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Controversial Topics in Total Knee Arthroplasty: A 5-Year Update (Part 1)

This review article examines updates to the literature during the past 5 years on numerous topics related to total knee arthroplasty which were felt to have ongoing controversy. These include the use of peripheral nerve blocks and local infiltrative analgesia, intrathecal morphine, patellar resurfac...

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Autores principales: van der Merwe, Johannes Michiel, Mastel, Matthew Semrau
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028773/
https://www.ncbi.nlm.nih.gov/pubmed/32672726
http://dx.doi.org/10.5435/JAAOSGlobal-D-19-00047
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author van der Merwe, Johannes Michiel
Mastel, Matthew Semrau
author_facet van der Merwe, Johannes Michiel
Mastel, Matthew Semrau
author_sort van der Merwe, Johannes Michiel
collection PubMed
description This review article examines updates to the literature during the past 5 years on numerous topics related to total knee arthroplasty which were felt to have ongoing controversy. These include the use of peripheral nerve blocks and local infiltrative analgesia, intrathecal morphine, patellar resurfacing, and bearing designs. METHODS: For each individual topic, a literature search was conducted on several databases with emphasis on studies that were published in the past 5 years. Preference was given to meta-analyses and randomized controlled trials. RESULTS: Multimodal periarticular injections may provide an equally effective analgesic effect to peripheral nerve blocks, but are also muscle sparing and less invasive. The use of intrathecal morphine in addition to periarticular injections is less desirable given the potential side effects, associated cost, and lack of clear benefit intrathecal morphine beyond the 6- to 12-hour postoperative period. Patellar resurfacing was associated with a lower rate of revision surgery, similar or potentially improved satisfaction and functional outcomes, and no increased risk of complications compared with nonresurfacing. There are no clear or notable differences between cruciate-retaining and posterior-stabilized total knee designs in terms of clinical outcomes and survivorship. Medial pivot designs theoretically recreate more normal knee kinematics compared with cruciate-retaining or posterior-stabilized designs, although superiority has not yet been clearly demonstrated and additional long-term data is necessary, particularly for survivorship. CONCLUSIONS: By analyzing the results of the aforementioned studies, surgeons can implement the most up-to-date evidence-based care when doing total knee arthroplasty surgery. However, many of these selected topics continue to have a component of ongoing controversy with no definitive conclusions developed in recent literature.
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spelling pubmed-70287732020-03-10 Controversial Topics in Total Knee Arthroplasty: A 5-Year Update (Part 1) van der Merwe, Johannes Michiel Mastel, Matthew Semrau J Am Acad Orthop Surg Glob Res Rev Review Article This review article examines updates to the literature during the past 5 years on numerous topics related to total knee arthroplasty which were felt to have ongoing controversy. These include the use of peripheral nerve blocks and local infiltrative analgesia, intrathecal morphine, patellar resurfacing, and bearing designs. METHODS: For each individual topic, a literature search was conducted on several databases with emphasis on studies that were published in the past 5 years. Preference was given to meta-analyses and randomized controlled trials. RESULTS: Multimodal periarticular injections may provide an equally effective analgesic effect to peripheral nerve blocks, but are also muscle sparing and less invasive. The use of intrathecal morphine in addition to periarticular injections is less desirable given the potential side effects, associated cost, and lack of clear benefit intrathecal morphine beyond the 6- to 12-hour postoperative period. Patellar resurfacing was associated with a lower rate of revision surgery, similar or potentially improved satisfaction and functional outcomes, and no increased risk of complications compared with nonresurfacing. There are no clear or notable differences between cruciate-retaining and posterior-stabilized total knee designs in terms of clinical outcomes and survivorship. Medial pivot designs theoretically recreate more normal knee kinematics compared with cruciate-retaining or posterior-stabilized designs, although superiority has not yet been clearly demonstrated and additional long-term data is necessary, particularly for survivorship. CONCLUSIONS: By analyzing the results of the aforementioned studies, surgeons can implement the most up-to-date evidence-based care when doing total knee arthroplasty surgery. However, many of these selected topics continue to have a component of ongoing controversy with no definitive conclusions developed in recent literature. Wolters Kluwer 2020-01-03 /pmc/articles/PMC7028773/ /pubmed/32672726 http://dx.doi.org/10.5435/JAAOSGlobal-D-19-00047 Text en Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
van der Merwe, Johannes Michiel
Mastel, Matthew Semrau
Controversial Topics in Total Knee Arthroplasty: A 5-Year Update (Part 1)
title Controversial Topics in Total Knee Arthroplasty: A 5-Year Update (Part 1)
title_full Controversial Topics in Total Knee Arthroplasty: A 5-Year Update (Part 1)
title_fullStr Controversial Topics in Total Knee Arthroplasty: A 5-Year Update (Part 1)
title_full_unstemmed Controversial Topics in Total Knee Arthroplasty: A 5-Year Update (Part 1)
title_short Controversial Topics in Total Knee Arthroplasty: A 5-Year Update (Part 1)
title_sort controversial topics in total knee arthroplasty: a 5-year update (part 1)
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028773/
https://www.ncbi.nlm.nih.gov/pubmed/32672726
http://dx.doi.org/10.5435/JAAOSGlobal-D-19-00047
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