Total Knee Arthroplasty in Complex Scenarios

The continued operative success of total knee arthroplasty (TKA) has resulted in the demand for this procedure to grow exponentially over the past decade. The superior clinical and patient-reported outcomes have helped establish TKA as a safe and effective procedure. Therefore, for the millions of patients suffering from knee pain, this procedure can provide an ultimate solution. However, as the safety of the procedure improves, so do the indications, such that more complex scenarios involving more patients are now being performed, with similar expected outcomes.

Therefore, in this Special Focus Section, we focus on patients with complex comorbidities who underwent TKA. Specifically, patients with histories of drug abuse, including opioid, narcotic, and alcohol abuse are addressed. This discussion is very topical and timely, as the United States is currently facing a nationwide opioid epidemic, and postoperative pain management following TKA commonly includes narcotic usage. Also described are institutional International Classification of Diseases, Ninth Revision coding of morbidly obese patients, outcomes of propensity score matched primary hinged TKA patients, as well as patient laboratory values that might influence postoperative wound complications.

As the indications, demand, and success of TKA continues to increase, so does the need to evaluate some of these more complex scenarios. Therefore, this Special Focus Section provides for the readership, an up-to-date analysis of some of these difficult patient subpopulations.