this study was to review the results of primary TKA in the morbidly obese (body mass index [BMI] ≥ 40) patient using a highly porous cementless tibial baseplate. This is a retrospective study of 167 TKAs in patients with morbid obesity undergoing primary cementless TKA with a minimum 5-year follow-up. A total of 6 patients died and 14 were lost to follow-up, leaving 147 TKAs in 136 patients with a mean follow-up of 66 months (range 60-79 months). The average age was 59 years (range 36-84 years) and average BMI was 45 kg/m
MeSH term(s)	Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/methods ; Obesity, Morbid/complications ; Obesity, Morbid/surgery ; Knee Prosthesis ; Retrospective Studies ; Follow-Up Studies ; Porosity ; Reoperation ; Prosthesis Design ; Bone Cements ; Prosthesis Failure ; Treatment Outcome
Chemical Substances	Bone Cements
Language	English
Publishing date	2022-06-09
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2075354-8
ISSN	1938-2480 ; 1538-8506 ; 0899-7403
ISSN (online)	1938-2480
ISSN	1538-8506 ; 0899-7403
DOI	10.1055/s-0042-1748900
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ab Jg. 2022: Lesesaal (EG)

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