Journal of Joint Surgery and Research最新文献

Chronological changes in lower leg swelling up to one year after total knee arthroplasty: A prospective case series 全膝关节置换术后一年内下肢肿胀的时间变化：前瞻性病例系列

Journal of Joint Surgery and Research

Pub Date : 2025-12-11 DOI: 10.1016/j.jjoisr.2025.10.004

Kohei Nishitani , Shinichi Kuriyama , Shinichiro Nakamura , Hiromu Ito , Shuichi Matsuda

Purpose

Lower leg swelling is a common complication following total knee arthroplasty (TKA). However, the long-term natural course of post-operative swelling remains unclear. This study aimed to evaluate chronological changes in calf circumference and to identify swelling patterns after TKA.

Methods

Patients with osteoarthritis who underwent unilateral TKA between 2020 and 2021 were included. Calf circumference on the operated side was measured on the day of surgery, at discharge (2–3 weeks post-operatively), and at 1.5, 3, 6, and 12 months after surgery. The minimum detectable change (MDC) of calf circumference was calculated to define a detectable change in swelling. Chronological changes were analyzed using Friedman's test, and factors associated with increased calf circumference were evaluated using multiple linear regression.

Results

A total of 104 patients (mean age 76.2 years) were enrolled. The MDC was calculated as 1.59 cm. The median calf circumference increased significantly at 1.5 months post-operatively (31.0 cm) compared with the pre-operative value (30.0 cm), then gradually decreased to baseline level. A detectable increase in swelling was observed in 31% of patients at 1.5 months. A greater increase in calf circumference at 1.5 months was associated with lower pre-operative calf circumference (β = −0.35; p < 0.001) and higher body mass index (β = 0.14; p = 0.02).

Conclusions

Calf circumference increased significantly at 1.5 months after TKA, and one-third of patients showed a detectable increase in swelling. These findings help clarify the time course of lower leg swelling and may guide patient education and post-operative monitoring.

目的：下肢肿胀是全膝关节置换术（TKA）后常见的并发症。然而，术后肿胀的长期自然过程仍不清楚。这项研究旨在评估小腿围的时间变化，并确定TKA后的肿胀模式。方法纳入2020年至2021年期间接受单侧TKA的骨关节炎患者。在手术当天、出院时（术后2-3周）以及术后1.5、3、6和12个月测量手术侧小腿围。计算小腿围的最小可检测变化（MDC）来定义肿胀的可检测变化。使用Friedman’s检验分析时间变化，并使用多元线性回归评估与小腿围增加相关的因素。结果共纳入104例患者，平均年龄76.2岁。MDC计算为1.59厘米。与术前（30.0 cm）相比，术后1.5个月中位小腿围明显增加（31.0 cm），然后逐渐下降到基线水平。在1.5个月时，31%的患者肿胀明显增加。1.5个月时小腿围增加较多，术前小腿围较低（β = - 0.35; p < 0.001），体重指数较高（β = 0.14; p = 0.02）。结论TKA术后1.5个月皮肤周长明显增加，1 / 3患者肿胀明显增加。这些发现有助于明确下肢肿胀的时间过程，并可指导患者教育和术后监测。

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引用次数: 0

Dual-mobility constructs or large femoral head bearings in revision total hip arthroplasty? 双活动装置或大股骨头轴承翻修全髋关节置换术？

Journal of Joint Surgery and Research

Pub Date : 2025-12-08 DOI: 10.1016/j.jjoisr.2025.10.001

Mohamad B. Adada, Stephen M. Lancia Jr, Jesus M. Villa, Carlos A. Higuera-Rueda

Purpose

Dislocation remains a leading cause of failure following revision total hip arthroplasty (rTHA). Dual-mobility cups (DMCs) and large femoral heads (LFHs) have been employed to mitigate this risk, yet the comparative effectiveness remains debated. This systematic literature review aimed to compare dislocation, re-revision, and complication rates between DMC and LFH constructs in rTHA.

Methods

This review followed PRISMA guidelines. A systematic search of Scopus, PubMed, and Embase databases yielded 2970 records. After screening using Covidence and removal of duplicates, 35 full texts were reviewed, and 9 studies met the inclusion criteria. Studies included patients undergoing rTHA with either DMC or LFH constructs and reporting on dislocation, re-revision, or related complications. Relative risk (RR), absolute risk reduction (ARR), and number needed to treat (NNT) for outcomes of interest were calculated.

Results

Nine comparative studies encompassing 3095 rTHAs (1204 DMCs and 1891 LFHs ≥36 mm) met the inclusion criteria. Post-operative dislocation occurred in 17 of 437 DMC hips (3.9%) and 54 of 711 LFH hips (7.6%), yielding a RR of 0.51 (49% reduction when DMC is used) and an ARR of 3.7% (NNT 27). Re-revision for any cause was also lower with DMCs (6.3% vs. 9.2%; ARR 2.9%), driven mainly by fewer re-revisions for instability (3.1% vs. 6.2%; ARR 3.1%).

Conclusions

In rTHA, DMCs offer a potential reduction in dislocation and re-revision risk compared with LFHs, particularly in high-risk patients. While cost-effectiveness and survivorship analyses support DMC use, well-powered randomized controlled trials with long-term data are warranted.

目的脱位仍然是翻修型全髋关节置换术（rTHA）失败的主要原因。双活动杯（DMCs）和大股骨头（LFHs）已被用于减轻这种风险，但其相对有效性仍存在争议。本系统的文献综述旨在比较DMC和LFH结构在rTHA中的脱位、重新翻修和并发症发生率。方法本综述遵循PRISMA指南。对Scopus、PubMed和Embase数据库的系统搜索产生了2970条记录。在使用covid进行筛选并去除重复项后，审查了35篇全文，其中9项研究符合纳入标准。研究包括采用DMC或LFH结构进行rTHA的患者，并报告脱位、重新翻修或相关并发症。计算相关结果的相对危险度（RR）、绝对危险度降低（ARR）和需要治疗的次数（NNT）。结果9项比较研究共纳入3095例rtha(1204例dmc和1891例LFHs≥36 mm)，符合纳入标准。437例DMC髋关节中有17例（3.9%）发生术后脱位，711例LFH髋关节中有54例（7.6%）发生术后脱位，RR为0.51（使用DMC时降低49%），ARR为3.7% （NNT 27）。DMCs的任何原因的重新修订也较低（6.3%对9.2%;ARR 2.9%），主要是由于不稳定的重新修订较少（3.1%对6.2%;ARR 3.1%）。结论在rTHA中，与LFHs相比，DMCs具有潜在的降低脱位和再翻修风险的能力，特别是在高危患者中。虽然成本效益和生存分析支持DMC的使用，但需要有长期数据的随机对照试验。

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引用次数: 0

Understanding the development of and theory behind the Coronal Plane Alignment of the Knee classification: Important concepts for contemporary total knee arthroplasty 了解膝关节冠状面排列分类的发展和理论：当代全膝关节置换术的重要概念

Journal of Joint Surgery and Research

Pub Date : 2025-12-08 DOI: 10.1016/j.jjoisr.2025.11.002

Samuel MacDessi

The Coronal Plane Alignment of the Knee (CPAK) classification provides a standardized framework for characterizing constitutional knee alignment and joint line obliquity, independent of arthritic deformity. Conceptualized and validated in both healthy and osteoarthritic populations, the CPAK matrix integrates the arithmetic hip–knee–ankle angle and joint line obliquity to define nine coronal phenotypes. Since its introduction, CPAK has been instrumental in advancing personalized alignment strategies in total knee arthroplasty by informing surgical planning, imaging protocols, and global phenotype mapping. This review outlines the theoretical basis, geographic and sex-based differences, and clinical applications of CPAK, emphasizing its role in refining patient-specific alignment philosophies.

膝关节冠状面对中（CPAK）分类提供了一个标准的框架来表征体质性膝关节对中和关节线倾角，独立于关节炎畸形。在健康人群和骨关节炎人群中概念化和验证，CPAK矩阵整合了算术髋关节-膝关节-踝关节角度和关节线倾角来定义九种冠状表型。自推出以来，CPAK通过告知手术计划、成像协议和全球表型图谱，在推进全膝关节置换术的个性化对齐策略方面发挥了重要作用。这篇综述概述了CPAK的理论基础、地理和性别差异以及临床应用，强调了其在完善患者特异性对齐哲学中的作用。

引用次数: 0

Relationship between intra-operative rotational knee kinematics and clinical outcomes in mechanically aligned bicruciate stabilized total knee arthroplasty 机械对准双交叉稳定全膝关节置换术中膝关节旋转运动学与临床结果的关系

Journal of Joint Surgery and Research

Pub Date : 2025-12-04 DOI: 10.1016/j.jjoisr.2025.11.003

Yohei Naito, Gai Kobayashi, Shine Tone, Masahiro Hasegawa

Purpose

The aim of this study was to investigate the relationship between intra-operative rotational knee kinematics and clinical outcomes in mechanically aligned bicruciate stabilized (BCS) total knee arthroplasty (TKA). The impact of pre-to post-operative changes in tibial rotation on intra-operative rotational kinematics was also examined.

Methods

A total of 117 primary cemented mechanically aligned BCS TKAs were performed using the CORI robotic system for patients with varus osteoarthritis. Tibial internal rotation was measured intra-operatively after implantation from 0° extension to 30°, 60°, 90°, and 120° flexion. The difference in tibial rotation between the pre-operative maximal extension and post-operative 0° extension was also recorded. Correlations between tibial rotation during knee flexion and clinical outcomes, including range of motion (ROM), 2011 Knee Society Score (2011 KSS), and Forgotten Joint Score-12 (FJS-12), at 6 weeks, 3 months, and 6 months were analyzed. Correlations between pre-to post-operative tibial rotational changes and tibial rotation during flexion were also assessed.

Results

Significant tibial internal rotation was observed throughout flexion. Tibial internal rotation correlated positively with ROM, 2011 KSS, and FJS-12 at 6 weeks and 3 months, but not at 6 months. A significant negative correlation was found between the increase in tibial internal rotation at post-operative 0° extension relative to the pre-operative maximal extension and the amount of tibial internal rotation during flexion.

Conclusion

Tibial internal rotation during flexion correlated positively with early outcomes, but this was not sustained at 6 months. An increase in tibial internal rotation at 0° extension compared with the pre-operative maximal extension negatively affected rotational kinematics.

目的本研究的目的是探讨机械对齐双十字稳定（BCS）全膝关节置换术（TKA）中术中膝关节旋转运动学与临床结果的关系。术前至术后胫骨旋转改变对术中旋转运动学的影响也被检查。方法采用CORI机器人系统对117例内翻性骨关节炎患者行一期骨水泥机械对准BCS tka。植入后术中测量胫骨内旋，从0°伸展到30°、60°、90°和120°屈曲。还记录了术前最大伸展和术后0°伸展胫骨旋转的差异。分析膝关节屈曲时胫骨旋转与临床结果的相关性，包括6周、3个月和6个月时的活动范围（ROM）、2011年膝关节学会评分（2011 KSS）和遗忘关节评分-12 （FJS-12）。还评估了术前和术后胫骨旋转变化与屈曲期间胫骨旋转的相关性。结果在整个屈曲过程中观察到明显的胫骨内旋。胫骨内旋在6周和3个月时与ROM、2011 KSS和FJS-12呈正相关，但在6个月时无相关。术后0°伸展时相对于术前最大伸展时胫骨内旋的增加与屈曲时胫骨内旋的量呈显著负相关。结论屈曲时胫骨内旋与早期预后呈正相关，但在6个月后不持续。与术前最大伸展相比，0°伸展时胫骨内旋增加会对旋转运动学产生负面影响。

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引用次数: 0

Total hip arthroplasty in very young patients aged under 21 years: A 25 year literature review (2000–2025) 21岁以下非常年轻患者的全髋关节置换术：25年的文献回顾（2000-2025）

Journal of Joint Surgery and Research

Pub Date : 2025-11-17 DOI: 10.1016/j.jjoisr.2025.11.001

Philippe Hernigou , Michel Dagher , Yasuhiro Homma , Charles Henri Flouzat Lachaniette

Purpose

Total hip arthroplasty (THA) in very young patients (aged <21 years) remains rare and challenging due to concerns about implant longevity and lifetime revision risk. Historically avoided, its use has increased over the past two decades thanks to advances in materials, fixation, and surgical techniques.

Methods

A systematic review of PubMed/MEDLINE (2000–2025) identified 10 studies reporting outcomes of primary THA in patients aged 10–21 years, representing 3106 hips. Data on indications, implant design, fixation, bearing surfaces, complications, and functional outcomes were extracted and analyzed.

Results

The mean patient age at surgery was 17.7 years, with a mean follow-up of 7.7 years. The main indications were avascular necrosis (35%) and dysplastic osteoarthritis (33%). Uncemented fixation predominated (82%). A clear temporal shift in bearing use was observed: ceramic-on-polyethylene increased from 5% to 65% between 2000 and 2021, while metal-on-metal declined from 30% to 2%. The overall revision rate was 8.3%, with loosening (53%) and wear (12%) as leading causes. Five to ten year survivorship averaged 91.7%, comparable with adult benchmarks.

Conclusions

Over the past 25 years, THA in very young patients has shown encouraging outcomes, with substantial functional gains and improved implant survival. Although lifetime revision risk remains, modern uncemented implants with advanced bearings appear durable in carefully selected cases. Continued long-term surveillance and registry-based studies are needed to refine implant selection and optimize management of early-onset hip disease.

目的全髋关节置换术（THA）在非常年轻的患者（21岁）中仍然罕见且具有挑战性，因为担心假体寿命和终身翻修风险。在过去的二十年里，由于材料、固定和手术技术的进步，它的使用有所增加。方法对PubMed/MEDLINE（2000-2025）进行系统回顾，确定了10项报告10 - 21岁患者原发性THA结果的研究，涉及3106例髋关节。提取并分析了适应症、种植体设计、固定、承载面、并发症和功能结果的数据。结果患者手术时平均年龄17.7岁，平均随访7.7年。主要适应症为无血管坏死（35%）和发育不良骨关节炎（33%）。非骨水泥固定占多数（82%）。观察到轴承使用的明显时间变化：2000年至2021年间，陶瓷对聚乙烯从5%增加到65%，而金属对金属从30%下降到2%。总体翻修率为8.3%，其中松动（53%）和磨损（12%）是主要原因。5 - 10年的平均生存率为91.7%，与成人基准相当。在过去的25年中，THA在非常年轻的患者中显示出令人鼓舞的结果，具有显著的功能改善和种植体存活率。尽管终生翻修风险仍然存在，但在精心挑选的病例中，带有先进轴承的现代非胶结种植体显得耐用。需要持续的长期监测和基于登记的研究来改进植入物的选择和优化早发性髋关节疾病的管理。

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引用次数: 0

Increased risk of deep vein thrombosis and post-operative delirium following total knee arthroplasty compared with unicompartmental knee arthroplasty in patients aged 80 years and older: A nationwide Japanese medical claims-based propensity score-matched study 80岁及以上患者全膝关节置换术与单室膝关节置换术相比，深静脉血栓形成和术后谵妄的风险增加：一项基于日本全国医疗索赔的倾向评分匹配研究

Journal of Joint Surgery and Research

Pub Date : 2025-11-17 DOI: 10.1016/j.jjoisr.2025.10.002

Yu Mori , Kunio Tarasawa , Hidetatsu Tanaka , Masayuki Kamimura , Naoko Mori , Kiyohide Fushimi , Toshimi Aizawa , Kenji Fujimori

Purpose

As life expectancy increases, the number of elderly patients undergoing knee arthroplasty continues to rise. Total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) are both viable options, yet comparative data on post-operative risks in very elderly patients are limited. The aim of this study was to compare in-hospital post-operative complications between TKA and UKA in patients aged ≥80 years using a large-scale Japanese nationwide database derived from Diagnosis Procedure Combination (DPC)-participating acute care hospitals.

Methods

A retrospective cohort study was conducted using the DPC database from 2016 to 2023. Patients aged ≥80 years undergoing TKA or UKA were identified. Propensity score matching (1:1) was used to balance baseline characteristics, including age, sex, body mass index, Charlson comorbidity index, anesthesia type, and simultaneous bilateral surgery. Outcomes included deep vein thrombosis (DVT), cognitive dysfunction, pneumonia, cerebrovascular events, surgical site infection, in-hospital mortality, length of stay, discharge disposition, and blood transfusion volume.

Results

After matching, 7782 TKA and 7782 UKA patients were analyzed. TKA was associated with higher rates of DVT [9.0% vs. 6.0%; odds ratio 1.56; p < 0.0001] and post-operative delirium (1.6% vs. 0.7%; odds ratio 2.31; p < 0.0001). Additionally, surgical site infections were more frequent and transfusion volumes were greater in TKA. UKA patients had shorter hospital stays and higher rates of discharge to home (75.3% vs. 65.4%).

Conclusions

In patients aged ≥80 years, TKA was associated with higher risks of DVT and cognitive dysfunction compared with UKA. Given the observational design, causal inference is limited. UKA may be a safer option in appropriately selected patients.

目的随着预期寿命的增加，接受膝关节置换术的老年患者数量持续上升。全膝关节置换术（TKA）和单室膝关节置换术（UKA）都是可行的选择，但关于高龄患者术后风险的比较数据有限。本研究的目的是使用来自诊断程序组合（DPC）参与的急性护理医院的大型日本全国数据库，比较年龄≥80岁患者TKA和UKA的院内术后并发症。方法采用2016 - 2023年DPC数据库进行回顾性队列研究。年龄≥80岁的患者接受TKA或UKA。倾向评分匹配（1:1）用于平衡基线特征，包括年龄、性别、体重指数、Charlson合并症指数、麻醉类型和同时双侧手术。结果包括深静脉血栓形成（DVT）、认知功能障碍、肺炎、脑血管事件、手术部位感染、住院死亡率、住院时间、出院处置和输血量。结果经配对后，对7782例TKA和7782例UKA患者进行分析。TKA与较高的DVT发生率相关[9.0% vs. 6.0%；优势比1.56；P <； 0.0001]和术后谵妄（1.6% vs. 0.7%；优势比2.31;P < 0.0001）。此外，TKA患者手术部位感染更频繁，输血量更大。UKA患者住院时间较短，出院率较高（75.3%对65.4%）。结论在年龄≥80岁的患者中，TKA与UKA相比具有更高的DVT和认知功能障碍风险。考虑到观察设计，因果推理是有限的。在适当选择的患者中，UKA可能是一个更安全的选择。

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引用次数: 0

Functional knee phenotyping: A paradigm for patient-specific alignment in total knee arthroplasty 功能性膝关节表型：全膝关节置换术中患者特异性对齐的范例

Journal of Joint Surgery and Research

Pub Date : 2025-11-16 DOI: 10.1016/j.jjoisr.2025.10.003

Yuma Onoi , Randa Elsheikh , Rolf Hügli , Heiko Graichen , Rüdiger von Eisenhart-Rothe , Andrej M. Nowakowski , Michael T. Hirschmann

Purpose

Total knee arthroplasty has historically relied on mechanical alignment (MA); however, a systematic neutral target cannot accommodate the biological diversity of the knee. Based on functional knee phenotype analysis, large imaging series have demonstrated broad coronal variability even in young, non-osteoarthritic knees, with constructs corresponding to classic neutral alignment in only 4–6% of limbs. These data indicate that MA as a universal goal is insufficient and the data support a paradigm shift toward patient-specific alignment (PSA).

Methods

The study institution practices a tibia-first, gap-balanced, phenotype-based PSA within defined safe zones to respect joint line obliquity and soft tissue balance while avoiding outlier alignment. Targets are defined with reproducible metrics, namely hip–knee–ankle angle, femoral mechanical angle, tibial mechanical angle, and joint line convergence angle (JLCA).

Results

Current evidence shows high target attainment and reliable intra-operative balance, with balanced gaps in >90% of PSA and JLCA improving from 1.8 to 4.3° pre-operatively to 0.6–1.2° post-operatively (p < 0.001). Moreover, results from related strategies (inverse kinematic alignment and functional alignment) consistently report outcomes at least equivalent, and in selected domains superior, to MA while requiring fewer soft tissue releases.

Conclusions

The next step for PSA is scalability: multicenter datasets, registry linkage, and long-term follow-up are needed to determine durability, to refine phenotype-specific safe zones, and to validate this strategy across implants and patient populations.

目的：全膝关节置换术历来依赖于机械对齐（MA）；然而，一个系统的中性靶标不能适应膝关节的生物多样性。基于功能性膝关节表型分析，大量影像序列显示，即使在年轻的、无骨关节炎的膝关节中，冠状面也有广泛的变异性，只有4-6%的肢体具有典型的中性排列结构。这些数据表明，MA作为一个普遍目标是不够的，数据支持向患者特异性对齐（PSA）的范式转变。该研究机构在确定的安全区域内采用胫骨优先、间隙平衡、基于表型的PSA，以尊重关节线倾角和软组织平衡，同时避免异常对齐。用可重复的指标定义目标，即髋关节-膝关节-踝关节角、股骨力学角、胫骨力学角和关节线收敛角（JLCA）。结果目前的证据显示高目标达成和可靠的术中平衡，90%的PSA和JLCA的平衡差距从术前的1.8 ~ 4.3°改善到术后的0.6 ~ 1.2°（p < 0.001）。此外，相关策略（逆运动学对齐和功能对齐）的结果一致报告的结果至少与MA相当，并且在选定的领域优于MA，同时需要较少的软组织释放。PSA的下一步是可扩展性：需要多中心数据集，注册表链接和长期随访来确定持久性，完善表型特异性安全区，并在植入物和患者群体中验证该策略。

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引用次数: 0

Impact of femoral component flexion on implant sizing in unicompartmental knee arthroplasty: A three-dimensional computed tomography-based simulation study 单室膝关节置换术中股骨假体屈曲对植入物大小的影响：一项基于三维计算机断层成像的模拟研究

Journal of Joint Surgery and Research

Pub Date : 2025-10-21 DOI: 10.1016/j.jjoisr.2025.09.006

Kazu Matsumoto, Daichi Ishimaru, Kazuki Sohmiya, Nobuo Terabayashi

Purpose

Accurate femoral component sizing is essential for successful unicompartmental knee arthroplasty (UKA). This study aimed to investigate the effect of sagittal alignment on femoral component sizing using three-dimensional (3D) simulation and to validate findings with post-operative measurements.

Methods

Thirty-two knees from 29 patients undergoing UKA were analyzed using 3D computed tomography (CT)-based planning with ZedKnee software. Femoral components were virtually implanted at seven sagittal alignments (−10°, −5°, 0°, 5°, 10°, 15°, and 20°), and changes in component size, bone resection surface area, and length were evaluated. Post-operative sagittal alignment was measured relative to the femoral mechanical axis using 3D CT. Repeated measures ANOVA with Bonferroni correction was performed.

Results

Increasing flexion led to reduced component size, while extension increased size. Deviations of ±10° from neutral resulted in a one-size change. Bone resection surface area and length decreased significantly with flexion (p < 0.05), correlating with downsizing. Post-operative measurements showed a mean femoral component flexion of 1.4 ± 3.6° (range −3.9° to 9.7°), with 87.5% implanted within ±5° of neutral.

Conclusions

Excessive femoral component flexion systematically reduces implant size by decreasing bone resection. Maintaining sagittal alignment within ±5° of neutral is crucial for accurate sizing. These findings emphasize the importance of precise pre-operative planning and intra-operative technique to optimize UKA outcomes.

目的：准确的股骨假体尺寸是单室膝关节置换术成功的关键。本研究旨在通过三维（3D）模拟研究矢状面对齐对股骨假体大小的影响，并通过术后测量验证结果。方法利用ZedKnee软件对29例UKA患者的32个膝关节进行三维CT规划分析。股骨假体以7个矢状位（- 10°，- 5°，0°，5°，10°，15°和20°）虚拟植入，并评估假体大小，骨切除表面积和长度的变化。术后使用3D CT测量相对于股骨机械轴的矢状位对齐。采用Bonferroni校正的重复测量方差分析。结果增加屈曲导致构件尺寸减小，而延长导致构件尺寸增大。偏离中性±10°导致一个尺寸的变化。骨切除表面积和长度随屈曲而显著减少（p < 0.05），与缩小相关。术后测量显示股骨假体平均屈曲1.4±3.6°（范围- 3.9°至9.7°），87.5%植入中性±5°。结论股骨假体过度屈曲可通过减少骨切除来减少假体的体积。保持矢状面对齐±5°的中性是至关重要的准确尺寸。这些发现强调了精确的术前计划和术中技术对于优化UKA预后的重要性。

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引用次数: 0

Midterm outcomes of total hip arthroplasty with a cementless tapered wedge stem designed for Japanese patients 为日本患者设计的无水泥锥形楔柄全髋关节置换术的中期结果

Journal of Joint Surgery and Research

Pub Date : 2025-10-09 DOI: 10.1016/j.jjoisr.2025.09.005

Yusuke Fujimoto , Daichi Arima , Toshiro Ijuin , Tomohiro Iuchi , Hirotaka Kawakami , Shunsuke Nakamura , Naohiro Uezono , Noboru Taniguchi

Purpose

Cementless tapered wedge stems are widely used in total hip arthroplasty (THA) based on their reliable initial fixation and favorable long-term outcomes. However, the mid-to long-term outcomes of the J-Taper cementless tapered wedge stem designed for Japanese patients remain unclear. This study aimed to evaluate its midterm clinical and radiographic results.

Methods

A total of 125 hips (106 patients) that underwent primary THA with the J-Taper stem between 2013 and 2018 and were assessed during a minimum 5 year follow-up were retrospectively reviewed. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) hip score and the JOA Hip Disease Evaluation Questionnaire (JHEQ). Radiographic evaluations included stem alignment, subsidence, cortical hypertrophy, stress shielding, and radiolucent lines.

Results

The JOA and JHEQ scores improved statistically significantly from pre-operatively to final follow-up (both p < 0.001). The stem survival rate was 100%, with no cases of clinically significant subsidence (≥2 mm) or radiolucent lines (≥2 mm). However, stress shielding (Engh grade ≥2) was observed in 38 hips (30.4%) and was statistically significantly associated with longer follow-up (p = 0.027), but did not adversely affect clinical outcomes. Binomial logistic regression confirmed that follow-up duration was a statistically significant risk factor for stress shielding (odds ratio 1.03, 95% confidence interval 1.01–1.05; p = 0.010).

Conclusions

The J-Taper stem demonstrated favorable midterm clinical and radiographic outcomes, including excellent implant survival and significant functional improvement. However, radiographic stress shielding was frequently observed and progressed over time, suggesting a risk of delayed complications and underscoring the need for longer-term follow-up.

无间隙锥形楔形假体因其可靠的初始固定和良好的远期疗效而广泛应用于全髋关节置换术（THA）。然而，为日本患者设计的j -锥度无水泥锥形楔形椎体的中长期预后尚不清楚。本研究旨在评估其中期临床和影像学结果。方法回顾性分析2013年至2018年期间共125髋（106例患者）采用j -锥柄行原发性全髋关节置换术，并在至少5年的随访期间进行评估。临床结果采用日本骨科协会（JOA）髋关节评分和JOA髋关节疾病评估问卷（JHEQ）进行评估。放射学评估包括茎对中、下沉、皮质肥大、应力屏蔽和放射透光线。结果JOA和JHEQ评分从术前到随访结束均有显著改善（p < 0.001）。茎部成活率100%，无明显临床沉降（≥2mm）或放射线（≥2mm）。然而，38髋（30.4%）观察到应力屏蔽（英语等级≥2），并且与更长的随访时间有统计学意义上的显著相关（p = 0.027），但对临床结果没有不利影响。二项logistic回归证实，随访时间是应激屏蔽的有统计学意义的危险因素（优势比1.03,95%可信区间1.01-1.05;p = 0.010）。结论j型锥度柄具有良好的中期临床和影像学结果，包括良好的种植体存活率和显著的功能改善。然而，经常观察到放射学应力屏蔽，并随着时间的推移而进展，这表明有延迟并发症的风险，并强调需要长期随访。

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引用次数: 0

Impact of the COVID-19 pandemic on hip surgery in Japan: An analysis using National Database Open Data COVID-19大流行对日本髋关节手术的影响：使用国家数据库开放数据的分析

Journal of Joint Surgery and Research

Pub Date : 2025-10-08 DOI: 10.1016/j.jjoisr.2025.09.004

Maho Tsuchiya , Kensuke Fukushima , Yoshihisa Ohashi , Noritaka Mamorita , Yoji Toyomura , Akira Norisugi , Kentaro Uchida , Naonobu Takahira , Masashi Takaso

Purpose

The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted surgical services worldwide. This study aimed to assess the pandemic's impact on hip surgeries in Japan using data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB).

Methods

Five types of hip surgery were analyzed, including total hip arthroplasty (THA), pelvic osteotomy, femoral osteotomy, hip arthroscopic synovectomy, and hip arthroscopic labral repair, based on NDB Open Data from 2014 to 2022. Annual procedure counts were examined, and percentage changes were calculated for 2019–2020, 2020–2022, and 2019–2022. Poisson regression was used to evaluate temporal trends.

Results

The total number of hip surgeries declined in 2020 compared with 2019 but rebounded by 2021 and exceeded pre-pandemic levels in 2022. During the observation period, THA and arthroscopic labral repair showed significant upward trends (p < 0.0001 and p = 0.0033, respectively), while pelvic osteotomy, femoral osteotomy, and arthroscopic synovectomy declined (p < 0.0001 for all). THA was the least affected by the pandemic. Arthroscopic labral repair showed the greatest post-pandemic growth, whereas pelvic osteotomy showed a persistent decline, remaining below pre-pandemic levels in 2022.

Conclusions

THA and arthroscopic labral repair recovered and increased during the later phase of the COVID-19 pandemic, while pelvic and femoral osteotomy experienced a decline and have not recovered. Although the trends might be temporary rather than sustained, the pandemic may have significantly impacted the strategy for hip disorders in Japan. Ongoing monitoring of these trends over the long term is warranted.

2019冠状病毒病（COVID-19）大流行严重扰乱了全球外科服务。本研究旨在利用日本国家健康保险索赔和特定健康检查数据库（NDB）的数据评估大流行对日本髋关节手术的影响。方法基于2014 - 2022年NDB开放数据，对全髋关节置换术（THA）、骨盆截骨术、股骨截骨术、髋关节镜下滑膜切除术和髋关节镜下唇部修复术5种髋关节手术类型进行分析。检查年度手术计数，并计算2019-2020年、2020-2022年和2019-2022年的百分比变化。用泊松回归评价时间趋势。结果与2019年相比，2020年髋关节手术总数有所下降，但到2021年有所反弹，并在2022年超过了大流行前的水平。观察期内，全髋关节置换术和关节镜下唇部修复术有明显的上升趋势（p <； 0.0001和p = 0.0033），而盆腔截骨术、股骨截骨术和关节镜下滑膜切除术呈下降趋势（p < 0.0001）。泰国是受疫情影响最小的国家。关节镜下唇部修复显示出大流行后最大的增长，而骨盆截骨术显示出持续下降，在2022年仍低于大流行前的水平。结论人工髋关节置换术和关节镜下唇部修复术在COVID-19大流行后期恢复并增加，而骨盆和股骨截骨术下降且未恢复。虽然这种趋势可能是暂时的，而不是持续的，但大流行可能对日本的髋关节疾病战略产生了重大影响。有必要对这些趋势进行长期的持续监测。

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