Dr. Samih Tarabichi’s Orthopedic Research & Scientific Publications
Dr. Samih Tarabichi’s scientific work spans several decades of research in total knee arthroplasty, joint reconstruction, implant design, knee biomechanics, revision surgery and postoperative recovery.
His publications examine clinical and technical questions encountered in joint replacement surgery, including deep knee flexion, implant positioning, anatomical variation, soft-tissue balancing, painful knee replacement, periprosthetic fractures, pain management and wound care.
This page brings together Dr. Tarabichi’s scientific publications, book chapters and clinical research, organized by topic to help patients, surgeons and researchers understand the relationship between his clinical practice, scientific work and orthopedic innovation.
Dr Samih Tarabichi Research Focus at a Glance
| Research Area | Main Focus |
|---|---|
| Implant Design & Alignment | Knee morphology, implant geometry, component sizing, tibial coverage, rotational alignment and anatomical fit |
| Surgical Techniques & Knee Reconstruction | Surgical approaches, soft-tissue balancing, ligament management, varus correction and techniques to optimize knee function |
| Deep Flexion & Knee Function | Range of motion, knee kinematics, kneeling, squatting, prayer and other high-flexion activities after knee replacement |
| Revision Knee Replacement & Complications | Painful or failed knee replacement, periprosthetic fractures, component malrotation and considerations relevant to revision surgery |
| Pain Management & Recovery | Postoperative pain control, cryo-neurolysis, patellar management and functional recovery after knee replacement |
| Wound Care & Complications | Wound closure, incision care, blood-loss management, persistent wound drainage and postoperative complication prevention |
Dr Samih Tarabichi Researche
This research area examines how implant design, component positioning, rotation and anatomical variation can influence total knee replacement. Dr. Samih Tarabichi’s studies investigate technical aspects of prosthetic components and their relationship with knee anatomy, alignment, function and postoperative outcomes.
Anatomic Tibial Component Design Can Increase Tibial Coverage and Rotational Alignment Accuracy: A Comparison of Six Contemporary Designs
Research focus: This study evaluated six contemporary tibial component designs—anatomic, asymmetric and symmetric—against a multi-ethnic dataset of 479 tibiae. The researchers assessed how well each design matched proximal tibial anatomy while balancing component coverage, rotational alignment and overhang during total knee arthroplasty.
Key finding: The anatomic design achieved 92% tibial coverage compared with 85–87% for the non-anatomic designs, while also demonstrating better morphological conformity and rotational alignment. Downsizing was required in 3% of cases with the anatomic design versus 39–60% with the other designs when proper rotational alignment was maintained.
Dai Y, Scuderi GR, Bischoff JE, Bertin K, Tarabichi S, Rajgopal A. Knee Surgery, Sports Traumatology, Arthroscopy. 2014;22:2911–2923. DOI: 10.1007/s00167-014-3282-0.
Read the original publication on Springer Nature →
BCR TKA Designs: A Systematic Review of the Literature
Research focus: This review examined the evolution of bicruciate-retaining total knee arthroplasty (BCR-TKA) designs, which preserve both the ACL and PCL. It reviewed historical and contemporary implant designs, their reported clinical limitations, and design challenges associated with maintaining the ACL during total knee replacement.
Key finding: The review found that contemporary BCR implants have addressed several limitations of earlier designs, but important challenges remain, including tibial fixation, implant stability, surgical complexity, ligament balancing and patient selection. The authors concluded that further design improvements are needed before the potential kinematic and proprioceptive advantages of BCR-TKA can be consistently translated into clinical outcomes.
Hybrid BCR-TKA: A Novel Proposed Tibial Design
Research focus: This publication examines the limitations of conventional and existing bicruciate-retaining total knee arthroplasty designs, particularly the challenges associated with preserving both the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). It proposes a hybrid tibial component design intended to combine cruciate preservation with improved implant fixation and stability.
Key clinical perspective: The proposed design aims to preserve both cruciate ligaments and thereby support more physiological knee kinematics and proprioception, while addressing technical concerns associated with traditional BCR tibial components. The publication presents the concept as a potential design direction rather than evidence of proven superior clinical outcomes; further clinical evaluation would be required to establish its effectiveness.
Posterolateral Overhang Affects Patient Quality of Life After Total Knee Arthroplasty
Research focus: This retrospective study evaluated 146 total knee arthroplasties to investigate posterolateral overhang of the tibial component, its relationship with rotational alignment, and its effect on residual knee pain and functional outcomes. Postoperative CT measurements were correlated with clinical outcomes at three years.
Key finding: Posterolateral tibial component overhang was identified in 111 patients (76%), while posterolateral pain was reported in 76 patients (52.1%). Patients with overhang had significantly worse KSS, KSS-F and WOMAC pain scores than those without overhang. The mean overhang was 3.6 ± 2.0 mm in patients with posterolateral pain, compared with 0.02 ± 3.4 mm in those without pain. The study concluded that posterolateral overhang can negatively affect clinical outcomes after TKA and that external rotation may increase the risk of posterolateral oversizing.
Simsek ME, Akkaya M, Gursoy S, Isik C, Zahar A, Tarabichi S, Bozkurt M. Archives of Orthopaedic and Trauma Surgery. 2018;138(3):409–418. DOI: 10.1007/s00402-017-2850-4.
Read the original publication on PubMed →
Special Considerations in Asian Knee Arthroplasty
Research focus: This book chapter reviews anatomical, morphological and biomechanical variations in Asian and Middle Eastern knees that may be relevant to total knee arthroplasty. It examines differences in distal femoral and proximal tibial morphology, component sizing, tibial slope, knee alignment and kinematics, alongside the functional requirements of these patient populations.
Key clinical perspective: The authors highlight that knee morphology and kinematics can vary across populations and that implants developed primarily from Caucasian anatomical datasets may not always provide optimal anatomical matching in Asian patients. The chapter emphasizes considering patient anatomy, component sizing and coverage, rotational positioning and functional requirements when planning TKA rather than assuming a single implant geometry is equally suitable across populations.
Hosseinzadeh HRS, Tarabichi S, Shahi AS, Hassas Yeganeh M, Saleh UH, Kazemian GR, Masoudi A. Special Considerations in Asian Knee Arthroplasty. In: Arthroplasty – Update. IntechOpen. 2013. DOI: 10.5772/53595.
Read the original book chapter on IntechOpen →
The Biomechanics of the Knee Joint
Research focus: This chapter examines the fundamental biomechanics of the knee, including articular cartilage mechanics, ligament and tendon behavior, knee kinematics, joint stability, tibiofemoral and patellofemoral forces, and mechanical loading. It explains how these interacting structures allow the natural knee to balance mobility and stability under substantial mechanical demands.
Key clinical perspective: The chapter highlights the complexity of reproducing natural knee mechanics with an artificial joint. Normal knee function depends on coordinated rotation, translation, ligament constraint, joint contact and load distribution, meaning that knee replacement design must consider more than simply replacing damaged joint surfaces. The authors discuss how biomechanical understanding contributes to the development and evaluation of existing and emerging implant designs.
Tarabichi S, Theobald P, Elfekky M. The Biomechanics of the Knee Joint. In: Bozkurt M, Açar HI, eds. Clinical Anatomy of the Knee: An Atlas. Springer International Publishing; 2021:355–362. DOI: 10.1007/978-3-030-57578-6_23.
Read the original chapter on Springer →
Morphometric Analysis of the Knee: A Comprehensive Evaluation of Knee Morphology in Designing Arthroplasties of Knee
Research focus: This chapter reviews knee morphology and morphometric assessment of the femur, tibia and patella, including implant sizing, bone coverage, component overhang, rotational alignment and anatomical variation. It examines both intraoperative measurements and computational imaging methods used to understand knee anatomy for arthroplasty design.
Key clinical perspective: The authors emphasize that appropriate implant fit requires balancing bone coverage, component size and rotational alignment. Excessive overhang—commonly discussed at a threshold of around 3 mm—is associated with soft-tissue impingement, pain and poorer outcomes, while simply downsizing an implant can reduce bone coverage. The chapter therefore highlights anatomical implant design and understanding variations in knee morphology across sexes and ethnic populations as important considerations in knee arthroplasty.
Tarabichi S, Elfekky M. Morphometric Analysis of the Knee: A Comprehensive Evaluation of Knee Morphology in Designing Arthroplasties of Knee. In: Bozkurt M, Açar HI, eds. Clinical Anatomy of the Knee: An Atlas. Springer International Publishing; 2021:341–353. DOI: 10.1007/978-3-030-57578-6_22.
Dr. Samih Tarabichi’s research on surgical technique examines methods used during total knee arthroplasty and complex knee reconstruction. These studies address areas such as soft-tissue management, surgical exposure, balancing and techniques intended to optimize range of motion and functional reconstruction of the knee.
Posterior Cruciate Ligament Substituting Total Knee Arthroplasty: Considerations in the Middle East
Research focus: This book chapter examines total knee arthroplasty in Middle Eastern patients, focusing on population-specific anatomical characteristics, functional requirements, deformity patterns and posterior cruciate ligament considerations that may influence implant selection and surgical technique.
Key clinical perspective: The authors discuss why posterior-stabilized knee designs may be particularly relevant in Middle Eastern patients, including the high-flexion requirements of daily activities and the presence of flexion-varus deformities in which the posterior cruciate ligament may become contracted or dysfunctional. The chapter emphasizes adapting TKA planning and technique to the patient’s anatomy and functional requirements rather than applying a uniform approach across populations.
Tarabichi S, Tarabichi M. Posterior Cruciate Ligament Substituting Total Knee Arthroplasty: Considerations in the Middle East. In: Insall & Scott Surgery of the Knee. 6th ed. Chapter 141, Volume II. Elsevier.
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Can an Anterior Quadriceps Release Improve Range of Motion in the Stiff Arthritic Knee?
Research focus: This study evaluated whether adhesions tethering the quadriceps contribute to restricted knee flexion in patients with advanced osteoarthritis. The researchers performed 42 modified quadriceps releases in 24 patients scheduled for total knee arthroplasty and measured range of motion immediately before and after the release, before other surgical interventions were performed.
Key finding: Knee range of motion improved significantly in all patients following the modified quadriceps release, with an average improvement of approximately 34° and an average post-release range of motion of 137°. The findings supported the authors’ hypothesis that quadriceps adhesions restricting normal tendon excursion can be an important contributor to limited deep flexion in stiff arthritic knees.
Tarabichi S, Tarabichi Y. The Journal of Arthroplasty. 2010;25(4):571–575. DOI: 10.1016/j.arth.2009.04.015.
Read the original publication on PubMed →
Primary Repair of Iatrogenic Medial Collateral Ligament Injury During TKA: A Modified Technique
Research focus: This retrospective study evaluated the prevalence of iatrogenic MCL injury during primary total knee arthroplasty and the outcomes of repairing mid-substance MCL tears using primary repair with synthetic ligament augmentation, without switching to a constrained knee implant. The series reviewed 3,432 TKAs.
Key finding: Intraoperative MCL tears occurred in 15 of 3,432 TKAs (0.43%). Among the patients treated with the described repair technique, none demonstrated subjective or objective coronal-plane instability during follow-up, and none required revision arthroplasty. The authors concluded that primary repair with augmentation may represent an alternative to constrained implants in selected cases, while noting that further investigation was warranted.
Shahi A, Tan TL, Tarabichi S, Maher A, Della Valle C, Saleh UH. The Journal of Arthroplasty. 2015. DOI: 10.1016/j.arth.2014.12.020.
Read the original publication via DOI →
Soft Tissue Release for Varus Knees during Posterior Stabilized Total Knee Arthroplasty: A New Algorithm
Research focus: This study evaluated a five-step soft-tissue release algorithm for varus osteoarthritic knees undergoing primary total knee arthroplasty. It included 105 knees with fixed varus deformities ranging from 10° to 40° and investigated whether appropriate intraoperative gap balancing could be achieved without releasing the superficial MCL.
Key finding: All 105 knees were successfully balanced without releasing the superficial MCL. Thirty-one cases required release through step 2, 35 through step 3, 25 through step 4, and 14 required the complete sequence through step 5. The authors concluded that preserving the superficial MCL can maintain knee stability and avoid increasing implant constraint, including in severe varus deformities.
Elkabbani M, Youssef K, Ragab M, Ibrahim O, Osman A, Dragos A, Tarabichi S. Journal of Orthopaedic Science and Research. 2022;3(1):1–9. DOI: 10.46889/JOSR.2022.3103.
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Operative Procedure for Primary TKR: How to Increase ROM
Research focus: This book chapter examines factors affecting range of motion after total knee replacement, including preoperative ROM, implant design, surgical technique, pain management and rehabilitation, with particular emphasis on a modified anterior quadriceps release designed to address adhesions that may restrict deep knee flexion.
Key clinical perspective: The authors describe a stepwise quadriceps-release technique performed before bone cuts, progressing until intraoperative ROM exceeds 130° when achievable. The chapter cites their earlier series of 42 modified quadriceps releases, in which passive flexion improved by an average of 32.4° immediately after release, supporting their view that quadriceps adhesions can substantially restrict flexion in stiff arthritic knees.
Tarabichi S, El-Naggar A, Adi M. Operative Procedure for Primary TKR: How to Increase ROM. In: Matsuda S, et al., eds. Soft Tissue Balancing in Total Knee Arthroplasty. Springer; 2017:139–149. DOI: 10.1007/978-3-662-54082-4_12.
Read the original chapter on Springer→
Subvastus Approach Improves Intraoperative Patellofemoral Tracking in Total Knee Arthroplasty for Varus Deformities – An In Vivo Study
Research focus: This study evaluated patellofemoral tracking in 54 consecutive patients with advanced varus knee osteoarthritis undergoing cemented posterior-stabilized total knee replacement through a subvastus approach. Intraoperative tracking was assessed throughout knee range of motion using the No Thumb Test and Vertical Patella Test, with particular attention to whether lateral retinacular release was required.
Key finding: Both patellar-tracking tests were negative in all 54 patients, with no intraoperative patellar dislocation or subluxation, and none of the patients required lateral retinacular release. The authors concluded that preserving the vastus medialis oblique attachment to the patella through the subvastus approach may improve intraoperative patellofemoral tracking and reduce the need for lateral retinacular release.
Elkabbani M, Adi M, Osman A, Khater A, Tarabichi S, Zaghloul A. Journal of Musculoskeletal Surgery and Research. 2024;8(4):368–374. DOI: 10.25259/JMSR_170_2024.
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Evaluation of the Pathological Anatomy of Posteromedial Corner in Varus Osteoarthritic Knees Using Magnetic Resonance Imaging
Research focus: This study used MRI to compare the posteromedial structures of 26 patients with severe varus osteoarthritic knees (Kellgren-Lawrence grade 4) scheduled for TKA with 10 patients without knee arthritis. The researchers specifically assessed the superficial medial collateral ligament (sMCL) and posteromedial corner to better understand the anatomical changes associated with severe varus deformity.
Key finding: In all severely varus arthritic knees, the sMCL was displaced medially and posteriorly, while the posteromedial corner showed significantly increased thickness and heterogeneous changes consistent with scarring. The authors proposed that the apparent tightness of the sMCL may result from retraction by scarred posteromedial tissues rather than simple ligament shortening. This finding supports a soft-tissue balancing strategy that frees the sMCL from surrounding pathological tissue rather than routinely releasing it, potentially helping preserve knee stability.
Elkabbani M, Osman A, Khater AM, Helaly M, Tarabichi S. Journal of Arthroscopy and Joint Surgery. 2021;8(2):116–121. DOI: 10.1016/j.jajs.2021.02.004.
Dr. Samih Tarabichi’s research on deep knee flexion examines knee biomechanics, range of motion and functional movement during activities such as kneeling, squatting, prayer and sitting cross-legged. These studies explore how knee replacement design and surgical techniques relate to functional movement and high-flexion activities.
Knee Kinematics of High-Flexion Activities of Daily Living Performed by Male Muslims in the Middle East.
Research focus: This study examined three-dimensional knee movement during high-flexion activities including kneeling, Muslim prayer, cross-legged sitting and squatting, comparing normal knees with patients who had undergone high-flexion total knee arthroplasty.
Key finding: During kneeling, average maximum knee flexion reached 141.6° in the normal group and 140.2° in the TKA group. The research provides biomechanical evidence about the knee-flexion requirements of activities that are particularly relevant to Middle Eastern populations.
Acker SM, Cockburn RA, Krevolin J, Li RM, Tarabichi S, Wyss UP. The Journal of Arthroplasty. 2011;26(2):319–327. DOI: 10.1016/j.arth.2010.08.003.
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Achieving Deep Flexion After Primary Total Knee Arthroplasty
Research focus: This prospective study evaluated the minimum 5-year clinical and radiographic outcomes of a high-flexion total knee arthroplasty system in Asian and Middle Eastern patients, with particular attention to achieving deep knee flexion required for daily and religious activities. The study included 218 knee replacements in 125 patients.
Key finding: At five years, average knee flexion was 140° ± 11.5°, and 103 knees (68%) achieved flexion greater than 140°. The researchers reported no differences in patellofemoral pain, complications or Knee Society scores despite an overall increase in flexion and function in the study population.
Tarabichi S, Tarabichi Y, Hawari M. The Journal of Arthroplasty. 2010;25(2):219–224. DOI: 10.1016/j.arth.2008.11.013.
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Excellent vs. Good Range of Motion after TKA, What Makes the Difference?
Research focus: This study investigated surgical and radiographic factors associated with postoperative range of motion after total knee arthroplasty. The researchers reviewed 227 TKAs in 132 patients, comparing knees with excellent flexion of 130° or more against those achieving 110°–129°.
Key finding: The study found significant differences in joint-line-to-fibular-head distance and the patellar-length-to-joint-line/tibial-tubercle ratio between the excellent- and good-ROM groups. The authors concluded that better postoperative range of motion was associated with controlling these measurements, while several other radiographic parameters could vary without significantly affecting ROM.
Alrefaee A, Tarabichi S, Alfeqqy M, Apostu D. Open Access Journal of Surgery. 2017;2(2):555581. DOI: 10.19080/OAJS.2017.02.555581.
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Importance of Full Flexion After Total Knee Replacement in Muslims’ Daily Lifestyle
Research focus: This study examined the importance of deep knee flexion after total knee replacement in Muslim patients whose daily activities may involve prayer, kneeling, sitting on the floor and other ground-level activities. The clinical series evaluated patients receiving an LPS Flex mobile-bearing knee implant designed to accommodate higher degrees of flexion.
Key finding: At two-year follow-up, 78.1% of evaluated cases achieved the study’s definition of full flexion, defined as active flexion beyond 140° together with the ability to kneel with the calf contacting the thigh for at least one minute. Average maximum range of motion increased from 129.6° preoperatively to approximately 140° at three months. The authors emphasized that conventional knee scores may not fully capture functional improvements associated with deep flexion.
Tarabichi S, Tarabichi Y, Tarabishy AR, Hawari M. Journal of the Islamic Medical Association of North America. 2006;38(1). DOI: 10.5915/38-1-5292.
Dr. Samih Tarabichi’s research in revision knee replacement investigates failed knee arthroplasty, implant-related complications, periprosthetic fractures and complex reconstruction. These studies examine causes of failure and diagnostic or surgical considerations relevant to patients
requiring further assessment or revision after previous knee replacement.
A Unique Pattern of Peri-Prosthetic Fracture Following Total Knee Arthroplasty: The Insufficiency Fracture
Research focus: This retrospective study investigated a distinctive lateral femoral condyle compression fracture occurring after primary total knee arthroplasty. The researchers reviewed 5,864 primary TKAs to describe the fracture pattern, estimate its incidence, identify potential risk factors and examine how it could be diagnosed.
Key finding: Among 5,864 primary TKAs, 56 periprosthetic fractures (0.9%) were identified, of which 15 (26.8%) showed this isolated compression-fracture pattern. Patients affected by the insufficiency fracture demonstrated poor bone quality and marked preoperative varus deformity. The study also highlighted that the fracture could be difficult to identify on routine radiographs and may require additional imaging when clinical suspicion remains high.
Shahi A, Saleh UH, Tan TL, Elfekky M, Tarabichi S. The Journal of Arthroplasty. 2015;30(6):1054–1057. DOI: 10.1016/j.arth.2015.01.006.
Read the original publication →
Evaluation of Tibial Component Rotation in Painful Total Knee Arthroplasties by MRI Enhanced with Metal Artifact Reduction Technique
Research focus: This study evaluated whether MRI with metal artifact reduction techniques could assess tibial component rotation in patients with persistent moderate-to-severe unexplained pain for at least six months after total knee replacement. Fifteen patients were evaluated after infection and implant loosening had been excluded.
Key finding: 11 of 15 patients (73.3%) showed internal rotation of the tibial component. Of the four patients without tibial internal malrotation, MRI identified abnormal intra-articular fibrous bands in two. The authors concluded that tibial component internal rotation should be considered when investigating persistent pain after TKA and that metal-artifact-reduction MRI can be useful in evaluating otherwise unexplained painful knee replacements.
Elkabbani M, Osman A, Helaly M, Tarabichi S. Journal of Musculoskeletal Research. 2021;24:2150012. DOI: 10.1142/S0218957721500123.
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Posterior Stabilized Total Knee Arthroplasty Increases the Risk of Postoperative Periprosthetic Fractures
Research focus: This retrospective study compared the incidence of early postoperative periprosthetic fractures between cruciate-retaining and posterior-stabilized total knee arthroplasty. Researchers evaluated 600 primary TKAs: 300 CR and 300 PS knees, examining whether implant design was associated with fracture risk.
Key finding: Eleven postoperative periprosthetic fractures occurred (1.83%): 10 in the PS group and one in the CR group. All fractures involved the femur and required surgical treatment. In this selected study population of obese Asian patients, the authors concluded that posterior-stabilized TKA was associated with a significantly higher risk of periprosthetic fracture than cruciate-retaining TKA.
Elkabbani M, Haidar F, Osman A, Adie Y, Dragos A, Tarabichi S. Journal of Orthopaedics, Trauma and Rehabilitation. 2022;29:1–8. DOI: 10.1177/22104917221082317.
Read the original publication on SAGE Journals →
Does Metal Allergy to Total Knee Arthroplasty Components Exist?
Research focus: This consensus publication reviews the clinical evidence surrounding metal hypersensitivity after total knee arthroplasty, including reported metal allergy, diagnostic testing, implant performance and whether suspected hypersensitivity should influence decisions about revision surgery.
Key clinical perspective: The authors concluded that although hypersensitivity-related complications after joint arthroplasty likely exist, implant failure caused by metal allergy appears to be very rare. Routine metal-allergy testing is not recommended because positive tests correlate poorly with implant failure. Revision TKA for suspected metal hypersensitivity should therefore be considered only after other causes of symptoms or implant failure have been excluded. The recommendation was graded as moderate-level evidence, with 75.2% expert agreement.
Mortazavi SMJ, Antoci V, Hosseini-Monfared P, Razzaghof M, Tsiridis E, Tarabichi S, Tsai SW, Smailys A, Socorro NEM, Gavrankapetanovic I. The Journal of Arthroplasty. 2025;40(2 Suppl 1):S113–S114. DOI: 10.1016/j.arth.2024.10.068.
This research focuses on strategies designed to improve pain control and postoperative recovery after total knee replacement. The studies examine approaches to managing postoperative discomfort, reducing reliance on opioid medications and supporting earlier rehabilitation and functional recovery following surgery.
Enhanced Pain Management in Total Knee Arthroplasty: A Retrospective Analysis on Intraoperative Cryo-Neurolysis
Research focus: This retrospective cohort study evaluated 34 patients undergoing primary total knee arthroplasty with intraoperative cryo-neurolysis, assessing postoperative pain over six months as well as opioid use and recovery-related outcomes. Cryo-neurolysis was performed intraoperatively after implantation, targeting selected genicular and anterior femoral cutaneous nerves.
Key finding: Median pain scores decreased from VAS 2 on postoperative Day 1 to VAS 0 by Month 3, with all patients in the cohort reaching complete pain resolution by Month 6. The median time to VAS 0 was 90 days. However, opioid-use data were inconsistently recorded, preventing firm conclusions about reductions in opioid consumption, and the authors called for randomized trials to validate the findings.
Tarabichi S, Elfekky M, Alsultan A, Adi MM, Aburezeq MNAA, Rajaeirad M. Journal of Orthopaedic Experience & Innovation. 2025. DOI: 10.60118/001c.136350.
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Befit Patelloplasty in TKA: A Targeted Approach to Improve Pain and Function
Research focus: This retrospective observational study evaluated early outcomes following patelloplasty during primary total knee arthroplasty, focusing on anterior knee pain, range of motion, unaided walking, stair climbing and the need for manipulation under anesthesia. The cohort included 408 patients and 727 knees, with outcomes assessed at three and six months.
Key finding: Anterior knee pain decreased from 8.8% at three months to 2.7% at six months. At six months, 86.0% of knees achieved ≥110° flexion, 77.9% of patients walked unaided and 72.1% could climb stairs. Manipulation under anesthesia was required in 3.2% of cases. Because the study had no comparator group, the authors appropriately concluded that patelloplasty was associated with favorable early outcomes rather than establishing that it caused them.
Tarabichi S, Elfekky M, Ben’Musbah MS, Abuhalguma S, Zaidan HM, Rajaeirad M, Abdel Wahab MM, Elgassi MM. Journal of Orthopaedic Experience & Innovation. 2025;6(2). DOI: 10.60118/001c.141826.
This research area examines perioperative factors that can influence recovery after joint replacement, including wound management, blood loss, drainage and postoperative complications. The studies evaluate clinical approaches intended to support wound healing, reduce surgical complications and improve postoperative management following arthroplasty.
Comparing the Effect of Tourniquet vs Tourniquet-Less in Simultaneous Bilateral Total Knee Arthroplasties
Research focus: This randomized controlled study compared two tourniquet strategies in 54 patients undergoing 108 simultaneous bilateral total knee arthroplasties. One knee used a tourniquet throughout the procedure, while the contralateral knee used it only during implant cementation. The researchers evaluated blood loss, implant alignment, swelling, pain, range of motion and early postoperative complications.
Key finding: Total blood loss was almost twice as high when the tourniquet was used only during cementation. However, the study found no significant differences between the groups in implant alignment, soft-tissue swelling, pain, range of motion or other early postoperative complications. The authors concluded that full-procedure tourniquet use reduced total blood loss without increasing the early complications measured in this study.
Hasanain MS, Apostu D, Alrefaee A, Tarabichi S. The Journal of Arthroplasty. 2018;33(7):2119–2124. DOI: 10.1016/j.arth.2018.02.013.
Read the original publication in The Journal of Arthroplasty →
Hip and Knee Section, Prevention, Surgical Technique: Proceedings of International Consensus on Orthopedic Infections
Research focus: This international consensus paper evaluated surgical factors that may influence infection risk in hip and knee arthroplasty, including tourniquet use during TKA, surgical approach in knee and hip replacement, periarticular injections, and simultaneous versus staged bilateral arthroplasty. Recommendations were developed from available evidence and expert delegate voting.
Key finding: The consensus found that evidence linking tourniquet use with SSI/PJI remained inconclusive, recommending that tourniquet time and pressure be minimized. It also concluded that the choice between parapatellar and subvastus approaches in primary TKA did not influence SSI/PJI incidence, based on moderate evidence and 97% delegate agreement. For primary THA, the consensus similarly found that surgical approach did not affect subsequent SSI/PJI incidence, supported by strong evidence.
Balato G, Barbaric K, Bićanić G, Bini S, Chen J, Crnogaca K, et al., including Majd Tarabichi and Samih Tarabichi. The Journal of Arthroplasty. 2019;34:S301–S307. DOI: 10.1016/j.arth.2018.09.015.
Read the original publication via DOI→
Incision Care and Dressing Selection in Surgical Wounds: Findings from an International Meeting of Surgeons
Research focus: This international expert meeting examined post-surgical incision care, dressing selection and dressing-change protocols, with particular attention to undisturbed wound healing, contamination and infection risk, patient-specific factors, and criteria indicating when a surgical dressing should be changed.
Key clinical perspective: The expert group supported greater consideration of undisturbed wound healing rather than routine dressing changes at predetermined intervals. Dressing changes should be driven by clinical need, with agreed triggers including dressing saturation, excessive bleeding, suspected local or systemic infection, and potential wound dehiscence. Patient characteristics, infection risk and individual circumstances should also guide dressing selection and management.
Morgan-Jones R, Bishay M, Hernández-Hermoso JA, Lantis JC, Murray J, Pajamaki J, Pellegrini A, Tarabichi S, Willy C. Wounds International. 2019.
Read the original consensus report →
From Incision to Recovery: Advances and Challenges in Wound Closure After Total Knee Arthroplasty
Research focus: This narrative review evaluates current wound closure and postoperative wound-management strategies after total knee arthroplasty, including conventional and barbed sutures, staples, tissue adhesives, hybrid closure techniques and negative-pressure wound therapy. It also examines biomechanical factors affecting healing and emerging technologies such as smart dressings and AI-assisted wound monitoring.
Key clinical perspective: The review concludes that no single wound-closure technique is universally optimal for TKA. Barbed sutures may improve closure efficiency, tissue adhesives can offer cosmetic advantages but have limitations in high-tension areas, and hybrid approaches may combine mechanical strength with improved cosmesis. Emerging technologies show potential, but standardized protocols and longer-term validation are still needed. The authors emphasize individualized wound-closure strategies that consider mechanical stability, biological compatibility and patient-specific factors.
Tarabichi S, Elfekky M, Rajaeirad M, Ahmed EM, Elsayed MAHA, Shalaby EM, Al Haroun MA, Aidek S, Bagheri F, Esmaeili H. Journal of Orthopaedic Experience & Innovation. 2026;7(1). DOI: 10.60118/001c.146307.
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Persistent Wound Drainage Among Total Joint Arthroplasty Patients Receiving Aspirin vs Coumadin
Research focus: This retrospective multi-institutional study evaluated 5,516 primary total hip and knee arthroplasties to compare persistent wound drainage in patients receiving aspirin (ASA) versus Coumadin for postoperative venous thromboembolism prophylaxis. The study also compared 30-day VTE and six-month periprosthetic joint infection rates and investigated independent risk factors for persistent wound drainage.
Key finding: Persistent wound drainage occurred significantly less often in patients receiving aspirin than in those receiving Coumadin (3.2% vs 8.5%, P < .0001). Meanwhile, 30-day VTE rates were comparable (1.3% vs 1.4%), as were six-month PJI rates (1.8% vs 1.4%). Multivariate analysis also identified Coumadin as an independent risk factor for persistent wound drainage.
Singh V, Shahi A, Saleh U, Tarabichi S, Oliashirazi A. The Journal of Arthroplasty. 2020;35(12):3743–3746. DOI: 10.1016/j.arth.2020.07.004.
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Tranexamic Acid to Reduce Blood Loss After Bilateral Total Knee Arthroplasty
Research focus: This prospective randomized study evaluated the effect of two intravenous tranexamic acid dosing regimens—10 mg/kg and 15 mg/kg—compared with saline placebo in 60 patients undergoing simultaneous bilateral total knee arthroplasty. The researchers assessed postoperative blood loss and transfusion requirements alongside an autologous reinfusion strategy.
Key finding: Mean blood loss was 462 mL in the 15 mg/kg group, 678 mL in the 10 mg/kg group, and 918 mL in the control group. Both TXA groups required significantly less combined autologous and allogeneic transfusion than controls. With the autologous reinfusion strategy used in this study, the authors concluded that the lower 10 mg/kg dose was sufficient to reduce allogeneic transfusion requirements.
MacGillivray RG, Tarabichi SB, Hawari MF, Raoof NT. The Journal of Arthroplasty. 2011;26(1):24–28. DOI: 10.1016/j.arth.2009.11.013.
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