Journal of Bone and Joint Surgery, American Volume最新文献

Background: Although total knee arthroplasty (TKA) is known to improve patient-reported outcome measure (PROM) scores in the short term to midterm, the long-term trajectories of both disease-specific and generic PROM scores remain unclear.

Methods: We retrospectively analyzed the prospectively collected registry data of 1,264 patients (mean age, 68.5 years; 93.7% female) who underwent primary TKA for osteoarthritis between 2005 and 2013 and completed PROM assessments at baseline and 10 years postoperatively. Disease-specific PROMs were assessed using the Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Generic PROMs were assessed using the Short Form-36 Health Survey (SF-36). Assessments were performed preoperatively and at 6 months and 1, 2, 5, 10, and 15 years postoperatively. Generalized linear models and linear mixed-effects models were used to evaluate temporal changes and subgroup differences by age and sex.

Results: All PROM scores improved significantly within 6 months after TKA. Thereafter, disease-specific PROMs showed modest changes up to 1 year, with relative stability until 5 years, whereas generic PROMs demonstrated heterogeneous patterns across different domains. Between 5 and 10 years postoperatively, WOMAC pain and stiffness scores did not show significant changes, the KSKS decreased but not significantly so, and WOMAC physical function scores exhibited small but significant deterioration that was not clinically meaningful. SF-36 domains demonstrated varied trajectories: physical and mental component scores declined by more than the minimal clinically important difference after 5 years, whereas the social functioning score showed continuous improvement, although not all changes were significant. Octogenarians demonstrated lower physical functioning scores but higher social functioning scores in the long term compared with younger patients, and female patients demonstrated inferior functional and vitality scores compared with male patients.

Conclusions: Both disease-specific and generic PROM scores after TKA improved significantly and remained superior to baseline scores over a 15-year period, although physical function scores tended to decline in the long term. In this large, predominantly female Korean cohort, the distinct age- and sex-specific trajectories highlight the importance of implementing individualized, time-adapted long-term management strategies to optimize patient outcomes.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: Pelvic tilt (PT) is an important sagittal parameter to be restored to the normal range in corrective surgery for spinopelvic malalignment. However, the normal value of PT varies among patients. With the introduction of the pelvic inclination angle (PIA), which is the angle subtended by the vertical axis and the line connecting the anterior pubic tubercle and the anterior superior iliac spine, we aimed to determine whether the PIA could reflect the symptom severity and whether normal PIA values exist.

Methods: The study cohort consisted of patients with spinopelvic malalignment (patient group) and normal healthy adults (normal group). In the patient group, correlation analyses were performed to investigate the relationship between the PIA and other sagittal parameters and between the sagittal parameters and patient-reported outcome measures. In the normal group, correlation analysis was performed to assess the relationship between pelvic incidence (PI) and other sagittal parameters. The radiographic parameters were compared according to PI categories.

Results: There were 162 patients in the patient group, with a mean age of 71.1 years, and 108 in the normal group, with a mean age of 32.1 years. In the patient group, the PIA strongly correlated with the conventional parameters such as PT, PI-lumbar lordosis mismatch, and T1-pelvic angle. The PIA had weak to moderate correlations with all patient-reported outcome measures, of which the correlation coefficients were similar to or greater than those of other sagittal parameters with patient-reported outcome measures. In the normal group, PI showed moderate to strong correlations with all conventional sagittal parameters except for the PIA, which correlated very weakly with PI. Unlike the other sagittal parameters, the PIA did not significantly differ among the PI categories.

Conclusions: The PIA reflected the symptom severity and had a normal value independent of PI. As an alternative to PT, the PIA can be a clinically useful parameter in evaluating and managing patients with spinopelvic malalignment.

Clinical relevance: As the PIA is independent of PI, it will be more useful in differentiating between patients with normal spinopelvic alignment and those with spinopelvic malalignment and in reflecting the clinical symptoms of patients with spinopelvic malalignment. In addition, by providing a cutoff value of 13.6°, the PIA can be used as a surgical target or to predict postoperative outcomes.

➢ The use of multirod constructs (≥3 rods) in complex spine surgery has increased as its utility has been recognized over the past decade.➢ There are multiple different rod configurations that may be utilized on the basis of the desired supplemental rod function, with each type having its own advantages and clinical indications.➢ Literature has continued to demonstrate a reduced incidence of pseudarthrosis, rod fracture, and reoperation when comparing multirod constructs with traditional dual-rod constructs.➢ The use of consistent nomenclature when describing multirod constructs will allow for more productive clinical and biomechanical research.

Background: We sought to evaluate the incidence of cardiovascular and cerebrovascular diseases in patients undergoing total knee arthroplasty (TKA) and the impact of perioperative physical activity levels on these risks.

Methods: This nationwide cohort study used data from the National Health Insurance Service of the Republic of Korea. Patients who underwent a pair of health examinations at 2-year or 4-year intervals and did not have a diagnosis of cardiovascular or cerebrovascular disease at the first examination were included. The study population was divided into those who underwent TKA and those who did not between the 2 examinations. Physical activity was defined on the basis of the frequency of moderate-to-high-intensity activities and was categorized into inactive or active 1 to 2, 3 to 4, and ≥5 times weekly. Cox proportional hazards models were used to evaluate the association between physical activity changes and disease incidence over a 5-year follow-up.

Results: Compared with controls who did not undergo TKA, patients who underwent TKA exhibited higher incidences of cardiovascular diseases (19.3% compared with 17.1%) and cerebrovascular diseases (25.7% compared with 23.9%). These incidences were associated with perioperative physical activity levels. Higher physical activity levels after TKA were associated with lower risks of both diseases. Specifically, engaging in physical activity ≥5 times per week was linked to lower cardiovascular risk (hazard ratio [HR], 0.918; p < 0.001) and cerebrovascular risk (HR, 0.890; p < 0.001). Previously inactive patients who began activity showed a reduction in the risks of both diseases, whereas previously active patients who became inactive had a significantly increased cerebrovascular risk.

Conclusions: Patients who underwent TKA demonstrated higher incidences of cardiovascular and cerebrovascular diseases compared with controls over a 5-year follow-up. Our findings underscore the importance of initiating regular physical activity after surgery, particularly among previously inactive patients. Conversely, the increased cerebrovascular events among patients who ceased activity emphasize the critical need to maintain activity levels after surgery. Therefore, maintaining or initiating physical activity may be a core component of optimizing long-term outcomes after TKA.

Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.