Joint Replacement Surgery

Joint replacement neither eliminates nor prevents ultrasound-detected synovitis among patients with rheumatoid arthritis, according to data published in BMC Rheumatology.

MAUI, Hawaii — Although advances in rheumatology have nearly eliminated the need for joint replacement surgery among patients with inflammatory disease, failure to similarly “move the needle” for osteoarthritis has created “a perfect storm” of joint replacement demands, according to a presentation at the 2020 Rheumatology Winter Clinical Symposium.

ORLANDO — Pharmacogenetic testing may determine which patients will respond well to conventional drugs or who may need alternative drugs during orthopedic surgery, according to a presenter at the Current Concepts in Joint Replacement Winter Meeting.

Clinical improvement may still be achieved among patients with borderline hip dysplasia who undergo revision hip arthroscopy despite being less likely to achieve patient-acceptable symptom state metrics for several subjective outcomes, according to published results.

ORLANDO — Eliminating knee swelling with elevation of the leg or a directed exercise program is a first step to managing knee stiff in a patient after total knee arthroplasty. After that, manipulation under anesthesia may be considered, according to a presenter at the Current Concepts in Joint Replacement Winter Meeting.

ORLANDO — At the Current Concepts in Joint Replacement Winter Meeting, A. Seth Greenwald, DPhil (Oxon), said it is inportant to advocate to ensure the safety and efficacy of products reaching the public. He said advocacy is in the best interest of the patients, and surgeons should advocate more for patients.

ORLANDO — Treatment with cefazolin may be safe in patients who report a penicillin allergy, may reduce the rate of infection and provide cost-savings in patients undergoing total joint replacement, according to a presenter at the Current Concepts in Joint Replacement Winter Meeting.

There are two areas in orthopedic surgery where robotics has been employed successfully: joint arthroplasty and pedicle screw instrumentation in spine surgery. In joint arthroplasty, robotics is used to aid the accuracy of bone cuts in total knee arthroplasty and the accurate placement of the acetabular component in total hip arthroplasty. Many cadaveric and retrospective clinical studies have demonstrated high accuracy with bone cuts in arthroplasty leading to improved overall implant alignment and increased accuracy of screw placement in pedicle instrumentation. Despite these advantages, however, it is unclear whether robotic assistance results in improved outcomes that justify its added costs. For example, the advantages gained from robotics must outweigh the added costs of the robotic system itself, the annual service and maintenance fees of the system, as well as the cost of disposables. One also has to factor in the possible increased anesthesia and operative time in the beginning of the learning curve for the surgeon, as well as the cost of preoperative advanced imaging or the use of intraoperative CT/fluoroscopy to register the patient to be tracked by the navigational system. One area where robotic surgery may improve cost-effectiveness is by decreasing the revision rates of joint arthroplasty and spine surgery. Some studies suggest a decreased need for revision surgery with robotic assistance; however, these studies, at present, are generally retrospective studies with implicit bias. Robotics in orthopedic surgery is here to stay and will help surgeons in particularly complex cases; however, more evidence is needed to determine whether outcomes truly outweigh the costs in more routine surgical procedures.

ORLANDO — Reducing opioid use is an ongoing concern despite that oral opiates remain an important component of pain management for some patients who undergo total knee replacement, a presenter said at the Current Concepts in Joint Replacement Winter Meeting.

ORLANDO — Orthopedic surgeons who play a role in the training of residents and fellows are not only “guardians of patient care,” according to a presenter here, but are obligated to promote new ways to improve how the physicians who will success them are trained.