Journal of Knee Surgery最新文献

{"title":"Surgical Management of Arthrofibrosis After Total Knee Arthroplasty: Open Lysis of Adhesions and Tibial Component Exchange.","authors":"Jacob Shermetaro, Giles R Scuderi","doi":"10.1055/a-2779-0420","DOIUrl":"10.1055/a-2779-0420","url":null,"abstract":"<p><strong>Abstract: </strong>Arthrofibrosis is a common and debilitating complication after total knee arthroplasty (TKA), with an incidence ranging from 1.3 to 19.8%. It is associated with pain, restricted range of motion, and elevated revision rates, yet diagnostic definitions and management strategies remain inconsistent. This review examines surgical options for arthrofibrosis after TKA, focusing on open lysis of adhesions (LOA) and tibial component exchange, and summarizes evidence on indications, patient selection, techniques, outcomes, complications, and predictors of success. A narrative review of the literature was performed, including studies on nonoperative strategies, manipulation under anesthesia (MUA), arthroscopic LOA, open LOA, and revision TKA. Nonoperative treatment and MUA are most effective in the early postoperative period (<12 weeks). Arthroscopic LOA benefits localized adhesions but is limited in diffuse or posterior fibrosis. Open LOA allows broader release and produces average range-of-motion gains, although outcomes vary. Tibial component or polyethylene exchange can be successful in select patients with moderate stiffness, whereas full component revision is more effective in severe cases or when mechanical errors are present. Complications include persistent stiffness, infection, fracture, and extensor mechanism compromise. Predictors of favorable outcomes include early intervention, correctable technical factors, and adherence to rehabilitation. Arthrofibrosis remains a multifactorial complication without a universally effective treatment. Management should be individualized and stepwise, beginning conservatively and escalating to surgical intervention when appropriate. Open LOA and tibial component exchange are valuable tools in select patients, but recurrence and complications remain common. Further prospective studies with standardized definitions and outcomes are needed to improve care.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"413-418"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Lysis of Adhesions for the Management of Arthrofibrosis Following Total Knee Arthroplasty.","authors":"Ivan Bandovic, Giles R Scuderi","doi":"10.1055/a-2779-0493","DOIUrl":"10.1055/a-2779-0493","url":null,"abstract":"<p><strong>Abstract: </strong>Arthrofibrosis remains a challenging complication to manage following total knee arthroplasty (TKA). Early arthrofibrosis, occurring within 12 weeks of TKA, is more responsive to manipulation under anesthesia, whereas late presentations often require surgical intervention. Arthroscopic lysis of adhesions (aLOA) has emerged as a reliable treatment when non-operative measures fail. The procedure involves thorough arthroscopic debridement followed by gentle manipulation and immediate rehabilitation. Published literature has demonstrated that aLOA consistently improves knee ROM by approximately 20 to 60 degrees, with corresponding gains in Knee Society Scores and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) indices, and reductions in pain. Although overall complication rates are rare, large database analyses warn of non-trivial risks, including recurrent stiffness, surgical site infection, and periprosthetic joint infection, with outcomes influenced by factors such as younger age, higher comorbidity burden, poor baseline ROM, and elevated body mass index. Careful patient selection, preoperative exclusion of mechanical or infectious causes of stiffness, and intensive postoperative rehabilitation are critical to the success of this procedure. When applied in appropriately selected patients, aLOA offers meaningful improvement in motion and function and represents a key therapeutic option in the management of arthrofibrosis.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"419-422"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and Clinical Assessment of Arthrofibrosis after Total Knee Arthroplasty: Challenges and Evolving Standards.","authors":"Amir Human Hoveidaei, Chase W Smitterberg, Reza M Katanbaf, Monica Misch, Ysa Le, James Nace, Ronald E Delanois, Michael A Mont","doi":"10.1055/a-2780-8167","DOIUrl":"10.1055/a-2780-8167","url":null,"abstract":"<p><strong>Abstract: </strong>Arthrofibrosis is a common complication following total knee arthroplasty (TKA), characterized by excessive fibrous tissue formation within the joint, leading to restricted range of motion (ROM), pain, and functional impairment. Accurate diagnosis is essential for distinguishing arthrofibrosis from other causes of postoperative knee stiffness, such as infection, mechanical block, or malalignment. This review aims to explore current diagnostic methods and evolving standards for arthrofibrosis after TKA, focusing on (1) clinical differentiation from other causes of knee stiffness; (2) assessment and diagnostic criteria; (3) imaging, laboratory, and histopathological techniques; and (4) an integrated diagnostic algorithm and future directions. Diagnosis is primarily based on persistent ROM limitation (flexion <90 degrees or extension >5 degrees) for more than 12 weeks, after excluding infection and mechanical causes. Advanced magnetic resonance imaging (MRI) with metal artifact reduction techniques can be used to visualize intra-articular fibrosis, with an MRI-based synovial classification correlating with ROM deficits and severity. Synovial fluid analysis helps rule out infection, and histopathology is employed when the diagnosis remains unclear. The study proposes a stepwise diagnostic algorithm that integrates clinical, imaging, and laboratory findings and discusses future directions for optimizing diagnosis and treatment pathways to improve patient outcomes.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"404-408"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiology of Arthrofibrosis After Total Knee Arthroplasty: Current Concepts and Future Directions.","authors":"Amir Human Hoveidaei, Chase W Smitterberg, Amirhossein Salmannezhad, Seyed Ali Mansouri, Monica Misch, Reza Katanbaf, James Nace, Ronald E Delanois, Michael A Mont","doi":"10.1055/a-2756-0694","DOIUrl":"10.1055/a-2756-0694","url":null,"abstract":"<p><strong>Abstract: </strong>Arthrofibrosis is a common complication following total knee arthroplasty (TKA), characterized by excessive fibrous tissue formation within the joint, leading to restricted range of motion, pain, and functional limitations. This review focuses on three key areas: (1) dysregulated wound healing processes and molecular risk factors; (2) histopathological and immunohistochemical features; and (3) emerging molecular targets and potential personalized treatment strategies. Dysregulated wound healing after TKA leads to persistent fibroblast and myofibroblast activation, excessive extracellular matrix deposition, and joint capsule contracture. Key molecular mediators, such as transforming growth factor-β 1 (TGF-β1), xylosyltransferase-I (XT-I), and β-catenin (β-catenin), drive these processes, exacerbating fibrosis. Genetic predisposition, inflammatory signaling, and immune cell infiltration further contribute to the progression of arthrofibrosis. Histopathologically, arthrofibrotic tissue shows increased collagen types I and III deposition, along with upregulated markers such as α-smooth muscle actin and TGF-β1 receptor 1, reflecting myofibroblast activation and inflammation. Immunohistochemical analysis reveals abundant CD68+ macrophages and T cell infiltration, supporting the inflammatory microenvironment. Recent advances in molecular profiling have identified potential biomarkers and therapeutic targets, including bromodomain-containing protein 4 and XT-I, offering hope for personalized medicine. Despite promising preclinical findings, clinical translation remains in its early stages. Future research should prioritize the validation of these biomarkers and explore genetic and epigenetic stratification to improve management and outcomes for high-risk patients.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"398-403"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Osteoporosis Medications on Postoperative Complications Following Total Knee Arthroplasty.","authors":"Emily Margaret Pilc, Reza Morshed Katanbaf, Gabrielle Nicole Swartz, Daniel Over, Jeremy Dubin, Whitney Anne Pettijohn, Ronald Emilio Delanois, Nirav K Patel","doi":"10.1055/a-2779-0300","DOIUrl":"10.1055/a-2779-0300","url":null,"abstract":"<p><strong>Abstract: </strong>Bisphosphonates have been the gold standard for osteoporosis treatment in the past decade. However, other medications available on the market are also valuable in the treatment of osteoporosis. Knowledge is limited regarding the incidence of postoperative complications following total knee arthroplasty (TKA) for patients taking these osteoporosis medications. Therefore, our primary objective was to examine the incidence of post-TKA complications in patients taking denosumab, selective estrogen receptor modulators (SERMs), teriparatide, or bisphosphonates at 90 days, 1 year, and 2 years. Our secondary objective was to examine the odds of post-TKA complications in patients taking denosumab, SERMs, or teriparatide, at 90 days, 1 year, and 2 years compared with bisphosphonates. Employing a retrospective cohort design, we used an all-payer national database to identify 28,514 post-TKA osteoporotic patients from 2015 to 2022 taking either bisphosphonates, denosumab, SERMs, or teriparatide. Postoperative complications investigated for each osteoporosis medication included prosthetic joint infection (PJI), surgical site infection, aseptic revision, manipulation under anesthesia, aseptic loosening, venous thromboembolism, and periprosthetic fracture. There was a higher incidence of aseptic revision in post-TKA patients taking denosumab (1.2 vs. 0.6%, 0.7%, 0.9%, <i>p</i> = 0.033) compared with patients taking bisphosphonates, SERMs, or teriparatide, respectively, at 90 days. There was a higher incidence of PJI (0.5 vs. 0.1%, 0%, 0.1%, <i>p</i> = 0.049) and aseptic revision (0.3 vs. 0.01%, 0.1%, 0.1%, <i>p</i> = 0.030) in post-TKA patients taking teriparatide compared with patients taking bisphosphonates, denosumab, or SERM's at 90 days and 1 year, respectively. After multivariate analysis with bisphosphonates set as the control, denosumab showed higher odds of aseptic revision at 90 days (odds ratio [OR] = 2.17, <i>p</i> = 0.007), and teriparatide showed higher odds of PJI at 90 days (OR = 3.46, <i>p</i> = 0.043) and aseptic loosening at 1 year (OR = 5.82, <i>p</i> = 0.026). Teriparatide and denosumab were associated with a higher incidence and odds of certain post-TKA complications compared with bisphosphonates. Our results indicate that bisphosphonates and SERMs are associated with the fewest post-TKA complications, but more studies are needed to appreciate the effectiveness of each medication.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"434-439"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and Risk Factors for Arthrofibrosis Following Total Knee Arthroplasty: Toward Effective Prevention.","authors":"Amir Human Hoveidaei, Chase W Smitterberg, Yasaman Tavakoli, Seyed Arman Moein, Reza Katanbaf, Monica Misch, James Nace, Ronald E Delanois, Michael A Mont","doi":"10.1055/a-2756-0644","DOIUrl":"10.1055/a-2756-0644","url":null,"abstract":"<p><strong>Abstract: </strong>Arthrofibrosis is a debilitating complication following total knee arthroplasty (TKA), resulting in limited knee range of motion (ROM) and functional impairment. This review explores the (1) epidemiology, (2) risk factors, and (3) prevention strategies associated with arthrofibrosis. The incidence of arthrofibrosis ranges from 3 to 10% in primary TKA cases, with up to 13% in some series, and it contributes to up to 10% of revision surgeries within 5 years. Genetic and molecular factors may play a role in predisposition. Other risk factors include younger age, preoperative limited ROM, and surgical factors like prosthetic malpositioning. Prevention strategies focus on patient education, rehabilitation, and pharmacological interventions, with emerging evidence supporting the use of celecoxib, dexamethasone, COX-2 inhibitors, and losartan in reducing the risk of arthrofibrosis. Despite progress, gaps remain, particularly regarding standardized definitions and high-quality randomized controlled trials to assess the optimal treatment methods.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"392-397"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for Opioid Minimization Following Total Knee Arthroplasty: A Comprehensive Review.","authors":"Vinod Dasa, Mitchell K Ng, Jennifer H Lin, Andrew I Spitzer, Adam Rivadeneyra, David Rogenmoser, Andrew L Concoff, Mary DiGiorgi, Joshua Urban, Giles R Scuderi, William M Mihalko, Michael A Mont","doi":"10.1055/a-2778-8820","DOIUrl":"10.1055/a-2778-8820","url":null,"abstract":"<p><strong>Abstract: </strong>The ongoing opioid epidemic has prompted a reexamination of perioperative pain management, especially in total knee arthroplasty (TKA)-a procedure known for its high amount of postoperative pain and historical reliance on opioids. Among strategies for opioid-naïve patients, three broad approaches have emerged: Quantity limitation, dynamic reassessment-based prescribing, and tiered, multimodal pain regimens. While limiting prescription size and scheduling timely follow-ups remain important tools, perhaps an important approach to consider is a tiered, multimodal pain management regimen. This strategy begins with baseline administration of non-opioid agents such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and gabapentinoids, escalating only as needed to tramadol and, if necessary, stronger opioids. Preoperative cryoneurolysis, intraoperative regional nerve blocks, and long-acting local anesthetics further enhance this regimen's ability to minimize opioid exposure. These clinical gains are now reinforced by the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act, which provides separate Medicare reimbursement for select non-opioid pain treatments beginning in 2025, helping to eliminate financial barriers to adoption of these measures. In addition, real-world data-including results from the Innovations in Genicular Outcomes Research (iGOR) registry-have demonstrated the effectiveness of these techniques in reducing opioid use and improving functional and quality-of-life outcomes following TKA. Together, this convergence of clinical strategy, supportive policy, and data infrastructure provides a scalable and sustainable framework for advancing opioid stewardship in orthopaedic surgery without compromising patient comfort or recovery.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"470-476"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Anterior Cruciate Ligament Reconstruction with Lateral Extra-Articular Tenodesis Improve Objective Stability and Functional Outcomes in Athletes with Isolated Anterior Cruciate Ligament Tear? A Randomized Controlled Trial.","authors":"Mostafa Aly El Abd, Amr Mohamed Abdel Hady, Mohamed Hassan Sobhy, Ahmed Abdel Salam Abdel Halim, Yehia Mohamed Haroun","doi":"10.1055/a-2778-8980","DOIUrl":"10.1055/a-2778-8980","url":null,"abstract":"<p><strong>Abstract: </strong>Numerous studies have compared anterior cruciate ligament reconstruction (ACLR) with and without lateral extra-articular tenodesis (LEAT) in patients with anterior cruciate ligament (ACL) tears and other associated pathologies. These associated conditions significantly affect the outcomes in terms of function and stability. Athletes with isolated ACL tears and high pivot shifts represent a unique and uncommon subgroup. Despite the presence of a high-grade pivot shift, these individuals do not exhibit associated meniscal, chondral, or ligamentous laxity. We have carefully selected this group of patients to evaluate objective stability and functional outcomes, focusing on the comparison between ACLR with and without LEAT in athletes by excluding ligamentous laxity and meniscal tears. This randomized controlled clinical trial compared the functional outcomes and side-to-side instability of ACLR with or without modified Lemaire technique. Patients in this study had the following inclusion criteria: (1) less than 40 years old, (2) isolated ACL tear without meniscal injury or ligamentous laxity, (3) high pivot shift grade (2 and 3), and (4) athlete patients. The main outcomes were the comparison of functional knee scores (Lysholm and International Knee Documentation Committee [IKDC]) and objective stability, measured by the KT1000 Lachmeter. Patients were evaluated every 3 months postoperatively for at least 1 year of follow-up. Postoperative complications or failure to regain knee function were recorded. Patients were considered to have failed surgery if they experienced a persistent pivot shift, and this was confirmed radiologically. A total of 41 patients were included in our study, randomized into two groups. Group A included 20 patients treated with arthroscopic anatomical single-bundle ACLR combined with the modified Lemaire technique. Group B included 21 patients who underwent anatomical single-bundle ACLR only. Two patients were lost during follow-up in group B and were excluded from statistical analysis. At 12 months of follow-up, patients treated with arthroscopic anatomical single-bundle ACLR combined with the modified Lemaire technique showed a statistically significant improvement in functional knee scores (Lysholm score and IKDC; <i>p</i> = 0.011 and 0.003, respectively) and significant improvements in the side-to-side KT 1000 difference (<i>p</i> = 0.002). No complications were experienced, except for one case (1/19) in group B that failed and refused further interventions. ACLR with LEAT, in athletes with isolated anterior cruciate ligament tears without meniscal tears or ligamentous laxity (Beighton score ≥ 5) with high pivot shift (grade 2 and 3), resulted in a significant improvement in objective stability and functional outcomes (Lysholm and IKDC scores) at the 12-month follow-up.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"477-484"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparable Outcome Scores for Medial Collateral Ligament Reconstruction and Repair in Isolated and Combined Grade III Injuries, with Lower Rates of Complication Following Repair at 2-year Follow-up: A Systematic Review.","authors":"Benjamin T Lack, Justin T Childers, Colton C Mowers, Andrea M Javier, Garrett R Jackson, Derrick M Knapik, Steven F DeFroda, Clayton W Nuelle, Jorge Chahla","doi":"10.1055/a-2778-8771","DOIUrl":"10.1055/a-2778-8771","url":null,"abstract":"<p><strong>Abstract: </strong>To compare patient-reported outcomes and complications of medial collateral ligament (MCL) repair versus reconstruction in patients with grade III MCL injuries, and to report whether these were isolated or associated lesions, with minimum 2-year follow-up. A comprehensive search of PubMed, Scopus, and Embase was conducted from database inception to August 2024 according to PRISMA 2020 guidelines. Studies reporting outcomes and complications following repair or reconstruction of grade III MCL injuries with ≥2-year follow-up were included. Data on concomitant procedures were extracted to determine the frequency of isolated versus combined lesions. A total of 12 studies met the criteria, comprising 388 patients: 277 underwent MCL reconstruction and 111 underwent MCL repair. Mean follow-up was 37.6 months for reconstruction and 56.2 months for repair. The majority of injuries were COMBINED LESIONS: , with concomitant anterior cruciate ligament (ACL) reconstruction performed in 70.8% of reconstruction and 58.6% of repair cohorts. Postoperative IKDC scores ranged 54.3 to 89 for reconstruction and 79.1 to 88.8 for repair; Lysholm scores ranged 59.4 to 94.8 and 83.8 to 98.5, respectively. Complications occurred in 14.4% of reconstruction and 4.5% of repair patients, most commonly range of motion deficits. Reoperation rates were comparable (6.1% vs. 7.2%). Both reconstruction and repair for grade III MCL injuries yielded favorable outcomes at ≥2-year follow-up. MCL repair demonstrated slightly higher IKDC and Lysholm scores with fewer complications overall. Most cases involved COMBINED MCL AND ACL INJURIES: , highlighting the rarity of isolated grade III MCL lesions. LEVEL OF EVIDENCE: is level IV, systematic review of level II to IV studies.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"463-469"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146067828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Medicare Advantage Patients Require More Follow-up to Complete Patient-Reported Outcome Measures After Total Knee Arthroplasty? An Analysis of 7,267 Medicare Patients.","authors":"Benjamin E Jevnikar, Khaled A Elmenawi, Yuxuan Jin, Yuta Umeda, Ahmed K Emara, Nicolas S Piuzzi","doi":"10.1055/a-2778-9046","DOIUrl":"10.1055/a-2778-9046","url":null,"abstract":"<p><strong>Abstract: </strong>Patient-reported outcome measures (PROMs) are increasingly used to evaluate quality and guide reimbursement in total joint arthroplasty. While PROM collection is mandated for Traditional Medicare beneficiaries under value-based care models, little is known about how enrollment in Medicare Advantage (MA) affects PROM completion and follow-up burden in clinical practice. We analyzed a prospectively collected cohort of 7,267 Medicare patients who underwent primary total knee arthroplasty (TKA) between 2019 and 2023 at a large academic health system. Baseline and 1-year PROMs, including Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Physical Function Short Form (PS), Veterans RAND-12 Mental Component Score (MCS) were collected through a structured digital and manual follow-up protocol. Multivariable logistic regression assessed predictors of requiring active (manual) outreach for 1-year PROMs. PROM completion rates were significantly lower among MA patients at both baseline (74.2 vs. 80.3%, <i>p</i> < 0.001) and 1-year (53.5 vs. 61.9%, <i>p</i> < 0.001). However, MA enrollment was not independently associated with the need for active follow-up (odds ratio [OR] = 0.99, 95% confidence interval [CI] = 0.89-1.10; <i>p</i> = 0.79). Instead, increased follow-up burden was associated with older age (OR = 1.16 per interquartile range), non-White race (Black: OR = 1.89; Other: OR = 1.79), greater Area Deprivation Index (OR = 1.15), and poorer baseline physical/mental health (Pain - PS - MCS phenotype: OR = 1.40; all <i>p</i> < 0.01). While MA patients are less likely to complete PROMs after TKA, they do not place greater follow-up demands on clinical teams. Disparities in PROM capture appear to reflect underlying patient complexity rather than insurance design. As Centers for Medicare and Medicaid Services may expand PROM-based reimbursement models to include MA populations, equitable reporting will require targeted outreach and structural risk adjustment to avoid penalizing systems that serve more vulnerable groups.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"455-462"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145858713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}