Hypothermically Stored Amniotic Membrane for the Treatment of Cartilage Lesions: A Single-Arm Prospective Study with 2-Year Follow-Up.

OBJECTIVE: The purpose of this study was to determine the safety and efficacy of hypothermically stored amniotic membrane (HSAM) for the treatment of cartilage lesions of the knee using imaging, patient-reported outcomes (PROs), second-look arthroscopy, and histology. Patients were treated with HSAM and followed for 2 years. DESIGN: Subjects with focal chondral lesions of the femur (International Cartilage Repair Society grade 3-4) were enrolled in this single-arm prospective study. Standard of care imaging was completed. PROs, including the Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Scale, and Visual Analog Scale (VAS), were collected at baseline and at 3, 6, 12, 18, and 24 months. Three subjects underwent an optional arthroscopy and biopsy of the repair at 24 months. RESULTS: Ten subjects were enrolled and completed the study. At 24 months, KOOS Sports & Recreation improved 173.3% and Quality of Life improved 195.3% from baseline. Marx Activity Scale increased 266.8% from 12 to 24 months. VAS scores improved 84.8% and 81.0% from baseline to 24 months for average and maximum pain. Modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring showed that 7 of 10 subjects had complete defect repair and filling by 24 months. Biopsy staining for collagen II revealed integration and remodeling of HSAM into a mix of hyaline-like cartilage and fibrocartilage matrix. CONCLUSION: This study provides evidence supporting the safety and efficacy of HSAM for treating symptomatic cartilage lesions. Subjects showed a high degree of defect fill and integration with the native cartilage and reported improvements in pain and function post-treatment. Results provide important original data for future clinical trials.

A Smartwatch Paired With A Mobile Application Provides Postoperative Self-Directed Rehabilitation Without Compromising Total Knee Arthroplasty Outcomes: A Randomized Controlled Trial.

BACKGROUND: Self-directed rehabilitation (SDR) after total knee arthroplasty (TKA) has not been traditionally recommended. The purpose of this study was to determine if there was an impact on postoperative outcomes with the use of an SDR program after primary TKA. METHODS: In this prospective, randomized, multicenter, controlled trial, we paired a smartwatch with a mobile application, providing an SDR program after TKA. Three groups were examined in this level I study: (1) control group (formal physical therapy [PT]), (2) high exercise compliance group, and (3) low exercise compliance group. Patient-reported outcome measures (PROMs) of knee injury and osteoarthritis outcome scores, joint replacement (KOOS, JR), and EuroQol five-dimension five-level (EQ-5D-5L) along with range of motion (ROM) and manipulation rates were evaluated. RESULTS: Three hundred thirty-seven patients were enrolled in two groups with 184 in the control group and 153 in the study groups (90 in the high-compliance group and 63 in the low-compliance group). The KOOS, JR score was statistically lower in the low-compliance group in net change from preoperative scores at 3 months (P = .046) and 6 months (P = .032) than that in the control group; difference was noted at 6 months for the high-compliance group, P = .036. However, these did not meet the threshold of 8.02 units for KOOS JR minimal clinically important difference. No differences were seen in PROMs at other time intervals and in manipulation rates or ROM. CONCLUSION: Postoperative outcomes including manipulation under anesthesia, ROM, and PROMs were not different when a smartwatch paired with a self-directed PT mobile application was compared with traditional formal PT. Surgeons can consider this an appropriate alternative to traditional PT programs after TKA.

Prospective, Randomized, Surgeon-Blinded Comparison of Standard Magnification Assumption vs Magnification Marker Usage for Preoperative Templating in Total Hip Arthroplasty.

BACKGROUND: We undertook this prospective, randomized, surgeon-blinded study to compare the accuracy of using of a magnification marker on preoperative radiographs for templating vs using a standard 21% magnification. METHODS: One hundred consecutive total hip arthroplasties were randomized to preoperative templating using a 25-mm magnification marker (50 patients) or a standard 21% magnification (50 patients). Intraoperative data were collected regarding the actual and predicted size of the femoral and acetabular components. RESULTS: The 2 groups were found to be comparable with respect to body mass index (28.9 vs 27.9, P = .26) and gender (P = .69). In the magnification marker group, we predicted the femoral size within 1 size in 80% of the cases and the acetabular component in 94%. In the group of a standard 21% magnification, we predicted the femoral size within 1 size in 90% of the cases and the acetabular component in 96%. These proportions did not statistically differ (femur: χ2P = .16, odds ratio = 2.3, 95% confidence interval = 0.7-7.1; acetabulum: χ2P = .65, odds ratio = 1.5, 95% confidence interval = 0.3-9.6). CONCLUSION: We did not detect a statistically significant difference in accuracy by using one method over the other when comparing the accuracy of component size selection. As the use of the magnification marker adds to the time and expense of preoperative radiographic acquisition, we feel using a standard 21% magnification is an equally accurate technique.

Acetabular Abduction and Dislocations in Direct Anterior vs Posterior Total Hip Arthroplasty: A Retrospective, Matched Cohort Study.

BACKGROUND: There is purported improvement in component positioning and hip stability with the use of direct anterior approach (DAA) total hip arthroplasty (THA). We sought to determine if there is a difference in acetabular component position or dislocation frequency between DAA and posterior THA. METHODS: One arthroplasty fellowship-trained surgeon introduced DAA THA into his practice. From the initiation of DAA in 4/2012-8/2015, this comparative series resulted in 66 DAA THAs. A matched cohort (age, gender, body mass index [BMI], and comorbidities) was then created for posterior THA, 66 hips. DAA THA used fluoroscopy with anterior capsular excision; posterior group used no image guidance and had capsular repair. Posterior group BMI was 27.8 and DAA group BMI was 27.6 (P = .36). Minimum 3-month follow-up occurred in both groups. RESULTS: Average acetabular abduction angle in the posterior group was 41.9° (range, 32°-60°; standard deviation [sdev], 6.24) and DAA group 43.8° (range, 30°-62°; sdev 6.9), P = .12. The percentage of outliers (outside Lewinnek safe zone, 30°-50°) was 9.1% (6 of 66) in posterior group and 13.6% (9 of 66) in DAA group. There were 2 anterior dislocations in the DAA THA group and 1 anterior dislocation in the posterior THA group, resulting in P = .56. The DAA dislocation frequency in this group was overall higher at 3.0% (2 of 66) compared with the matched posterior (1.5%, 1 of 66) and unmatched posterior larger series (.8%, 3 of 360). CONCLUSION: We demonstrated no observable difference in hip stability or acetabular abduction. This study provides realistic outcomes for surgeons implementing DAA THA into their practice.