PCL Preservation vs. PCL Sacrifice: Comparing Patient Outcomes in Medial Congruent Total Knee Arthroplasty.

INTRODUCTION: The aim of this study was to compare outcomes and complication rates between posterior cruciate ligament (PCL) retention and excision utilizing a medial congruent (MC) polyethylene insert in total knee arthroplasty (TKA) in a specialized ambulatory surgery center (ASC) dedicated to hip and knee arthroplasty. MATERIALS & METHODS: A retrospective review was performed between May 2023 and October 2023 analyzing 398 patients who underwent primary MC TKA by high-volume joint arthroplasty surgeons (n=9) with either PCL preservation (n=264) or sacrifice (n=134) in a single free-standing ASC. Patients were matched chronologically on a 2:1 basis. Demographics, baseline function, 90 day complications, and patient reported outcomes were recorded for each patient. RESULTS: There were no differences in pre-op baseline function or patient-reported outcome measures (PROMs), Charlson Comorbidity Index (COI), or American Society of Anesthesiologists (ASA) class amongst patient groups. The PCL-preserve and PCL-sacrifice cohorts showed significant variation in 12 week post-op Knee injury and Osteoarthritis Outcome, Junior (KOOS, JR.) scores. Specifically, the number of patients who achieved the minimal clinically important difference (MCID) in KOOS, JR. scores was higher in the PCL-sacrifice group (p<0.05). Yet, no complications within the 90 day period were associated with PCL status and other patient-reported outcomes. CONCLUSION: This manuscript comparing outcomes between MC TKAs with PCL retention and sacrifice suggests that both techniques are viable options with similar functional outcomes, pain scores and complication rates which may have benefits in an ASC setting. The PCL-sacrifice group exhibited a statistically significant increase in patients who achieved the MCID in KOOS, JR. score compared to the PCL-preserving at early follow up. Future research should employ prospective, randomized designs to further validate these findings and explore long-term implications.

Wound Management following Total Knee Arthroplasty: An Updated Review.

Optimal wound closure techniques following total knee arthroplasty (TKA) have focused on enhancing healing potential, preventing infection, yielding satisfactory cosmesis, and allowing early ambulation and functionality. An appropriate layered closure and management of the TKA typically involves addressing the (1) deep fascial layer; (2) subdermal layer; (3) intradermal layer, including the subcuticular region; and (4) final application of a specific aseptic dressing, each of which are covered here in detail. This focused critical review of the literature discusses traditional techniques used in all layers of wound closure following TKA while introducing several emerging popular techniques. For example, absorbable barbed skin sutures and occlusive dressings have the potential to reduce operative time, limit the need for early postoperative visits, obviate the need for suture or staple removal, and safely promote patient communication via telemedicine. As novel wound closure techniques continue to emerge and traditional approaches are improved upon, future comparative studies will assist in elucidating the key advantages of various options. In an extremely important field that has tremendous variability, these efforts may enable the reaching of a classically elusive standard of care for these techniques.

Can Component Size in Total Knee Arthroplasty Be Predicted Preoperatively?-An Analysis of Patient Characteristics.

Accurately predicting component sizing in total knee arthroplasty (TKA) can ensure appropriate implants are readily available, avoiding complications from malsizing while also reducing cost by improving workflow efficiency through a reduction in instrumentation. This study investigated the utility of demographic variables to reliably predict TKA component sizes. A retrospective chart review of 337 patients undergoing primary TKA was performed. Patient characteristics (age, sex, race, height, weight) were recorded along with implant and shoe size. Correlation between shoe size and TKA component size was assessed using Pearson's correlation coefficient and linear regression analysis using three models: (A) standard demographic variables, (B) shoe size, and (C) combination of both models. Shoe size demonstrated the strongest correlation with femoral anteroposterior (FAP) (p < 0.001) followed by height (p < 0.001). Conversely, height exhibited the strongest correlation with tibial mediolateral (TML) (p < 0.001) followed by shoe size (p < 0.001). Model C was able to correctly predict both the femur and tibia within one and two sizes in 83.09 and 98.14% of cases, respectively. Individually, model C predicted the FAP within one and two sizes in 83.09 and 96.14% of cases, and the TML in 98.81 and 100% of cases, respectively. A patient's shoe size demonstrates a strong correlation to the TKA implant size, and when combined with standard demographic variables the predictive reliability is further increased. Here, we present a predictive model for implant sizing based solely on easily attainable demographic variables, that will be useful for preoperative planning to improve surgical efficiency. LEVEL OF EVIDENCE: II, Diagnostic.