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

Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews
Johannes Michiel van der Merwe, Matthew Semrau Mastel

Abstract

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. 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. 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-stabiliz...Continue Reading

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