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Background: As total knee arthroplasty (TKA) continues moving to the outpatient arena, the demand for revision surgery will subsequently increase which draws into question the feasibility for some revision scenarios as an outpatient. The purpose of this study is to report on the safety of outpatient revision knee arthroplasty. Methods: From June 2013 through December 2018, 102 patients (106 knees) underwent revision knee arthroplasty at a free-standing ambulatory surgery center. Mean patient age was 58.0 years, and 43% of patients were male. Procedures included the following: 45 cases of unicompartmental arthroplasty to TKA, 54 TKA revisions, and 52 cases involved a full exchange of components. Results: Ninety-three patients (88%) were discharged the same day without incident, none required transfer to acute facility, and 13 required overnight stay with 4 of these for convenience and 9 for medical reasons. There were no major complications within the first 48 hours postoperative. One patient required readmission for treatment of ileus 11 days postoperative. There were no other readmissions, no subsequent surgeries, and no deaths within 90 days. One or more major comorbidities were present in 66 patients. Conclusion: Outpatient revision knee arthroplasty was found to be safe in carefully selected patients and case scenarios. Presence of medical comorbidities was not associated with risk of complications. The paradigm changes of patient education, medical optimization, and a multimodal program to mitigate the risk of blood loss and reduce need for narcotics facilitates performing some revision arthroplasties safely in an outpatient setting.

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Background: Most implants for total knee arthroplasty (TKA) are comprised of alloys that contain nickel. Controversy exists whether metal allergies produce negative effects and affect clinical outcomes. The purpose of this study was to retrospectively review a minimum 2-year follow-up with an ion-bombarded titanium TKA implant in patients with reported metal sensitivity. Methods: A retrospective review of patients who underwent primary TKA with the ion-bombarded titanium Vanguard (Zimmer Biomet, Warsaw, IN) implant with 2-year minimum follow-up was performed from 2008 through 2017. The query revealed 346 patients (451 knees) with minimum 2-year follow-up. The mean age was 64.7 years, the mean body mass index was 35.1 kg/m 2 , and 95% of patients were women. Results: The mean follow-up was 4.6 years. The mean range of motion improved from 109 to 112 (P ¼ .03), University of California Los Angeles activity scale from 4.1 to 5.1 (P < .001), Knee Society Clinical scores from 36 to 89 (P < .001), and Knee Society Functional scores from 48 to 73 (P < .001). There were 5 (1.1%) revisions: 2 infections (2-staged exchange), 1 tibial revision for aseptic loosening after a fall, and 2 bearing exchanges for instability. Other surgeries were open reduction internal fixation of periprosthetic fracture, 1 arthroscopic release of snapping popliteus, and 4 local wound incision and debridement (2 superficial infections and 2 nonhealing wounds). Manipulation under anesthesia was required in 27 (6%) patients. Conclusions: These early results are encouraging for the use of alternative metal titanium alloy implants in metal-sensitive patients undergoing primary TKA. At 4.6 years of mean follow-up, patients had substantial improvement in the range of motion and clinical outcomes with a low frequency of revision.

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A universal total knee arthroplasty system able to accurately resurface either left or right knees of all shapes and sizes is compelling as there is an increased need for improved efficiency and value. With a modern universal total knee system, a single instrument tray can be utilized for more than 90% of cases and doesn’t require any specific customization or disposable instruments. This streamlined workflow is accomplished with unique instrumentation that features a symmetrical femoral and tibial implant for all patients. Symmetrical tibial implants have been shown to have equivalent outcomes and low complications compared to asymmetric tibial trays. The universal symmetrical femoral implant, with its deepened trochlear groove, allows for optimal patellar tracking and recent studies have demonstrated this symmetrical femoral implant to have comparable femoral rollback and axial rotation to native knees. This efficient instrumentation reduces overall inventory, decreases turnover times, and exposes fewer instruments that may otherwise be susceptible to contamination. All without detriment to the patient outcome or surgeon workflow. Studies have shown clinical scores of the modern universal total knee arthroplasty system are a great value not only to the surgeon but also to the healthcare system as a whole—a necessity in modern healthcare.