What’s New in Adult Reconstructive Knee Surgery

Abstract

In this Guest Editorial, we review and summarize the key findings from the most noteworthy and impactful studies relating to adult reconstructive knee surgery across different areas of research over the past year. This review includes studies of various Levels of Evidence, but special attention was paid to higher Levels of Evidence and award-winning publications. Health-Care Policy and Economics As orthopaedic surgeons strive to provide improved patient outcomes, there remains a wide disparity in the equity of health-care access for the most vulnerable patient populations. There is an increased recognition of adverse outcomes based on social determinants of health (SDOH) and of the need for policy and health-care system changes to bridge the gap in patient access and the quality of care that they receive1. The International Classification of Diseases, Tenth Revision (ICD-10) contains Z code categories (Z55-Z65) to document the presence of SDOH. Although these codes currently lack financial incentives for their use, they provide data for tracking and research purposes to identify potential areas for targeted interventions1. In a large database study, Z codes were used to identify matched cohorts of patients with and without SDOH. After the propensity matching of 207,844 patients, the authors observed that patients with disparities in SDOH had higher odds of readmissions and complications within 90 days and higher rates of revision surgery and periprosthetic joint infection (PJI) within 2 years following total knee arthroplasty (TKA) compared with the control group2. One specific socioeconomic metric, the Social Vulnerability Index (SVI), uses 16 variables from the U.S. Census data to identify at-risk communities3,4. Two database studies separately demonstrated that higher SVI was associated with increased length of stay, readmissions, and complications after TKA3, whereas SVI subthemes of household composition and disability were risk factors for 90-day complications following TKA4. These studies encourage a broader adoption of the SDOH and the SVI for screening and preoperative intervention to optimize outcomes in the most vulnerable patient populations. Treatment of Knee Osteoarthritis Biologic interventions to treat knee osteoarthritis and prevent progression remain a trending topic. In a randomized controlled trial (RCT), platelet-rich plasma (PRP) injections alone were compared with exercise and PRP combined with exercise in the treatment of symptomatic grade-2 and 3 knee osteoarthritis. A commercially available kit was used to prepare the PRP injections, which were given 3 times at weekly intervals. Although improvements in patient-reported outcomes were seen in all 3 groups after 24 weeks, the exercise group and the exercise combined with PRP group were superior to the PRP group alone with respect to pain, function, and quality of life. PRP alone had no benefit in treating knee osteoarthritis compared with exercise, allowing the authors to conclude that there is no role of PRP in the treatment of mild to moderate knee osteoarthritis5. Unicompartmental Knee Arthroplasty (UKA) Indications and Utilization The utilization of UKA continues to increase as a treatment for compartment-specific osteoarthritis. A review of the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List database revealed that the volume of UKAs performed by newly trained surgeons more than doubled between 2011 (18.8 per 10,000 cases) and 2021 (39.5 per 10,000 cases). UKA, compared with periarticular knee osteotomy performed for osteoarthritis, demonstrated significantly lower rates of surgical complications (7.3% compared with 23.7%; p < 0.001), reoperation (1.9% compared with 5.2%; p = 0.002), and infection (1.4% compared with 6.7%; p < 0.001)6. Similarly, a large health-care network database study demonstrated a 590% increase in utilization between 2012 (241 UKAs) and 2022 (1,662 UKAs), with a similar increase in the adoption