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Controversial Topics in Total Knee Arthroplasty: A 5-Year Update (Part 1)
Johannes Michiel van der Merwe1, Matthew Semrau Mastel
1From the Department of Orthopaedics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Summary
Recent total knee arthroplasty literature reviews show multimodal injections are effective analgesics. Patellar resurfacing may reduce revisions, but controversies in knee arthroplasty persist.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Review of recent literature on controversial topics in total knee arthroplasty (TKA).
- Focus on evidence from the past 5 years to address ongoing debates.
Purpose of the Study:
- To synthesize current evidence on TKA controversies.
- To guide surgeons in adopting evidence-based practices.
Main Methods:
- Literature search emphasizing meta-analyses and randomized controlled trials (RCTs) from the last 5 years.
- Systematic review of studies on peripheral nerve blocks, local infiltrative analgesia, intrathecal morphine, patellar resurfacing, and bearing designs.
Main Results:
- Multimodal periarticular injections offer comparable analgesia to peripheral nerve blocks with fewer side effects.
- Patellar resurfacing is linked to lower revision rates and similar/improved outcomes.
- No significant differences found between cruciate-retaining and posterior-stabilized knee designs; medial pivot designs require further long-term data.
Conclusions:
- Surgeons can utilize updated evidence for TKA care.
- Several TKA topics remain controversial with no definitive conclusions in recent literature.
