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Body Mass Index Above 35 Has Increased Risk of Complications but Still Achieves Clinically Meaningful Improvement in Patient-Reported Outcomes After Anterior-Based Total Hip Arthroplasty

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-15 DOI: 10.1016/j.artd.2025.101665

Alexander S. Dash MD, MSCR, Michael A. Hewitt BA, Richard A. Ruberto MD, Tiffany A. Smith MD, Carl L. Herndon MD, Nana O. Sarpong MD, MBA

Background

Increased perioperative complications in obese patients undergoing total hip arthroplasty (THA) have previously been reported. There is a relative paucity of data evaluating these complications strictly in the context of anterior-based THA. In this study, we compare the outcomes following anterior-based THA as a function of body mass index (BMI).

Methods

A 1:1 matched retrospective cohort study was conducted. Patients undergoing anterior-based THA from January 2022 to June 2024 with a BMI >35 kg/m² were matched 1:1 based on age and sex to patients with a BMI <35 kg/m² from our division registry. Demographic data, surgical details, complications (intraoperative and postoperative), and patient-reported outcome measures (PROMs: 12-Item Short Form P/M, Western Ontario and McMaster Universities Osteoarthritis Index-P/S/F) were collected and analyzed.

Results

There were 280 patients included (140 per group). There were 27 postoperative complications in the BMI >35 kg/m² group and 10 in the BMI <35 kg/m² group (P < .01). There were 10 major complications (4 dislocations, 2 periprosthetic fractures, and 4 deep infections requiring incision and drainage) in the BMI over 35 kg/m² group, with no major complications occurring in the lower BMI group. There were 3 intraoperative complications (periprosthetic fracture), all in patients with BMI >35 kg/m². There was significant improvement in Western Ontario and McMaster Universities Osteoarthritis Index P/S/F scores and 12-Item Short Form pain in both groups at 3 months postoperatively, with greater improvements seen in the BMI >35 kg/m² group.

Conclusions

The present study found that despite significant differences in postoperative complications, there were significant improvements in PROMs in patients with a BMI above and below 35 kg/m² who underwent anterior THA.

{"title":"Body Mass Index Above 35 Has Increased Risk of Complications but Still Achieves Clinically Meaningful Improvement in Patient-Reported Outcomes After Anterior-Based Total Hip Arthroplasty","authors":"Alexander S. Dash MD, MSCR, Michael A. Hewitt BA, Richard A. Ruberto MD, Tiffany A. Smith MD, Carl L. Herndon MD, Nana O. Sarpong MD, MBA","doi":"10.1016/j.artd.2025.101665","DOIUrl":"10.1016/j.artd.2025.101665","url":null,"abstract":"<div><h3>Background</h3><div>Increased perioperative complications in obese patients undergoing total hip arthroplasty (THA) have previously been reported. There is a relative paucity of data evaluating these complications strictly in the context of anterior-based THA. In this study, we compare the outcomes following anterior-based THA as a function of body mass index (BMI).</div></div><div><h3>Methods</h3><div>A 1:1 matched retrospective cohort study was conducted. Patients undergoing anterior-based THA from January 2022 to June 2024 with a BMI >35 kg/m<sup>2</sup> were matched 1:1 based on age and sex to patients with a BMI <35 kg/m<sup>2</sup> from our division registry. Demographic data, surgical details, complications (intraoperative and postoperative), and patient-reported outcome measures (PROMs: 12-Item Short Form P/M, Western Ontario and McMaster Universities Osteoarthritis Index-P/S/F) were collected and analyzed.</div></div><div><h3>Results</h3><div>There were 280 patients included (140 per group). There were 27 postoperative complications in the BMI >35 kg/m<sup>2</sup> group and 10 in the BMI <35 kg/m<sup>2</sup> group (<em>P</em> < .01). There were 10 major complications (4 dislocations, 2 periprosthetic fractures, and 4 deep infections requiring incision and drainage) in the BMI over 35 kg/m<sup>2</sup> group, with no major complications occurring in the lower BMI group. There were 3 intraoperative complications (periprosthetic fracture), all in patients with BMI >35 kg/m<sup>2</sup>. There was significant improvement in Western Ontario and McMaster Universities Osteoarthritis Index P/S/F scores and 12-Item Short Form pain in both groups at 3 months postoperatively, with greater improvements seen in the BMI >35 kg/m<sup>2</sup> group.</div></div><div><h3>Conclusions</h3><div>The present study found that despite significant differences in postoperative complications, there were significant improvements in PROMs in patients with a BMI above and below 35 kg/m<sup>2</sup> who underwent anterior THA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101665"},"PeriodicalIF":1.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fracture of the Femoral Broach Locking Mechanism and Surgical Technique to Retrieve the Broach

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-15 DOI: 10.1016/j.artd.2025.101642

Peter P. Hsiue MD , Jeffrey A. O’Donnell MD , Ryan Cheng BA , Elliot Sappey-Marinier MD , Tarik Ait Si Selmi MD , Friedrich Boettner MD

The current case series reports on 4 cases of intraoperative fracture of the femoral broach locking mechanism during total hip arthroplasty and subsequent entrapment of the broach. Three of the cases were performed via the direct anterior approach and 1 was performed with the posterolateral approach. Two femoral broach locking mechanisms fractured with the use of a power broaching device and 2 occurred when using the calcar planar. The authors also discuss a minimally invasive technique to remove the broach. While intraoperative fracture of the femoral broach locking mechanism is not a common complication, surgeons should be aware of the potential causes of these complications as well as strategies and techniques to retrieve the broach should they encounter this issue.

引用次数: 0

How Much Does a Computed Tomography-Based Mixed-Reality Navigation System Change Freehand Acetabular Component Position?

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-14 DOI: 10.1016/j.artd.2025.101661

Justin Leal BS , Alexander F. Heimann MD , Eric S. Dilbone MD , Sean P. Ryan MD , Samuel S. Wellman MD

Background

This study evaluates how a computed tomography-based mixed-reality (MR) navigation system impacts acetabular component orientation compared to freehand positioning in total hip arthroplasty.

Methods

A series of 79 patients who underwent total hip arthroplasty utilizing a computed tomography-based MR navigation system were reviewed. The surgeon initially placed the acetabular cup freehand, attempting to achieve the preoperative plan, and this initial intraoperative orientation was recorded. The cup was then adjusted to the planned position. The difference between freehand and planned tilt-adjusted operative anteversion (OA) and inclination (OI) determined the navigation tool’s impact.

Results

The mean preoperative planned OA was 30.1 ± 2.0 (range: 25, 35) degrees, and the mean freehand intraoperative OA was 30.2 ± 9.1 (range: 4, 57) degrees (P = .885), requiring a mean adjustment of 6.8 ± 5.1 (range: 0, 23) degrees. Freehand OA was corrected at least 5 degrees in 54.4% (43/79) of cases. The mean preoperative planned OI was 40.8 ± 0.6 (range: 39, 42) degrees, and the mean freehand intraoperative OI was 37.8 ± 6.6 (range: 18, 53) degrees (P < .001), requiring a mean adjustment of 5.7 ± 4.5 (range: 0, 22) degrees to achieve. Freehand OI was corrected at least 5 degrees in 43.0% (34/79) of cases.

Conclusions

Freehand acetabular component positioning in the lateral position is variable when attempting to execute patient-specific numerical cup orientation targets. Use of this navigation tool led the surgeon to correct more than 5 degrees in both OA and OI in roughly half of the hips.

{"title":"How Much Does a Computed Tomography-Based Mixed-Reality Navigation System Change Freehand Acetabular Component Position?","authors":"Justin Leal BS , Alexander F. Heimann MD , Eric S. Dilbone MD , Sean P. Ryan MD , Samuel S. Wellman MD","doi":"10.1016/j.artd.2025.101661","DOIUrl":"10.1016/j.artd.2025.101661","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluates how a computed tomography-based mixed-reality (MR) navigation system impacts acetabular component orientation compared to freehand positioning in total hip arthroplasty.</div></div><div><h3>Methods</h3><div>A series of 79 patients who underwent total hip arthroplasty utilizing a computed tomography-based MR navigation system were reviewed. The surgeon initially placed the acetabular cup freehand, attempting to achieve the preoperative plan, and this initial intraoperative orientation was recorded. The cup was then adjusted to the planned position. The difference between freehand and planned tilt-adjusted operative anteversion (OA) and inclination (OI) determined the navigation tool’s impact.</div></div><div><h3>Results</h3><div>The mean preoperative planned OA was 30.1 ± 2.0 (range: 25, 35) degrees, and the mean freehand intraoperative OA was 30.2 ± 9.1 (range: 4, 57) degrees (<em>P</em> = .885), requiring a mean adjustment of 6.8 ± 5.1 (range: 0, 23) degrees. Freehand OA was corrected at least 5 degrees in 54.4% (43/79) of cases. The mean preoperative planned OI was 40.8 ± 0.6 (range: 39, 42) degrees, and the mean freehand intraoperative OI was 37.8 ± 6.6 (range: 18, 53) degrees (<em>P</em> < .001), requiring a mean adjustment of 5.7 ± 4.5 (range: 0, 22) degrees to achieve. Freehand OI was corrected at least 5 degrees in 43.0% (34/79) of cases.</div></div><div><h3>Conclusions</h3><div>Freehand acetabular component positioning in the lateral position is variable when attempting to execute patient-specific numerical cup orientation targets. Use of this navigation tool led the surgeon to correct more than 5 degrees in both OA and OI in roughly half of the hips.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101661"},"PeriodicalIF":1.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Residual Postoperative Valgus After Total Knee Arthroplasty for Preoperative Valgus Deformity Results in Inferior Patient-Reported Outcomes

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-13 DOI: 10.1016/j.artd.2025.101660

Anastasia A. Hunt MD, Ian Hollyer MD, Nicole S. Pham MPH, William J. Maloney MD, James I. Huddleston III MD

Background

The optimal postoperative coronal alignment after total knee arthroplasty (TKA) for preoperative valgus deformity is unknown. This study aims to evaluate the impact of postoperative coronal alignment on clinical outcomes following TKA for valgus deformities.

Methods

Patients in preoperative valgus undergoing primary TKA between 2010 and 2020 with at least 1 year of follow-up were retrospectively reviewed. Preoperative and postoperative mechanical alignment was assessed on long-leg radiographs via the hip-knee-ankle angle. Postoperative alignment was categorized into valgus (>2° valgus), neutral (within 2° of the mechanical axis), or varus (>2° varus). Patient demographics, preoperative and postoperative outcome scores, and complications were collected.

Results

106 patients met inclusion criteria, with a mean preoperative valgus deformity of 11° (standard deviation ± 6.1). Postoperatively, 18 patients were in varus alignment, 58 were neutral, and 30 remained in valgus. At 2-year follow-up, multivariate analyses showed that patients in neutral or varus alignment postoperatively had superior Veterans RAND 12-Item Health Survey Physical and Knee injury and Osteoarthritis Outcome Score Pain scores compared to those in residual valgus. Varus knees showed significantly greater improvement in Knee Society Score Function scores compared to valgus knees. At final follow-up, Knee injury and Osteoarthritis Outcome Score Pain scores were significantly better in varus knees. Patients in varus were 7.79 times more likely to achieve the minimal clinically important difference VR-12 Physical score, while patients in neutral were 3.26 times more likely to achieve the minimal clinically important difference for Knee Society Score Function when compared to valgus knees.

Conclusions

Correcting preoperative valgus coronal alignment to neutral or varus yields improved patient-reported outcomes when compared to residual valgus.

{"title":"Residual Postoperative Valgus After Total Knee Arthroplasty for Preoperative Valgus Deformity Results in Inferior Patient-Reported Outcomes","authors":"Anastasia A. Hunt MD, Ian Hollyer MD, Nicole S. Pham MPH, William J. Maloney MD, James I. Huddleston III MD","doi":"10.1016/j.artd.2025.101660","DOIUrl":"10.1016/j.artd.2025.101660","url":null,"abstract":"<div><h3>Background</h3><div>The optimal postoperative coronal alignment after total knee arthroplasty (TKA) for preoperative valgus deformity is unknown. This study aims to evaluate the impact of postoperative coronal alignment on clinical outcomes following TKA for valgus deformities.</div></div><div><h3>Methods</h3><div>Patients in preoperative valgus undergoing primary TKA between 2010 and 2020 with at least 1 year of follow-up were retrospectively reviewed. Preoperative and postoperative mechanical alignment was assessed on long-leg radiographs via the hip-knee-ankle angle. Postoperative alignment was categorized into valgus (>2° valgus), neutral (within 2° of the mechanical axis), or varus (>2° varus). Patient demographics, preoperative and postoperative outcome scores, and complications were collected.</div></div><div><h3>Results</h3><div>106 patients met inclusion criteria, with a mean preoperative valgus deformity of 11° (standard deviation ± 6.1). Postoperatively, 18 patients were in varus alignment, 58 were neutral, and 30 remained in valgus. At 2-year follow-up, multivariate analyses showed that patients in neutral or varus alignment postoperatively had superior Veterans RAND 12-Item Health Survey Physical and Knee injury and Osteoarthritis Outcome Score Pain scores compared to those in residual valgus. Varus knees showed significantly greater improvement in Knee Society Score Function scores compared to valgus knees. At final follow-up, Knee injury and Osteoarthritis Outcome Score Pain scores were significantly better in varus knees. Patients in varus were 7.79 times more likely to achieve the minimal clinically important difference VR-12 Physical score, while patients in neutral were 3.26 times more likely to achieve the minimal clinically important difference for Knee Society Score Function when compared to valgus knees.</div></div><div><h3>Conclusions</h3><div>Correcting preoperative valgus coronal alignment to neutral or varus yields improved patient-reported outcomes when compared to residual valgus.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101660"},"PeriodicalIF":1.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Corrigendum to ‘A Modified Wagner Stem Design Increases the Primary Stability in Cementless Revision Hip Arthroplasty’ [Arthroplasty Today 32 (2025) 101622]

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-13 DOI: 10.1016/j.artd.2025.101657

Julius M. Boettcher MSc , Kay Sellenschloh (Dipl. Ing) , Gerd Huber (Dr.) , Benjamin Ondruschka (Professor) , Michael M. Morlock (Professor)

引用次数: 0

Is Robotic-Assisted Unicompartmental Knee Arthroplasty Compared to Manual Unicompartmental Knee Arthroplasty Associated With Decreased Revision Rates? An Updated Matched Cohort Analysis

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-12 DOI: 10.1016/j.artd.2025.101652

George Guild MD , Joseph Schwab MD , Bailey J. Ross MD , Mary Jane McConnell BS , Farideh Najafi MD , Thomas L. Bradbury MD

Background

Despite increased utilization of robotic assistance during unicompartmental knee arthroplasty (UKA), its impact on postoperative outcomes remains unclear. This study aimed to compare rates of postoperative revision and complications among patients undergoing robotic-assisted UKA (RA-UKA) versus manual UKA.

Methods

A retrospective matched cohort study was performed. Trends analysis of the annual proportion of RA-UKA between 2010 and 2021 was performed, and RA-UKA patients (n = 3976) were matched 1:3 with manual UKA patients (n = 11,766) across age, sex, Elixhauser Comorbidity Index, and comorbidities. Rates of 2-year prosthesis-related complications were compared between the matched cohorts using multivariable logistic regression.

Results

The annual proportion of UKA procedures performed with robotic assistance trended significantly upward (1.51% to 5.19%, P < .001). Within 2 years postoperatively, the RA-UKA cohort exhibited significantly lower rates of aseptic revision (1.84% vs 2.37%; odds ratio: 0.76; P = .040) and aseptic loosening (0.13% vs 0.42%; odds ratio: 0.32; P = .010). Total cost for the index UKA was significantly higher for the RA-UKA cohort ($10,321 vs $7,366; P < .001).

Conclusions

There has been a marked increase in utilization of RA-UKA. Compared to matched manual UKA, RA-UKA had lower rates of revision and aseptic loosening at 2-year follow-up, but at a higher total cost for the index procedure. Further research exploring the use of robotics in UKA with attention to patient outcomes and cost is crucial for defining its evolving role in orthopaedic surgery.

{"title":"Is Robotic-Assisted Unicompartmental Knee Arthroplasty Compared to Manual Unicompartmental Knee Arthroplasty Associated With Decreased Revision Rates? An Updated Matched Cohort Analysis","authors":"George Guild MD , Joseph Schwab MD , Bailey J. Ross MD , Mary Jane McConnell BS , Farideh Najafi MD , Thomas L. Bradbury MD","doi":"10.1016/j.artd.2025.101652","DOIUrl":"10.1016/j.artd.2025.101652","url":null,"abstract":"<div><h3>Background</h3><div>Despite increased utilization of robotic assistance during unicompartmental knee arthroplasty (UKA), its impact on postoperative outcomes remains unclear. This study aimed to compare rates of postoperative revision and complications among patients undergoing robotic-assisted UKA (RA-UKA) versus manual UKA.</div></div><div><h3>Methods</h3><div>A retrospective matched cohort study was performed. Trends analysis of the annual proportion of RA-UKA between 2010 and 2021 was performed, and RA-UKA patients (n = 3976) were matched 1:3 with manual UKA patients (n = 11,766) across age, sex, Elixhauser Comorbidity Index, and comorbidities. Rates of 2-year prosthesis-related complications were compared between the matched cohorts using multivariable logistic regression.</div></div><div><h3>Results</h3><div>The annual proportion of UKA procedures performed with robotic assistance trended significantly upward (1.51% to 5.19%, <em>P</em> < .001). Within 2 years postoperatively, the RA-UKA cohort exhibited significantly lower rates of aseptic revision (1.84% vs 2.37%; odds ratio: 0.76; <em>P</em> = .040) and aseptic loosening (0.13% vs 0.42%; odds ratio: 0.32; <em>P</em> = .010). Total cost for the index UKA was significantly higher for the RA-UKA cohort ($10,321 vs $7,366; <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>There has been a marked increase in utilization of RA-UKA. Compared to matched manual UKA, RA-UKA had lower rates of revision and aseptic loosening at 2-year follow-up, but at a higher total cost for the index procedure. Further research exploring the use of robotics in UKA with attention to patient outcomes and cost is crucial for defining its evolving role in orthopaedic surgery.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101652"},"PeriodicalIF":1.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143601390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

One High-Volume Posteromedial Knee Capsular Injection Can Provide Safe Anesthetic Infiltration Across the Entire Posterior Knee Capsule

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-12 DOI: 10.1016/j.artd.2025.101651

Ran Atzmon MD , Landon Polakof MD , Adam Wang PhD , Seth Sherman MD , Nicholas John Giori MD, PhD

Background

Anesthetic injection through the central or posterolateral knee capsule for analgesia after knee surgery risks popliteal vessel and tibial and peroneal nerve injury. We evaluated the distribution of a high volume of fluid injected through only the posteromedial capsule and compared it to a technique involving injections through the posteromedial and posterolateral capsules.

Methods

Four fresh cadaveric knees were injected with 50 ml of Omnipaque 350 diluted 1:4 with normal saline through the posteromedial knee capsule. In four other specimens, we followed a published protocol by injecting 12.5 ml posteromedially and 12.5 ml posterolaterally. The knees were then ranged 20 times over 20 minutes before obtaining a computed tomography scan to evaluate the spread of injected contrast fluid.

Results

Both techniques demonstrated broad distribution of injected fluid posterior to the capsule. An average of 80% of the capsular width at the level of the injection was within 5 mm of the injected contrast with the single injection, while 63% was with the two-injection technique.

Conclusions

One 50 mL injection through the posteromedial knee capsule can provide broad medial, lateral, superior, and inferior distribution of anesthetic without risking injury to neurovascular structures. This has become our preferred method of anesthetizing the posterior knee during knee surgery.

{"title":"One High-Volume Posteromedial Knee Capsular Injection Can Provide Safe Anesthetic Infiltration Across the Entire Posterior Knee Capsule","authors":"Ran Atzmon MD , Landon Polakof MD , Adam Wang PhD , Seth Sherman MD , Nicholas John Giori MD, PhD","doi":"10.1016/j.artd.2025.101651","DOIUrl":"10.1016/j.artd.2025.101651","url":null,"abstract":"<div><h3>Background</h3><div>Anesthetic injection through the central or posterolateral knee capsule for analgesia after knee surgery risks popliteal vessel and tibial and peroneal nerve injury. We evaluated the distribution of a high volume of fluid injected through only the posteromedial capsule and compared it to a technique involving injections through the posteromedial and posterolateral capsules.</div></div><div><h3>Methods</h3><div>Four fresh cadaveric knees were injected with 50 ml of Omnipaque 350 diluted 1:4 with normal saline through the posteromedial knee capsule. In four other specimens, we followed a published protocol by injecting 12.5 ml posteromedially and 12.5 ml posterolaterally. The knees were then ranged 20 times over 20 minutes before obtaining a computed tomography scan to evaluate the spread of injected contrast fluid.</div></div><div><h3>Results</h3><div>Both techniques demonstrated broad distribution of injected fluid posterior to the capsule. An average of 80% of the capsular width at the level of the injection was within 5 mm of the injected contrast with the single injection, while 63% was with the two-injection technique.</div></div><div><h3>Conclusions</h3><div>One 50 mL injection through the posteromedial knee capsule can provide broad medial, lateral, superior, and inferior distribution of anesthetic without risking injury to neurovascular structures. This has become our preferred method of anesthetizing the posterior knee during knee surgery.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101651"},"PeriodicalIF":1.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143601386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Two-Dimensional Preoperative Digital Templating is Less Accurate When Using a Collared Triple Taper Stem Versus a Single Taper Design

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-11 DOI: 10.1016/j.artd.2025.101658

Claudio Diaz-Ledezma MD , Angel X. Xiao MD, MSE , Juan David Lizcano MD , Erik N. Hansen MD , Camilo Restrepo MD , William J. Hozack MD

Background

Collared triple taper stems (CTTS) and single taper stems (STS) have an excellent performance in primary total hip arthroplasty (THA). While 2-dimensional radiographic templating is accurate for STS, data are lacking for CTTS. We hypothesize that CTTS’ more anatomical design in the anteroposterior dimension may lead to inaccurate templating sizing. This study compared templating accuracy of CTTS to a predecessor STS in THA patients.

Methods

106 THA performed with CTTS were compared to 106 THA performed with STS by 2 high-volume surgeons. The stems chosen for comparison were manufactured by the same company, use the same templating software, shared an identical medial-lateral profile, and offered the same size range. The ability of digital templating to predict final implant size was evaluated.

Results

Template to stem accuracy was 36.8% for CTTS and 49.1% for STS (P = .07). Accuracy within 1 size was 88.7% for CTTS versus 95.2% for STS (P = .1). CTTS was implanted using a smaller size compared to the template twice as frequently as STS (43.4% vs 20.8%; P < .01). CTTS was 3.7 times more likely to have implants 2 or more sizes under the template compared to STS (10.4% vs 2.8%; P = .02). In logistic regression, the only predictor of implant 2+ sizes under the template was type of stem (P = .04).

Conclusions

The accuracy of conventional templating for CTTS is lower than the predecessor STS, with the template often suggesting a larger size. Bi-planar or 3-dimensional preoperative templating could potentially be a more accurate technique, especially during the initial learning curve with these stems.

{"title":"Two-Dimensional Preoperative Digital Templating is Less Accurate When Using a Collared Triple Taper Stem Versus a Single Taper Design","authors":"Claudio Diaz-Ledezma MD , Angel X. Xiao MD, MSE , Juan David Lizcano MD , Erik N. Hansen MD , Camilo Restrepo MD , William J. Hozack MD","doi":"10.1016/j.artd.2025.101658","DOIUrl":"10.1016/j.artd.2025.101658","url":null,"abstract":"<div><h3>Background</h3><div>Collared triple taper stems (CTTS) and single taper stems (STS) have an excellent performance in primary total hip arthroplasty (THA). While 2-dimensional radiographic templating is accurate for STS, data are lacking for CTTS. We hypothesize that CTTS’ more anatomical design in the anteroposterior dimension may lead to inaccurate templating sizing. This study compared templating accuracy of CTTS to a predecessor STS in THA patients.</div></div><div><h3>Methods</h3><div>106 THA performed with CTTS were compared to 106 THA performed with STS by 2 high-volume surgeons. The stems chosen for comparison were manufactured by the same company, use the same templating software, shared an identical medial-lateral profile, and offered the same size range. The ability of digital templating to predict final implant size was evaluated.</div></div><div><h3>Results</h3><div>Template to stem accuracy was 36.8% for CTTS and 49.1% for STS (<em>P</em> = .07). Accuracy within 1 size was 88.7% for CTTS versus 95.2% for STS (<em>P</em> = .1). CTTS was implanted using a smaller size compared to the template twice as frequently as STS (43.4% vs 20.8%; <em>P</em> < .01). CTTS was 3.7 times more likely to have implants 2 or more sizes under the template compared to STS (10.4% vs 2.8%; <em>P</em> = .02). In logistic regression, the only predictor of implant 2+ sizes under the template was type of stem (<em>P</em> = .04).</div></div><div><h3>Conclusions</h3><div>The accuracy of conventional templating for CTTS is lower than the predecessor STS, with the template often suggesting a larger size. Bi-planar or 3-dimensional preoperative templating could potentially be a more accurate technique, especially during the initial learning curve with these stems.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101658"},"PeriodicalIF":1.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143592786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Administration of a Methylprednisolone Taper and Complication Rates Following Total Knee Arthroplasty: A Multicenter Retrospective Study

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-08 DOI: 10.1016/j.artd.2024.101603

Andrew A. Fuqua BS , Sean H. Gordon BS , Anoop S. Chandrashekar BS , Bridger Rodoni MD, MBA , Thea Xerogaenes , Ryan Martin MD , James Roberson MD , Gregory Polkowski MD, MSc , Jacob M. Wilson MD , Ajay Premkumar MD, MPH

Background

Most patients undergoing total knee arthroplasty (TKA) report moderate to severe pain in the acute postoperative period. Recent preliminary data have suggested that a short course of oral corticosteroid may improve early postoperative pain after various orthopedic operations, but the safety of this practice has not been rigorously evaluated in larger patient populations. The purpose of this study was to evaluate complication rates in patients receiving a methylprednisolone taper (MT) vs controls after primary TKA.

Methods

Records were reviewed for patients undergoing primary TKA from 2018 to 2023 by 2 surgeons at different institutions who began routinely prescribing a 6-day MT to patients without a contraindication or poorly controlled diabetes. The primary outcome of periprosthetic joint infection at 90 days and final follow-up was assessed as were secondary outcomes of surgical site infection and wound complications. A total of 930 patients were included in the study, with 641 patients in the control cohort and 289 patients in the methylprednisolone cohort.

Results

There were no significant differences between the methylprednisolone and control cohorts in 90-day periprosthetic joint infection (0.7% vs 0%, P = .1, respectively), surgical site infection (1.0% vs 1.4%, P = .4, respectively), or wound complication (1.0% vs 2.0%, P = .4, respectively). There were no significant differences in any complication at final follow-up.

Conclusions

MT following TKA did not significantly increase rates of wound complications or infections in this multi-institutional retrospective cohort study. This study provides preliminary evidence regarding the safety profile of a short duration of postoperative oral corticosteroids following TKA.

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引用次数: 0

Assessment of 90-Day Outcomes Following Total Joint Arthroplasty in Ambulatory Surgery Centers, Hospital Outpatient Departments, and Hospitals: A Michigan Arthroplasty Registry Collaborative Quality Initiative Analysis

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-08 DOI: 10.1016/j.artd.2025.101659

Simarjeet Puri MD , Martin Weaver MD , Lisheng Chen PhD , Tae Kim MHSA , Elizabeth Dailey MD , David C. Markel MD

Background

Total joint arthroplasty is shifting from hospitals to ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). A Michigan Arthroplasty Registry Quality Collaborative Initiative quality improvement project examined readmissions, emergency room (ER) visits, periprosthetic joint infection (PJI), fracture, and dislocation after primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) across sites.

Methods

Primary TJAs between July 1, 2021, and June 30, 2022 (N = 41,696: 3910 ASC, 1,834 HOPD, and 35,952 hospital) were reviewed. Of 17,100 THAs, 9.5% (1,631) were at ASCs, 4.7% (798) at HOPDs, and 85.8% (14,671) at hospitals. Of 24,596 TKAs, 9.3% (2,279) were at ASC, 4.2% (1,036) at HOPDs, and 86.5% (21,281) at hospitals. Hospitals treated more elderly, women, non-White, obese, diabetics, smokers, and governmental insurance.

Results

For THAs, ASCs had the lowest 30-day (ASC 1%, HOPD 1.8%, hospital 3.4%, P < .001) and 90-day (ASC 1.7%, HOPD 3.4%, hospital 5.5%, P < .001) readmissions, 30-day ER visits (ASC 1.8%, HOPD 3.5%, hospital 5.3%, P < .001), and fractures (ASC 0.4%, HOPD 0.6%, hospital 1.2%, P < .001). Similar trends were observed for TKAs: 30-day readmissions (ASC 1.3%, HOPD 1.4%, hospital 3.1%, P < .001), 90-day readmissions (ASC 2.2%, HOPD 2.3%, hospital 5.2%, P < .001), and 30-day ER visits (ASC 3%, HOPD 6.5%, hospital 6.4%, P < .001). PJI (THA: P = .1, TKA: P = .6) and dislocation rates (P = .5) were similar across sites.

Conclusions

Patients receiving primary total joint arthroplasty at an ASC had the least postoperative hospital-based care despite similar rates of PJI and dislocation.

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