UKA: Who Gets One, Who Doesn't

Unicondylar knee arthroplasty (UKA) is the best operation for a select group of patients with knee osteoarthritis, according to Mark W. Pagnano, MD, from Mayo Clinic, Rochester, Minnesota.

Speaking at the 6th Annual ICJR Winter Hip & Knee course in Vail, Colorado, Dr. Pagnano said UKA is a reliable procedure that can be quite durable, as long as it is performed well. In his practice, patients have a faster recovery after UKA than after total knee arthroplasty (TKA), they achieve better range of motion, and they are happier.

Patient selection is critical. Dr. Pagnano noted that the ideal UKA candidate is the patient with:

Antero-medial osteoarthritis
Intact ACL
Correctable varus deformity
Intact lateral compartment
Intact patellofemoral joint
Good range of motion

In his practice, Dr. Pagnano sees UKA as an option for patients with isolated medial compartment disease and symptoms confined to the medial joint line.

This is so important that during the preoperative visit, he wants the patient to specifically point to the medial joint line as the source of pain without prompting from him.

The Effects of Tranexamic Acid on Bleeding in TKA

Bleeding is one of primary reasons for impaired recovery after total knee arthroplasty (TKA) because it can cause:

Knee swelling
Increased pain
Restricted motion
Greater risk of wound complications

Tranexamic acid (TXA) is now being used in major joint reconstruction to control bleeding. Is it having the desired effect on bleeding and, by extension, on recovery after TKA?

At the recent ICJR Australia meeting in Sydney, Samuel J. MacDessi, MBBS (Hons), FRACS, FAOA, from Sydney Knee Specialists, sought to answer that question.

First, what is TXA? A synthetic amino acid, TXA is an antifibrinolytic agent that:

Saturates the lysine binding sites of plasminogen
Inhibits plasminogen from binding to fibrin

So TXA does not act in a "pro-thrombotic" way, but instead inhibits the breakdown of clots.

What's Hot on ICJR's App?

In the second quarter of 2014, thousands of videos from ICJR meetings were downloaded through our app, ICJR Mobile. Hot topics included:

Why I Use a Posterior Approach and Why I Don't Use a Direct Anterior Approach
Mini-Posterior THA: Today's Gold Standard
Managing Instability in THA
Anterolateral Approach to the Hip and How to Make It Extensile
A Perfect X-ray but an Unhappy Patient: Expectations and Satisfaction after TKA

If you haven't downloaded ICJR's app for iOS and Android devices, what are you waiting for? It's free for ICJR members!

Treatment Options for Posterior Shoulder Instability

By T. Bradley Edwards, MD; Benjamin W. Szerlip, DO; and Brent J. Morris, MD

The diagnosis of posterior instability is often delayed or even missed due to the relatively uncommon incidence and vague clinical presentation. Posterior instability incorporates a broad spectrum of pathology that may involve both soft tissue and bony architecture, making surgical management technically challenging.

It is critical for the surgeon to accurately identify the nature of instability, as well as have a clear understanding of the anatomy and biomechanics, to achieve a successful outcome.

Surgical management for posterior instability, including new arthroscopic techniques, has evolved over the past several years with promising results.

Femoral Revision: What Are the Options?

At the recent ICJR Australia meeting in Sydney, Paul N. Smith, BM BS, FRACS, FAOrthA, reviewed his goals when performing a revision total hip:

Achieve an "anatomic" reconstruction
- Restoration of the hip center of rotation, done largely on the acetabular side
- Restoration of femoral offset, done on the femoral side
- Restoration of limb length
Achieve a "mechanically sound" construct
- Good fixation to host bone
Ensure a stable reconstruction that does not dislocate

Dr. Smith emphasized the importance of an anatomic reconstruction. Failure to restore "normal" anatomy in a hip arthroplasty has been associated with a higher rate of dislocation, muscle weakness, limping, leg length discrepancy, and impingement, as well as higher risk of early failure due to the increased load on the joint interphases.

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