Journal of orthopaedics最新文献

Evaluating the learning curve and outcomes of a new rectangular femoral stem in total hip arthroplasty: A comparative study

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-04-23 DOI: 10.1016/j.jor.2025.04.007

Kyle Goldstein, Michaela Nickol, Johannes M. van der Merwe

Background

Total hip arthroplasty (THA) is a widely successful procedure, but the adoption of new femoral stems is often met with hesitation due to concerns regarding a learning curve and potential complications. This study evaluates the impact of introducing a new rectangular femoral stem by comparing radiographic, clinical, and functional outcomes with those of an established metaphyseal loading stem.

Methods

A retrospective comparative study was conducted between January 2022 and January 2024. Patients were categorized into three groups: (1) control group receiving an established metaphyseal loading stem, (2) “learning curve” group (first half of patients receiving the new rectangular stem), and (3) “experienced” group (second half of patients receiving the rectangular stem). Primary outcomes included femoral stem subsidence and diaphyseal canal filling. Secondary outcomes comprised Oxford Hip Scores (OHS), EQ-5D-5L scores, length of hospital stay, complications, and readmission rates. Statistical analysis utilized ANOVA and chi-square tests, with significance set at p < 0.05.

Results

A total of 115 patients (33 control, 41 learning curve, 41 experienced) were included. No significant differences were found in demographics. Subsidence was comparable across groups (p = 0.381). AP canal filling showed no significant differences (p = 0.839), but lateral canal filling was greater in the rectangular stem groups (p<0.001). Functional outcomes (p = 0.646), complications (p = 0.318), and readmission rates (p = 0.402) were similar across groups. However, hospital stay was significantly shorter in the rectangular stem groups (p = 0.015).

Conclusion

The introduction of a new rectangular femoral stem did not result in a significant learning curve affecting subsidence, complications, or functional outcomes. The stem demonstrated improved lateral canal filling and was associated with reduced hospital stay, suggesting a safe transition to this design without compromising early outcomes.

{"title":"Evaluating the learning curve and outcomes of a new rectangular femoral stem in total hip arthroplasty: A comparative study","authors":"Kyle Goldstein, Michaela Nickol, Johannes M. van der Merwe","doi":"10.1016/j.jor.2025.04.007","DOIUrl":"10.1016/j.jor.2025.04.007","url":null,"abstract":"<div><h3>Background</h3><div>Total hip arthroplasty (THA) is a widely successful procedure, but the adoption of new femoral stems is often met with hesitation due to concerns regarding a learning curve and potential complications. This study evaluates the impact of introducing a new rectangular femoral stem by comparing radiographic, clinical, and functional outcomes with those of an established metaphyseal loading stem.</div></div><div><h3>Methods</h3><div>A retrospective comparative study was conducted between January 2022 and January 2024. Patients were categorized into three groups: (1) control group receiving an established metaphyseal loading stem, (2) “learning curve” group (first half of patients receiving the new rectangular stem), and (3) “experienced” group (second half of patients receiving the rectangular stem). Primary outcomes included femoral stem subsidence and diaphyseal canal filling. Secondary outcomes comprised Oxford Hip Scores (OHS), EQ-5D-5L scores, length of hospital stay, complications, and readmission rates. Statistical analysis utilized ANOVA and chi-square tests, with significance set at p < 0.05.</div></div><div><h3>Results</h3><div>A total of 115 patients (33 control, 41 learning curve, 41 experienced) were included. No significant differences were found in demographics. Subsidence was comparable across groups (p = 0.381). AP canal filling showed no significant differences (p = 0.839), but lateral canal filling was greater in the rectangular stem groups (<strong>p<0.001</strong>). Functional outcomes (p = 0.646), complications (p = 0.318), and readmission rates (p = 0.402) were similar across groups. However, hospital stay was significantly shorter in the rectangular stem groups (<strong>p</strong> = <strong>0.015</strong>).</div></div><div><h3>Conclusion</h3><div>The introduction of a new rectangular femoral stem did not result in a significant learning curve affecting subsidence, complications, or functional outcomes. The stem demonstrated improved lateral canal filling and was associated with reduced hospital stay, suggesting a safe transition to this design without compromising early outcomes.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"64 ","pages":"Pages 139-146"},"PeriodicalIF":1.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Does Surgical Treatment of Varicose Veins Prior to Total Knee Arthroplasty Decrease Rates of Postoperative Venous Thromboembolism? A Matched Cohort Study

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-04-23 DOI: 10.1016/j.jor.2025.04.006

Mary Jane McConnell , Bailey J. Ross , Jordan Murphy , George N. Guild Ⅲ , Brandon H. Naylor , Thomas L. Bradbury

Background

Venous thromboembolism (VTE) is a possible complication following total knee arthroplasty (TKA). The presence of varicose veins has been associated with increased risk of VTEs following arthroplasty procedures. The purpose of the present study was to assess the impact of previous varicose vein surgery on the incidence of VTE following TKA.

Methods

A retrospective matched cohort study was performed using the PearlDiver database. Patients undergoing primary TKA with diagnoses of lower extremity varicose veins were identified. Subsequently, patients who underwent varicose vein surgery before TKA (n = 7,730) were matched 1:2 with controls who did not have vein surgery (n = 15,460) across age, sex, Elixhauser comorbidity index, anticoagulation exposure, and comorbidities. Rates of venous thromboembolism (VTE) associated with the index TKA within six months postoperatively were compared between the matched cohorts using multivariable logistic regression.

Results

Patients who had prior varicose vein surgery exhibited significantly lower rates of VTE events during the 0–30 day interval (0.76 % vs. 1.05 %; OR: 0.70), the 31–90 day interval (0.34 % vs. 0.52 %; OR: 0.60), and the 91–180 day interval (0.94 % vs 1.37 %; OR: 0.65). In subgroup analyses of the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE), the varicose vein surgery cohort exhibited significantly lower rates of PE at 31–90 days (0.07 % vs. 0.30 %; OR: 0.42) and 91–180 days (0.48 % vs. 0.80 %; OR: 0.59), while rates of DVT were comparable.

Conclusion

Patients who underwent previous varicose vein surgery exhibited significantly lower rates of VTE within six months after TKA compared to matched controls. The present study suggests operative treatment of varicose veins before TKA may reduce rates of VTE events postoperatively.

{"title":"Does Surgical Treatment of Varicose Veins Prior to Total Knee Arthroplasty Decrease Rates of Postoperative Venous Thromboembolism? A Matched Cohort Study","authors":"Mary Jane McConnell , Bailey J. Ross , Jordan Murphy , George N. Guild Ⅲ , Brandon H. Naylor , Thomas L. Bradbury","doi":"10.1016/j.jor.2025.04.006","DOIUrl":"10.1016/j.jor.2025.04.006","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE) is a possible complication following total knee arthroplasty (TKA). The presence of varicose veins has been associated with increased risk of VTEs following arthroplasty procedures. The purpose of the present study was to assess the impact of previous varicose vein surgery on the incidence of VTE following TKA.</div></div><div><h3>Methods</h3><div>A retrospective matched cohort study was performed using the PearlDiver database. Patients undergoing primary TKA with diagnoses of lower extremity varicose veins were identified. Subsequently, patients who underwent varicose vein surgery before TKA (n = 7,730) were matched 1:2 with controls who did not have vein surgery (n = 15,460) across age, sex, Elixhauser comorbidity index, anticoagulation exposure, and comorbidities. Rates of venous thromboembolism (VTE) associated with the index TKA within six months postoperatively were compared between the matched cohorts using multivariable logistic regression.</div></div><div><h3>Results</h3><div>Patients who had prior varicose vein surgery exhibited significantly lower rates of VTE events during the 0–30 day interval (0.76 % vs. 1.05 %; OR: 0.70), the 31–90 day interval (0.34 % vs. 0.52 %; OR: 0.60), and the 91–180 day interval (0.94 % vs 1.37 %; OR: 0.65). In subgroup analyses of the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE), the varicose vein surgery cohort exhibited significantly lower rates of PE at 31–90 days (0.07 % vs. 0.30 %; OR: 0.42) and 91–180 days (0.48 % vs. 0.80 %; OR: 0.59), while rates of DVT were comparable.</div></div><div><h3>Conclusion</h3><div>Patients who underwent previous varicose vein surgery exhibited significantly lower rates of VTE within six months after TKA compared to matched controls. The present study suggests operative treatment of varicose veins before TKA may reduce rates of VTE events postoperatively.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"64 ","pages":"Pages 169-175"},"PeriodicalIF":1.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effects of obstructive sleep apnea on postoperative outcomes following total shoulder arthroplasty: A matched cohort analysis

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-04-22 DOI: 10.1016/j.jor.2025.04.009

Catherine Hand, Camden Bohn, Morgan Angotti, Henry Eilen, Matthew Varano, Brian Forsythe

Introduction

Obstructive sleep apnea (OSA), marked by recurrent airway obstruction and disrupted sleep, is linked to increased perioperative risk in major surgeries. However, its impact on total shoulder arthroplasty (TSA) remains unclear. This study investigates the association between OSA and postoperative outcomes.

Methods

This retrospective cohort study used the PearlDiver Mariner Database to identify patients who underwent TSA from 2010 to 2021. Patients with OSA were compared to a matched control group without OSA, with matching based on demographics and comorbidities. Postoperative complications, including deep vein thrombosis (DVT), pulmonary embolism (PE), surgical site infection (SSI), transfusions, and revision TSA, were identified using ICD and CPT codes. Multivariate logistic regression was used to adjust for confounders.

Results

A total of 57,118 TSA patients were included, with 50 % (n = 28,559) having a documented diagnosis of OSA. Patients with OSA had a significantly higher prevalence of comorbidities, including hypertension (65.0 % vs. 62.1 %, p < 0.001), obesity (27.3 % vs. 18.8 %, p < 0.001), asthma (8.7 % vs. 4.9 %, p < 0.001), and COPD (17.8 % vs. 14.4 %, p < 0.001). The incidence of DVT, PE, SSI, and wound disruption was not significantly different between groups. However, OSA was associated with a significantly higher risk of revision TSA within two years (0.3 % vs. 0.2 %; OR: 1.43, 95 % CI: 1.04–2.00; p = 0.028). Additionally, OSA patients had a significantly lower rate of blood transfusion (0.6 % vs. 0.8 %; OR: 0.68, 95 % CI: 0.55–0.83; p < 0.001).

Conclusion

OSA does not significantly raise the risk of acute complications after TSA but is linked to a higher rate of revision surgeries, suggesting a role in long-term failure, possibly from poor wound healing, systemic inflammation, or obesity-related stress. Preoperative screening and postoperative optimization may help reduce these risks. Further research is needed to assess the effects of OSA severity and CPAP adherence on TSA outcomes.

{"title":"Effects of obstructive sleep apnea on postoperative outcomes following total shoulder arthroplasty: A matched cohort analysis","authors":"Catherine Hand, Camden Bohn, Morgan Angotti, Henry Eilen, Matthew Varano, Brian Forsythe","doi":"10.1016/j.jor.2025.04.009","DOIUrl":"10.1016/j.jor.2025.04.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Obstructive sleep apnea (OSA), marked by recurrent airway obstruction and disrupted sleep, is linked to increased perioperative risk in major surgeries. However, its impact on total shoulder arthroplasty (TSA) remains unclear. This study investigates the association between OSA and postoperative outcomes.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used the PearlDiver Mariner Database to identify patients who underwent TSA from 2010 to 2021. Patients with OSA were compared to a matched control group without OSA, with matching based on demographics and comorbidities. Postoperative complications, including deep vein thrombosis (DVT), pulmonary embolism (PE), surgical site infection (SSI), transfusions, and revision TSA, were identified using ICD and CPT codes. Multivariate logistic regression was used to adjust for confounders.</div></div><div><h3>Results</h3><div>A total of 57,118 TSA patients were included, with 50 % (n = 28,559) having a documented diagnosis of OSA. Patients with OSA had a significantly higher prevalence of comorbidities, including hypertension (65.0 % vs. 62.1 %, <em>p</em> < 0.001), obesity (27.3 % vs. 18.8 %, <em>p</em> < 0.001), asthma (8.7 % vs. 4.9 %, <em>p</em> < 0.001), and COPD (17.8 % vs. 14.4 %, <em>p</em> < 0.001). The incidence of DVT, PE, SSI, and wound disruption was not significantly different between groups. However, OSA was associated with a significantly higher risk of revision TSA within two years (0.3 % vs. 0.2 %; OR: 1.43, 95 % CI: 1.04–2.00; <em>p</em> = 0.028). Additionally, OSA patients had a significantly lower rate of blood transfusion (0.6 % vs. 0.8 %; OR: 0.68, 95 % CI: 0.55–0.83; <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>OSA does not significantly raise the risk of acute complications after TSA but is linked to a higher rate of revision surgeries, suggesting a role in long-term failure, possibly from poor wound healing, systemic inflammation, or obesity-related stress. Preoperative screening and postoperative optimization may help reduce these risks. Further research is needed to assess the effects of OSA severity and CPAP adherence on TSA outcomes.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"64 ","pages":"Pages 163-168"},"PeriodicalIF":1.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bone marrow aspirate concentrate (BMAC) harvested in the axial and appendicular skeleton does not differ in progenitor cell count: A systematic review and meta-analysis

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-04-22 DOI: 10.1016/j.jor.2025.04.008

Udit Dave , Jared Rubin , Harshal Shah , Cameron Gerhold , Johnathon R. McCormick , Andrew S. Bi , Catherine Yuh , Luciano A. Rossi , Jorge Chahla

Introduction

Bone marrow aspirate concentrate (BMAC) is a reliable source of progenitor cells that facilitate healing, and it is typically harvested from the iliac crest. The purpose of this systematic review and meta-analysis was to compare total nucleated cell (TNC) count and the presence of colony-forming units (CFUs) in BMAC harvested from axial versus appendicular harvest sites.

Methods

In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Embase, and Cochrane Library databases were searched in August 2024 for studies published after 2004. Studies were included if they evaluated cell counts within BMAC samples harvested from males and females of any age and were prospective. Studies that had no reported cell count within BMAC samples, had evaluations of biologic material other than BMAC, or were translational or cadaveric studies, as well as review articles or technical notes, were excluded. Patients were divided into two cohorts based on whether BMAC was harvested from their axial or appendicular skeleton.

Results

The initial search identified 2126 studies, of which 15 non-randomized prospective studies with a total of 583 patients were included. Each study had low risk of bias. In the axial skeleton, TNC counts ranged from 0.1–502 × 10⁶ cells/mL, and CFU concentration ranged from 0 to 807 CFU/mL. In the appendicular skeleton, TNC counts ranged from 0.1–87 × 10⁶ cells/mL and CFU counts ranged from 0 to 802.7 CFU/mL. No significant differences in TNC or CFU count in BMAC harvested from the axial versus appendicular skeleton were observed.

Conclusions

BMAC harvested from the axial and appendicular skeletons demonstrate significant variability in progenitor cell concentration. These findings suggest that harvesting at appendicular sites near the operative location allows the surgeon to extract sufficient quality BMAC as compared to harvest sites within the axial skeleton, such as the iliac crest.

Level of evidence

Level II, systematic review of level II studies.

{"title":"Bone marrow aspirate concentrate (BMAC) harvested in the axial and appendicular skeleton does not differ in progenitor cell count: A systematic review and meta-analysis","authors":"Udit Dave , Jared Rubin , Harshal Shah , Cameron Gerhold , Johnathon R. McCormick , Andrew S. Bi , Catherine Yuh , Luciano A. Rossi , Jorge Chahla","doi":"10.1016/j.jor.2025.04.008","DOIUrl":"10.1016/j.jor.2025.04.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Bone marrow aspirate concentrate (BMAC) is a reliable source of progenitor cells that facilitate healing, and it is typically harvested from the iliac crest. The purpose of this systematic review and meta-analysis was to compare total nucleated cell (TNC) count and the presence of colony-forming units (CFUs) in BMAC harvested from axial versus appendicular harvest sites.</div></div><div><h3>Methods</h3><div>In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Embase, and Cochrane Library databases were searched in August 2024 for studies published after 2004. Studies were included if they evaluated cell counts within BMAC samples harvested from males and females of any age and were prospective. Studies that had no reported cell count within BMAC samples, had evaluations of biologic material other than BMAC, or were translational or cadaveric studies, as well as review articles or technical notes, were excluded. Patients were divided into two cohorts based on whether BMAC was harvested from their axial or appendicular skeleton.</div></div><div><h3>Results</h3><div>The initial search identified 2126 studies, of which 15 non-randomized prospective studies with a total of 583 patients were included. Each study had low risk of bias. In the axial skeleton, TNC counts ranged from 0.1–502 × 10<sup>6</sup> cells/mL, and CFU concentration ranged from 0 to 807 CFU/mL. In the appendicular skeleton, TNC counts ranged from 0.1–87 × 10<sup>6</sup> cells/mL and CFU counts ranged from 0 to 802.7 CFU/mL. No significant differences in TNC or CFU count in BMAC harvested from the axial versus appendicular skeleton were observed.</div></div><div><h3>Conclusions</h3><div>BMAC harvested from the axial and appendicular skeletons demonstrate significant variability in progenitor cell concentration. These findings suggest that harvesting at appendicular sites near the operative location allows the surgeon to extract sufficient quality BMAC as compared to harvest sites within the axial skeleton, such as the iliac crest.</div></div><div><h3>Level of evidence</h3><div>Level II, systematic review of level II studies.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"63 ","pages":"Pages 216-223"},"PeriodicalIF":1.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143863871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Robotic-assistance did not reduce complications in total hip arthroplasty

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-04-22 DOI: 10.1016/j.jor.2025.04.011

Joshua T. Ou , Winston Tawiah , Jared Wainwright , Samuel S. Gay , Adam Nguyen , Bardia Barimani , Joseph C. Wenke

Aims & objectives

Robotic-assisted total hip arthroplasty (rTHA) is an increasingly common method of joint arthroplasty used to improve surgical accuracy and reduce human error. Despite not having compelling clinical data on long-term complications or outcomes to justify additional time costs, its rate of use is increasing. In this study we compare the longitudinal rates of complications between patients undergoing conventional total hip arthroplasty (cTHA) and rTHA.

Materials & methods

Data from the TriNetX Research Network identified subjects with at least 5 years of patient follow up data through electronic health records. The first cohort were patients undergoing cTHA, and the second cohort included patients undergoing rTHA. Propensity score matching of known factors that can affect clinical outcomes at 1:1 ratio was performed to reduce confounding variables. Records with conditions unrelated to primary THA such as pathological fracture or revision arthroplasty were excluded. Rates of complication in five outcomes were observed at 1, 3 and 5 years: prosthetic joint infection, dislocation, revision, loosening, and periprosthetic fracture.

Results

The database contained 95,085 THA patients. Analysis was performed with 2241 patients in each matched cohort. At 5 years, there was no difference in all-cause complications between the cTHA cohort and rTHA cohort [OR (95 % CI), 1.073 (0.772–1.491)]. Also, no differences were noted in rates of revision [OR (95 % CI), 1.1.604(0.726, 3.543)] or dislocation [OR (95 % CI), 1.775(0.976, 3.228)].

Conclusion

Despite evidence for improved surgical accuracy and reduced errors, robotic assistance did not reduce the rate of complications over a 5-year period after total hip arthroplasty.

{"title":"Robotic-assistance did not reduce complications in total hip arthroplasty","authors":"Joshua T. Ou , Winston Tawiah , Jared Wainwright , Samuel S. Gay , Adam Nguyen , Bardia Barimani , Joseph C. Wenke","doi":"10.1016/j.jor.2025.04.011","DOIUrl":"10.1016/j.jor.2025.04.011","url":null,"abstract":"<div><h3>Aims & objectives</h3><div>Robotic-assisted total hip arthroplasty (rTHA) is an increasingly common method of joint arthroplasty used to improve surgical accuracy and reduce human error. Despite not having compelling clinical data on long-term complications or outcomes to justify additional time costs, its rate of use is increasing. In this study we compare the longitudinal rates of complications between patients undergoing conventional total hip arthroplasty (cTHA) and rTHA.</div></div><div><h3>Materials & methods</h3><div>Data from the TriNetX Research Network identified subjects with at least 5 years of patient follow up data through electronic health records. The first cohort were patients undergoing cTHA, and the second cohort included patients undergoing rTHA. Propensity score matching of known factors that can affect clinical outcomes at 1:1 ratio was performed to reduce confounding variables. Records with conditions unrelated to primary THA such as pathological fracture or revision arthroplasty were excluded. Rates of complication in five outcomes were observed at 1, 3 and 5 years: prosthetic joint infection, dislocation, revision, loosening, and periprosthetic fracture.</div></div><div><h3>Results</h3><div>The database contained 95,085 THA patients. Analysis was performed with 2241 patients in each matched cohort. At 5 years, there was no difference in all-cause complications between the cTHA cohort and rTHA cohort [OR (95 % CI), 1.073 (0.772–1.491)]. Also, no differences were noted in rates of revision [OR (95 % CI), 1.1.604(0.726, 3.543)] or dislocation [OR (95 % CI), 1.775(0.976, 3.228)].</div></div><div><h3>Conclusion</h3><div>Despite evidence for improved surgical accuracy and reduced errors, robotic assistance did not reduce the rate of complications over a 5-year period after total hip arthroplasty.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"64 ","pages":"Pages 147-152"},"PeriodicalIF":1.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-04-22 DOI: 10.1016/j.jor.2025.04.004

Lenka Stroobant , Hannes Vermue , Ewoud Jacobs , Nele Arnout , Stefaan Van Onsem , Scott A. Banks , Jan Victor , Amélie Chevalier

Background

The rising incidence of primary total knee arthroplasty (pTKA) is expected to lead to more revision TKAs (rTKA), which pose greater challenges and poorer outcomes, burdening both patients and healthcare systems. Knee kinematics play a key role in pTKA outcomes, but less is known about rTKA, where high-constraint implants and joint line elevation (JLE) may affect knee kinematics. The study aimed to: (1) Compare kinematic patterns between posterior-stabilized (PS) and condylar constrained (CCK) implants during open- and closed-chain exercises in rTKA; (2) Assess the impact of JLE on anteroposterior translation and post-cam engagement.

Methods

Thirty patients (19 with PS implants and 11 with CCK implants) who underwent rTKA between 2022 and 2024 were tested at a minimum six-month follow-up. Tibiofemoral kinematics during open-chain flexion-extension (FE) and closed-chain exercises (sit-to-stand (STS) and squatting (SQ)) were analyzed using fluoroscopy. (1) Kinematic patterns were compared between PS and CCK implants, focusing on AP translation, internal-external (IE) rotation, varus-valgus (VV) rotation, range of motion (ROM) and post-cam engagement. (2) Joint line elevation was defined as a ≥4 mm increase compared to the native knee on a weight-bearing radiograph, and comparisons were made between patients with and without JLE.

Results

(1) No significant differences were observed in kinematic patterns between PS and CCK implants in rTKA. (2) A JLE ≥4 mm led to instability during squatting, particularly in early- and mid-flexion, with a significantly more anterior position in the medial compartment (0–30°: p = 0.037; 30–60°: p = 0.021). Although post-cam engagement was delayed in patients with JLE, the difference was not statistically significant (p = 0.173)

Conclusion

(1) CCK implants have a kinematic pattern similar to PS implants in revision setting, supporting their use when appropriate, (2) JLE is associated with instability during squatting in early- and mid-flexion.

{"title":"Similar kinematic patterns in posterior-stabilized and condylar constrained knee prostheses in revision knee arthroplasty: a prospective cohort study","authors":"Lenka Stroobant , Hannes Vermue , Ewoud Jacobs , Nele Arnout , Stefaan Van Onsem , Scott A. Banks , Jan Victor , Amélie Chevalier","doi":"10.1016/j.jor.2025.04.004","DOIUrl":"10.1016/j.jor.2025.04.004","url":null,"abstract":"<div><h3>Background</h3><div>The rising incidence of primary total knee arthroplasty (pTKA) is expected to lead to more revision TKAs (rTKA), which pose greater challenges and poorer outcomes, burdening both patients and healthcare systems. Knee kinematics play a key role in pTKA outcomes, but less is known about rTKA, where high-constraint implants and joint line elevation (JLE) may affect knee kinematics. The study aimed to: (1) Compare kinematic patterns between posterior-stabilized (PS) and condylar constrained (CCK) implants during open- and closed-chain exercises in rTKA; (2) Assess the impact of JLE on anteroposterior translation and post-cam engagement.</div></div><div><h3>Methods</h3><div>Thirty patients (19 with PS implants and 11 with CCK implants) who underwent rTKA between 2022 and 2024 were tested at a minimum six-month follow-up. Tibiofemoral kinematics during open-chain flexion-extension (FE) and closed-chain exercises (sit-to-stand (STS) and squatting (SQ)) were analyzed using fluoroscopy. (1) Kinematic patterns were compared between PS and CCK implants, focusing on AP translation, internal-external (IE) rotation, varus-valgus (VV) rotation, range of motion (ROM) and post-cam engagement. (2) Joint line elevation was defined as a ≥4 mm increase compared to the native knee on a weight-bearing radiograph, and comparisons were made between patients with and without JLE.</div></div><div><h3>Results</h3><div>(1) No significant differences were observed in kinematic patterns between PS and CCK implants in rTKA. (2) A JLE ≥4 mm led to instability during squatting, particularly in early- and mid-flexion, with a significantly more anterior position in the medial compartment (0–30°: p = 0.037; 30–60°: p = 0.021). Although post-cam engagement was delayed in patients with JLE, the difference was not statistically significant (p = 0.173)</div></div><div><h3>Conclusion</h3><div>(1) CCK implants have a kinematic pattern similar to PS implants in revision setting, supporting their use when appropriate, (2) JLE is associated with instability during squatting in early- and mid-flexion.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"64 ","pages":"Pages 153-162"},"PeriodicalIF":1.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical outcomes of a 'patella-friendly' medial pivot total knee arthroplasty with and without patella resurfacing: A prospective randomised study

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-04-21 DOI: 10.1016/j.jor.2025.04.005

Piers J. Yates , Georgina Waters , Stephen J. Edmondston

Background

Advances in knee implant design brings new focus on the benefit of patella resurfacing in total knee arthroplasty (TKA). The “patella-friendly” medial pivot SAIPH™ knee was designed to provide a more optimal patella articular environment, potentially reducing the requirement for patella resurfacing. This study examined anterior knee pain and related clinical outcomes when patella resurfacing (PR) was randomised against retention of the native knee.

Methods

In a prospective study, fifty-one patients having a primary TKA were randomised to PR or non-RP prior to surgery. All patients received the same ‘patella-friendly’ implant using a standardized surgical technique. Patient demographics were recorded prior to surgery and intra-operative assessment of patella surface degeneration was conducted for all patients. Outcomes were evaluated at 4 weeks and one year. The primary outcome was the Kujala Anterior Knee Pain Score (KS), and secondary outcomes were the Patient Knee Implant Performance Score (PKIP), Oxford Knee Score (OKS) and Forgotten Joint Score (FJS). Complications requiring surgical management or mobility restriction treated with manipulation under anaesthesia (MUA) were recorded over the duration of the study.

Results

There was no significant difference between groups in baseline age (p = 0.67) or BMI (p = 0.97). Between-group differences in KS were not significant at 4 weeks (PR 55.3 Non-PR 53.6, p = 0.67) and 12 months (PR 78.4 Non-PR 77.6, p = 0.86). No significant between group differences were identified for the PKIP, OKS or FJS at both follow-up time points. The proportion of satisfied patients was not significantly different between groups (p = 0.14). No patients required revision surgery. Three patients in the non-PR group and one patient in the PR group required MUA (p = 0.32).

Conclusion

Patella resurfacing demonstrated no superiority compared to non-resurfacing in relation to clinical outcomes and post-operative complications when using a 'patella-friendly' implant.

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引用次数: 0

Predictors of improved and decreased range of motion after medial pivot total knee arthroplasty: A multicenter retrospective analysis

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-04-14 DOI: 10.1016/j.jor.2025.04.002

Tsuneari Takahashi , Kazuhisa Hatayama , Masahiro Nishino , Tatsuya Kubo , Hironari Hai , Yuichiro Yamada , Kosuke Suzuki , Katsushi Takeshita

Introduction

No study has identified predictors of improvement and decrease in postoperative range of motion (ROM) after medial pivot (MP) total knee arthroplasty (TKA) compared to preoperative ROM. This multicenter study aimed to identify predictors of improved postoperative range of motion (ROM) after MP-TKA.

Methods

The study included 107 consecutive patients who underwent MP-TKA for knee osteoarthritis at six different centers. Data on patient age, gender, hip knee angle, and pre- and postoperative ROM in extension and flexion were collected. A 9° improvement or decrease in postoperative knee flexion was considered positive. Patients were divided into three groups according to whether knee flexion improved by more than 9° (group I; 35 patients), changed within the minimal clinically important difference (MCID) (group M; 54 patients), or decreased by more than 9° (group D; 18 patients) one year after surgery.

Results

Significant differences in preoperative ROM for flexion were observed between the groups (P < 0.001). Multivariate and receiver operating characteristic (ROC) curve analyses revealed that preoperative flexion less than 118.0° (area under the curve (AUC): 0.957, 95 % confidence interval (CI): 0.924–0.990) was a significant positive prognostic factor for improved postoperative ROM one year postoperatively (odds ratio (OR): 0.75, 95 % CI: 0.66–0.85, P < 0.001) and that preoperative flexion greater than 128.0° (AUC: 0.899, 95 % CI: 0.836–0.961) was a significant positive prognostic factor for decreased postoperative ROM one year postoperatively (OR: 1.14, 95 % CI: 1.07–1.22, P < 0.001).

Discussion

The results showed that a preoperative knee flexion ROM of less than 118° was a significant positive predictor of an improvement in knee flexion ROM of MCID or greater after MP-TKA, and a knee flexion ROM of 128° or greater was a significant positive predictor of a decrease in knee flexion ROM of MCID or greater one year after surgery.

导言：与术前运动范围（ROM）相比，目前还没有研究确定内侧枢轴（MP）全膝关节置换术（TKA）术后运动范围（ROM）改善或缩小的预测因素。这项多中心研究旨在确定MP-TKA术后活动范围（ROM）改善的预测因素。研究纳入了在六个不同中心接受MP-TKA治疗膝骨关节炎的107名连续患者。研究收集了患者的年龄、性别、髋膝关节角度、术前术后伸屈ROM等数据。术后膝关节屈曲度提高或降低9°为阳性。根据术后一年膝关节屈曲度改善是否超过 9°（I 组；35 例患者）、变化是否在最小临床意义差异（MCID）范围内（M 组；54 例患者）或减少是否超过 9°（D 组；18 例患者），将患者分为三组。多变量和接收器操作特征曲线（ROC）分析表明，术前屈曲度小于 118.0°（曲线下面积（AUC）：0.957，95 % 置信度）的患者术后一年后的屈曲 ROM 比术前小于 118.0°的患者术后一年后的屈曲 ROM 高：0.957，95% 置信区间（CI）：0.924-0.990）是术后一年 ROM 改善的重要积极预后因素（几率比（OR）：0.75，95% CI：0.66-0.85，P < 0.001），术前屈曲度大于 128.0°（AUC：0.899，95 % CI：0.836-0.961）是术后一年 ROM 下降的显著阳性预后因素（OR：1.讨论结果显示，术前膝关节屈曲 ROM 小于 118° 是 MP-TKA 术后膝关节屈曲 ROM 改善达到或超过 MCID 的显著阳性预测因子，而膝关节屈曲 ROM 达到或超过 128° 是术后一年膝关节屈曲 ROM 降低达到或超过 MCID 的显著阳性预测因子。

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引用次数: 0

Ream-and-run technique offers equivalent clinical outcomes as anatomical total shoulder arthroplasty but with a high rate of complications: A systematic review and meta-analysis 切口缝合技术的临床效果与解剖型全肩关节置换术相当，但并发症发生率较高：系统回顾和荟萃分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-04-14 DOI: 10.1016/j.jor.2025.04.003

Omar E. S. Mostafa , Robert W. Jordan , Tanujan Thangarajah , Simon MacLean , Jarret Woodmass , Peter D'Alessandro , Shahbaz S. Malik

Purpose

This review aims to explore if the Ream and Run (RnR) technique is associated with better outcomes and lower complications than the traditional Anatomical Total Shoulder Replacement (aTSA) for osteoarthritis.

Methods

A systematic search of the literature was conducted using Medline, Embase and Cochrane in accordance with the PRISMA guidelines on March 2, 2024. Only comparative studies of adult patients with glenohumeral osteoarthritis (OA) comparing RnR and aTSA were included. Basic demographics, patient-reported outcome measures (PROMs) and complications were extracted and analysed. Quality assessment was performed using the Newcastle-Ottawa Score (NOS) tool and meta-analysis of outcomes reported by two or more studies was performed using Cochrane RevMan Web.

Results

A total of 1548 patients were pooled from eight studies [RnR 738 vs aTSA 810]. Mean age in the RnR group ranged from 52.8 to 60.3 years with 93.6 % being male, compared with age range of 53–67.5 years in the aTSA group with 56 % being male. Five patients in the RnR group were Walch grade C or D, compared with three patients in the aTSA. No difference was observed between the two groups in post-operative SST score [P < 0.04], post-operative ASES score [P = 0.57] or degree of post-operative forward flexion [P < 0.41]. There was a statistically significant improvement in post-operative degree of external rotation, favouring RnR [MD -8.35, 95 % CI -14.69 to −2.01, P < 0.01] but without a significant clinical importance. The overall rate of complications in the RnR group was 15.4 % and 5.3 % in the aTSA group. The commonest reported complication in RnR group was chronic pain and stiffness (3.9 %) and soft tissue failure in the aTSA group (2.7 %). Overall rate of return-to-theatre was 7 % in RnR and 2.7 % in aTSA group.

Conclusion

Both aTSA and RnR offer improvement in shoulder PROMS. However, the overall re-operation rate and complications appeared high in RnR group. The choice of technique should be tailored to the patient's pre-operative baseline, activity level and desired goals.

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引用次数: 0

Comparative outcomes of kinematically aligned TKA with medial stabilized design vs. mechanically aligned TKA with bi-cruciate stabilized design: A propensity score-matched analysis

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-04-11 DOI: 10.1016/j.jor.2025.04.001

Ryota Fujii , Tsuneari Takahashi , Masaki Iguchi , Katsushi Takeshita , Kazuyoshi Nakanishi

Purpose

Patient dissatisfaction after total knee arthroplasty (TKA) is often linked to altered knee kinematics and stability. This study compared the short-term clinical outcomes of kinematically aligned TKA (KA-TKA) and mechanically aligned TKA (MA-TKA) using bi-cruciate stabilized (BCS) implants.

Methods

In this propensity score-matched study, 60 patients who underwent either KA-TKA or MA-TKA (30 per group) with BCS implants were analyzed. Baseline characteristics, including age, sex, preoperative range of motion (ROM), and hip-knee-ankle alignment, were matched. ROM and clinical outcomes were evaluated preoperatively and at 1 year postoperatively using the 2011 Knee Society Score (KSS) subscales and Forgotten Joint Score-12 (FJS).

Results

At 1 year, the KA group achieved higher scores in KSS subscales for symptoms (23.2 vs. 20.0, p < 0.001), satisfaction (28.1 vs. 22.5, p < 0.001), functional activities (82.1 vs. 74.2, p = 0.011), and FJS (83.8 vs. 62.5, p < 0.001). No significant differences were observed in maximum extension, flexion, or KSS expectations.

Conclusions

KA-TKA demonstrated superior satisfaction and functional recovery than MA-TKA with BCS implants in the short term. These results suggested that KA-TKA, which reconstructs patient-specific alignment, may provide a more natural knee feel, leading to higher patient satisfaction compared to implant-driven BCS-TKA.

{"title":"Comparative outcomes of kinematically aligned TKA with medial stabilized design vs. mechanically aligned TKA with bi-cruciate stabilized design: A propensity score-matched analysis","authors":"Ryota Fujii , Tsuneari Takahashi , Masaki Iguchi , Katsushi Takeshita , Kazuyoshi Nakanishi","doi":"10.1016/j.jor.2025.04.001","DOIUrl":"10.1016/j.jor.2025.04.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Patient dissatisfaction after total knee arthroplasty (TKA) is often linked to altered knee kinematics and stability. This study compared the short-term clinical outcomes of kinematically aligned TKA (KA-TKA) and mechanically aligned TKA (MA-TKA) using bi-cruciate stabilized (BCS) implants.</div></div><div><h3>Methods</h3><div>In this propensity score-matched study, 60 patients who underwent either KA-TKA or MA-TKA (30 per group) with BCS implants were analyzed. Baseline characteristics, including age, sex, preoperative range of motion (ROM), and hip-knee-ankle alignment, were matched. ROM and clinical outcomes were evaluated preoperatively and at 1 year postoperatively using the 2011 Knee Society Score (KSS) subscales and Forgotten Joint Score-12 (FJS).</div></div><div><h3>Results</h3><div>At 1 year, the KA group achieved higher scores in KSS subscales for symptoms (23.2 vs. 20.0, <em>p</em> < 0.001), satisfaction (28.1 vs. 22.5, <em>p</em> < 0.001), functional activities (82.1 vs. 74.2, <em>p</em> = 0.011), and FJS (83.8 vs. 62.5, <em>p</em> < 0.001). No significant differences were observed in maximum extension, flexion, or KSS expectations.</div></div><div><h3>Conclusions</h3><div>KA-TKA demonstrated superior satisfaction and functional recovery than MA-TKA with BCS implants in the short term. These results suggested that KA-TKA, which reconstructs patient-specific alignment, may provide a more natural knee feel, leading to higher patient satisfaction compared to implant-driven BCS-TKA.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"63 ","pages":"Pages 196-200"},"PeriodicalIF":1.5,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0