Pub Date : 2024-11-16DOI: 10.1016/j.artd.2024.101558
Adam E. Roy MD , Alexandre Barbieri Mestriner MD , Brielle Antonelli BS, PA-S , Jakob Ackermann MD , Antonia F. Chen MD, MBA , Jeffrey K. Lange MD
Background
The second generation of a custom total knee arthroplasty (TKA) implant cast from a 3D-printed mold was introduced into the market in 2012. The purpose of this retrospective study was to investigate short- to mid-term survivorship and complication rates of this novel implant.
Methods
This study is a retrospective analysis of 314 TKA procedures (264 patients) performed by a single surgeon using a customized TKA from September 2012 to November 2015. Patient demographics, rate of implant revision, rate of reoperation for any reason, and rate of postoperative complications were recorded.
Results
At the time of index surgery, the mean patient age was 64.7 years, and the mean follow-up duration was 3 years. At the final follow-up, implant survivorship free from revision was 98.1%, and survivorship free from reoperation for any reason was 92.4%.
Conclusions
Our analysis revealed favorable short- to mid-term survivorship for a customized TKA implant. While the short- to mid-term outcomes for this implant are promising, future studies are required to assess long-term outcomes and durability.
{"title":"Early Results of a Patient-Specific Total Knee Arthroplasty Implant Cast From a 3D-Printed Mold","authors":"Adam E. Roy MD , Alexandre Barbieri Mestriner MD , Brielle Antonelli BS, PA-S , Jakob Ackermann MD , Antonia F. Chen MD, MBA , Jeffrey K. Lange MD","doi":"10.1016/j.artd.2024.101558","DOIUrl":"10.1016/j.artd.2024.101558","url":null,"abstract":"<div><h3>Background</h3><div>The second generation of a custom total knee arthroplasty (TKA) implant cast from a 3D-printed mold was introduced into the market in 2012. The purpose of this retrospective study was to investigate short- to mid-term survivorship and complication rates of this novel implant.</div></div><div><h3>Methods</h3><div>This study is a retrospective analysis of 314 TKA procedures (264 patients) performed by a single surgeon using a customized TKA from September 2012 to November 2015. Patient demographics, rate of implant revision, rate of reoperation for any reason, and rate of postoperative complications were recorded.</div></div><div><h3>Results</h3><div>At the time of index surgery, the mean patient age was 64.7 years, and the mean follow-up duration was 3 years. At the final follow-up, implant survivorship free from revision was 98.1%, and survivorship free from reoperation for any reason was 92.4%.</div></div><div><h3>Conclusions</h3><div>Our analysis revealed favorable short- to mid-term survivorship for a customized TKA implant. While the short- to mid-term outcomes for this implant are promising, future studies are required to assess long-term outcomes and durability.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101558"},"PeriodicalIF":1.5,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653764","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}
Pub Date : 2024-11-16DOI: 10.1016/j.artd.2024.101549
Leina Suzuki BE(Hons) , Francis Connon MBBS, FRACS , Selin Munir PhD , Sarah Piplica BHlthSci, MPH , Hemant Pandit FRCS (Orth), D Phil (Oxon) , Daevyd Rodda MBBS, FRACS
Background
Paper-based patient-reported outcome measures (PROMs) and patient education can assist in improving outcomes but is administratively burdensome. Mobile phone applications (‘apps’) can distribute extensive information and PROMs at relevant time points. This study aimed to assess the suitability of an app to guide postoperative management and record PROMs based on satisfaction and compliance.
Methods
Thirty-four patients who were scheduled for a total hip/knee arthroplasty were enrolled into the study. Automatic notifications were sent by the app to complete PROMs at the appropriate time points. Patients were reminded via phone call if PROMs were not completed. An app satisfaction questionnaire was also completed, where a high score represented satisfaction with the app.
Results
Patients remained satisfied with the app throughout the study with a mean score of 19.0 out of 25. 57% found the app to be helpful with completing surveys, with 63% preferring the app over paper handouts. Majority of the participants (68%) stated that they would use the app again. There was an overall mean compliance of 78% at all time points. Most patients (82%) required at least one phone call reminder, with 18% of patients completing their PROMs prompted by the app notification alone.
Conclusions
A mobile phone app can be useful for both distributing patient education and collecting PROMs. PROMs collected using a mobile phone app still caused some administrative burden with many participants requiring multiple reminders to complete their questionnaires. While paper-forms will still be required for some patients, most found the app preferable to paper-form.
{"title":"Evaluation of a Mobile App to Assist Patient Education and Research in Arthroplasty","authors":"Leina Suzuki BE(Hons) , Francis Connon MBBS, FRACS , Selin Munir PhD , Sarah Piplica BHlthSci, MPH , Hemant Pandit FRCS (Orth), D Phil (Oxon) , Daevyd Rodda MBBS, FRACS","doi":"10.1016/j.artd.2024.101549","DOIUrl":"10.1016/j.artd.2024.101549","url":null,"abstract":"<div><h3>Background</h3><div>Paper-based patient-reported outcome measures (PROMs) and patient education can assist in improving outcomes but is administratively burdensome. Mobile phone applications (‘apps’) can distribute extensive information and PROMs at relevant time points. This study aimed to assess the suitability of an app to guide postoperative management and record PROMs based on satisfaction and compliance.</div></div><div><h3>Methods</h3><div>Thirty-four patients who were scheduled for a total hip/knee arthroplasty were enrolled into the study. Automatic notifications were sent by the app to complete PROMs at the appropriate time points. Patients were reminded via phone call if PROMs were not completed. An app satisfaction questionnaire was also completed, where a high score represented satisfaction with the app.</div></div><div><h3>Results</h3><div>Patients remained satisfied with the app throughout the study with a mean score of 19.0 out of 25. 57% found the app to be helpful with completing surveys, with 63% preferring the app over paper handouts. Majority of the participants (68%) stated that they would use the app again. There was an overall mean compliance of 78% at all time points. Most patients (82%) required at least one phone call reminder, with 18% of patients completing their PROMs prompted by the app notification alone.</div></div><div><h3>Conclusions</h3><div>A mobile phone app can be useful for both distributing patient education and collecting PROMs. PROMs collected using a mobile phone app still caused some administrative burden with many participants requiring multiple reminders to complete their questionnaires. While paper-forms will still be required for some patients, most found the app preferable to paper-form.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101549"},"PeriodicalIF":1.5,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653997","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}
Pub Date : 2024-11-14DOI: 10.1016/j.artd.2024.101578
Stephen Duncan MD, Ryland Kagan MD
{"title":"Vancomycin Is Not an Effective Prophylactic Agent Alone and Should Be Combined With Another Agent","authors":"Stephen Duncan MD, Ryland Kagan MD","doi":"10.1016/j.artd.2024.101578","DOIUrl":"10.1016/j.artd.2024.101578","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101578"},"PeriodicalIF":1.5,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653893","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}
Pub Date : 2024-11-13DOI: 10.1016/j.artd.2024.101551
Matilda F.R. Powell-Bowns BSc, MMed, FRCSEd , Damien Martin MBChB, MRCSEd , Abbey Bowley BSc , Matthew Moran MSc, FRCSEd , Nick D. Clement MD, PhD, FRCS , Chloe E.H. Scott MD, MSc, BSc, FRCSEd (Tr&Orth), MFSTEd
Background
Transverse or short oblique periprosthetic femoral fractures around total hip arthroplasty (THA) stems are typically classified as B1 fractures (stem well-fixed) and usually managed with fixation. These fractures have high non-union rates. This study aimed to identify reoperation rates in patients with operatively managed transverse or short oblique fractures around a cemented polished taper-slip stem and determine any associations with treatment failure.
Methods
This retrospective cohort study included 31 patients with Arbeitsgemeinschaft für Osteosynthesefragen transverse or short oblique Vancouver B1 periprosthetic femoral fractures around THA with a cemented taper slip stem: 12 males (39%); mean age 74 ± 11.9 years (range 44-91); mean BMI 28.5 ± 1.4 (range 16-48); median American Society of Anesthesiologists score 3. Patient journeys were assessed and re-interventions recorded. The primary outcome was reoperation.
Results
The mean time from primary THA to fracture was 11.3 ± 7.8 years (0.5-26 years). Surgical management involved fixation in 27/31 cases and revision-THA (r-THA) in 4/31. Ten patients (32%) required reoperation (8 following ORIF and 2 following r-THA, P = .584), most commonly within 2 years of injury (9/10) due to non-union (6/10). No significant associations with reoperation requirement were identified. Kaplan-Meier survival free from reoperation was 67.4% (95% CI 49.8-85.0) at 2 years, unaffected by initial management with fixation or revision (Log rank 0.898). Of those reoperated, 60% (6/10) required multiple reoperations to achieve bony union or a stable revision construct.
Conclusions
These fractures are challenging to manage with either fixation or revision. Patients should be counseled about a one in 3 risk of reoperation and a one in 5 risk of requiring multiple reoperations.
背景全髋关节置换术（THA）骨干周围的横向或短斜股骨假体周围骨折通常被归类为B1骨折（骨干固定良好），通常采用固定治疗。这些骨折的不愈合率很高。本研究旨在确定经手术治疗的骨水泥抛光锥形滑动柄周围横向或短斜向骨折患者的再手术率，并确定与治疗失败的任何关联。方法这项回顾性队列研究纳入了31例Arbeitsgemeinschaft für Osteosynthesefragen横向或短斜Vancouver B1股骨假体周围骨折患者，这些患者均为使用骨水泥锥形滑移骨干的THA患者：12例男性（39%）；平均年龄为74±11.9岁（范围44-91岁）；平均体重指数为28.5±1.4（范围16-48岁）；美国麻醉医师协会评分中位数为3分。对患者的行程进行了评估，并记录了再次干预的情况。结果从初次THA到骨折的平均时间为11.3 ± 7.8年（0.5-26年）。27/31例患者接受了固定手术，4/31例患者接受了翻修型THA（r-THA）手术。10例患者（32%）需要再次手术（8例在ORIF术后，2例在翻修-THA术后，P = .584），最常见的是在受伤后2年内（9/10），原因是不愈合（6/10）。未发现与再次手术要求有明显关联的情况。2 年后免再次手术的 Kaplan-Meier 生存率为 67.4% (95% CI 49.8-85.0)，不受最初固定或翻修处理的影响（对数秩 0.898）。在再次手术的患者中，60%（6/10）需要多次再次手术才能达到骨性结合或稳定的翻修结构。应告知患者三分之一的患者有再次手术的风险，五分之一的患者有需要多次再次手术的风险。
{"title":"Operatively Managed Transverse or Short Oblique B1 Periprosthetic Fractures Around a Polished Taper-Slip Femoral Stem Are Associated With Reoperation in One Third of Cases: A Retrospective Cohort Study","authors":"Matilda F.R. Powell-Bowns BSc, MMed, FRCSEd , Damien Martin MBChB, MRCSEd , Abbey Bowley BSc , Matthew Moran MSc, FRCSEd , Nick D. Clement MD, PhD, FRCS , Chloe E.H. Scott MD, MSc, BSc, FRCSEd (Tr&Orth), MFSTEd","doi":"10.1016/j.artd.2024.101551","DOIUrl":"10.1016/j.artd.2024.101551","url":null,"abstract":"<div><h3>Background</h3><div>Transverse or short oblique periprosthetic femoral fractures around total hip arthroplasty (THA) stems are typically classified as B1 fractures (stem well-fixed) and usually managed with fixation. These fractures have high non-union rates. This study aimed to identify reoperation rates in patients with operatively managed transverse or short oblique fractures around a cemented polished taper-slip stem and determine any associations with treatment failure.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 31 patients with Arbeitsgemeinschaft für Osteosynthesefragen transverse or short oblique Vancouver B1 periprosthetic femoral fractures around THA with a cemented taper slip stem: 12 males (39%); mean age 74 ± 11.9 years (range 44-91); mean BMI 28.5 ± 1.4 (range 16-48); median American Society of Anesthesiologists score 3. Patient journeys were assessed and re-interventions recorded. The primary outcome was reoperation.</div></div><div><h3>Results</h3><div>The mean time from primary THA to fracture was 11.3 ± 7.8 years (0.5-26 years). Surgical management involved fixation in 27/31 cases and revision-THA (r-THA) in 4/31. Ten patients (32%) required reoperation (8 following ORIF and 2 following r-THA, <em>P</em> = .584), most commonly within 2 years of injury (9/10) due to non-union (6/10). No significant associations with reoperation requirement were identified. Kaplan-Meier survival free from reoperation was 67.4% (95% CI 49.8-85.0) at 2 years, unaffected by initial management with fixation or revision (Log rank 0.898). Of those reoperated, 60% (6/10) required multiple reoperations to achieve bony union or a stable revision construct.</div></div><div><h3>Conclusions</h3><div>These fractures are challenging to manage with either fixation or revision. Patients should be counseled about a one in 3 risk of reoperation and a one in 5 risk of requiring multiple reoperations.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101551"},"PeriodicalIF":1.5,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653901","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}
Pub Date : 2024-11-13DOI: 10.1016/j.artd.2024.101576
Sagar Telang BS , Amir Human Hoveidaei MD, MSc , Cory K. Mayfield MD , Jay R. Lieberman MD , Michael A. Mont MD , Nathanael D. Heckmann MD
Background
There remains a lack of universal guidelines regarding the appropriate level of postoperative activity restrictions following total hip arthroplasty (THA). This systematic review aims to assess whether the liberalization of postoperative activity restrictions following THA impacts implant survivorship, return to sport, patient satisfaction, and functional health outcomes.
Methods
A comprehensive search strategy was completed across PubMed, Scopus, and Web of Science databases using targeted keywords from January 1, 2010, to November 22, 2023. Inclusion criteria included randomized clinical trials, case-control, and cohort studies written in English. Data extraction focused on activity levels, rehabilitation protocols, implant survivorship, and physical and psychological outcomes. The primary search yielded 7420 articles, with 28 studies included after screening.
Results
Return to sports outcomes demonstrated notable variability (20%-98.5%). Most studies reported improved survivorship in high-activity patients. High-activity participants had all-cause revision rates of 0.9%-8.57% and aseptic revision rates of 0.4%-5.7%. Low-activity participants had all-cause revision rates of 0.7%-3.4% and aseptic revision rates of 0.0%-2.1%. There was no clear association between activity level and dislocation rates. Positive associations between post-THA activities and improved mental health and patient satisfaction were observed.
Conclusions
The current arthroplasty literature demonstrates that patients engaging in high-activity levels after THA exhibit similar or improved implant survivorship rates compared to patients participating in low-activity levels. However, high-quality prospective studies are needed to provide evidence-based guidelines. Patients should be encouraged to partake in activities at their own comfort levels with an understanding of their own limitations and risks.
{"title":"Are Activity Restrictions Necessary After Total Hip Arthroplasty: A Systematic Review","authors":"Sagar Telang BS , Amir Human Hoveidaei MD, MSc , Cory K. Mayfield MD , Jay R. Lieberman MD , Michael A. Mont MD , Nathanael D. Heckmann MD","doi":"10.1016/j.artd.2024.101576","DOIUrl":"10.1016/j.artd.2024.101576","url":null,"abstract":"<div><h3>Background</h3><div>There remains a lack of universal guidelines regarding the appropriate level of postoperative activity restrictions following total hip arthroplasty (THA). This systematic review aims to assess whether the liberalization of postoperative activity restrictions following THA impacts implant survivorship, return to sport, patient satisfaction, and functional health outcomes.</div></div><div><h3>Methods</h3><div>A comprehensive search strategy was completed across PubMed, Scopus, and Web of Science databases using targeted keywords from January 1, 2010, to November 22, 2023. Inclusion criteria included randomized clinical trials, case-control, and cohort studies written in English. Data extraction focused on activity levels, rehabilitation protocols, implant survivorship, and physical and psychological outcomes. The primary search yielded 7420 articles, with 28 studies included after screening.</div></div><div><h3>Results</h3><div>Return to sports outcomes demonstrated notable variability (20%-98.5%). Most studies reported improved survivorship in high-activity patients. High-activity participants had all-cause revision rates of 0.9%-8.57% and aseptic revision rates of 0.4%-5.7%. Low-activity participants had all-cause revision rates of 0.7%-3.4% and aseptic revision rates of 0.0%-2.1%. There was no clear association between activity level and dislocation rates. Positive associations between post-THA activities and improved mental health and patient satisfaction were observed.</div></div><div><h3>Conclusions</h3><div>The current arthroplasty literature demonstrates that patients engaging in high-activity levels after THA exhibit similar or improved implant survivorship rates compared to patients participating in low-activity levels. However, high-quality prospective studies are needed to provide evidence-based guidelines. Patients should be encouraged to partake in activities at their own comfort levels with an understanding of their own limitations and risks.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101576"},"PeriodicalIF":1.5,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653765","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}
Pub Date : 2024-11-13DOI: 10.1016/j.artd.2024.101577
Stephanie V. Kaszuba MD , Noah Gordon BS , Alex C. Gordon MD
Background
The addition of computer navigation (CN) technology in direct anterior approach (DAA) total hip arthroplasty (THA) has the potential to improve restoration of hip offset and leg length. In this investigation, we examine the effect of one fluoroscopic-based CN system on biomechanical parameters in DAA THA with femur-first (FF) workflow.
Methods
A retrospective review was performed on 235 primary DAA FF THA cases, with 100 CN cases and 135 in the conventional fluoroscopic overlay (FO) group. Radiographic examination was performed. Radiographic outcome measures included differences in hip center position, femoral offset, global offset, and leg length between the THA and native hips. Intraoperative and postoperative complications were also documented. Statistical analysis was performed using a t test for continuous data and a ꭓ2 test for categorical data.
Results
While there were differences in individual components of femoral offset and the horizontal hip center, mean difference in global offset was not statistically different between the CN (mean: 2.15 mm) and FO (mean: 1.85 mm) groups (P = .898). The number of outliers was also statistically insignificant. The CN group demonstrated significant improvement in mean leg length discrepancy (mean: 1.52 mm) in comparison to the FO group (mean: 2.26 mm) (P = .001), with 1.09% and 8.89% of outliers, respectively (P = .013).
Conclusions
The addition of CN technology to DAA FF THA improved the accuracy and precision of restoring leg length. CN did not significantly affect global offset. There was no significant difference in complications between the CN and FO groups.
{"title":"The Addition of Navigation Technology to the Femur-First Approach in Anterior Total Hip Arthroplasty Improves Leg Length Restoration","authors":"Stephanie V. Kaszuba MD , Noah Gordon BS , Alex C. Gordon MD","doi":"10.1016/j.artd.2024.101577","DOIUrl":"10.1016/j.artd.2024.101577","url":null,"abstract":"<div><h3>Background</h3><div>The addition of computer navigation (CN) technology in direct anterior approach (DAA) total hip arthroplasty (THA) has the potential to improve restoration of hip offset and leg length. In this investigation, we examine the effect of one fluoroscopic-based CN system on biomechanical parameters in DAA THA with femur-first (FF) workflow.</div></div><div><h3>Methods</h3><div>A retrospective review was performed on 235 primary DAA FF THA cases, with 100 CN cases and 135 in the conventional fluoroscopic overlay (FO) group. Radiographic examination was performed. Radiographic outcome measures included differences in hip center position, femoral offset, global offset, and leg length between the THA and native hips. Intraoperative and postoperative complications were also documented. Statistical analysis was performed using a <em>t</em> test for continuous data and a ꭓ<sup>2</sup> test for categorical data.</div></div><div><h3>Results</h3><div>While there were differences in individual components of femoral offset and the horizontal hip center, mean difference in global offset was not statistically different between the CN (mean: 2.15 mm) and FO (mean: 1.85 mm) groups (<em>P</em> = .898). The number of outliers was also statistically insignificant. The CN group demonstrated significant improvement in mean leg length discrepancy (mean: 1.52 mm) in comparison to the FO group (mean: 2.26 mm) (<em>P =</em> .001), with 1.09% and 8.89% of outliers, respectively (<em>P =</em> .013).</div></div><div><h3>Conclusions</h3><div>The addition of CN technology to DAA FF THA improved the accuracy and precision of restoring leg length. CN did not significantly affect global offset. There was no significant difference in complications between the CN and FO groups.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101577"},"PeriodicalIF":1.5,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653902","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}
Pub Date : 2024-11-12DOI: 10.1016/j.artd.2024.101575
Sung Jun Son MD, MS , Justin Sedgewick MD , Geordie Lonza MD , Jose George MD , Julissa Li BS , John Andrawis MD
Background
Health literacy is a major determinant of health outcomes, with low literacy correlated with increased risk of postoperative complications and lower patient-reported outcomes. This study sought to increase health literacy in a subset of Los Angeles County patients who would be undergoing total joint arthroplasty (TJA) using a video-based intervention.
Methods
We enrolled 51 patients scheduled to undergo TJA. The first 26 patients were allocated into the prevideo group who underwent the typical preoperative visit, and the next 25 patients were enrolled into the video-intervention (postvideo) group.
Results
No differences in baseline health literacy based on the Newest Vital Sign survey were noted between the groups (1.88 ± 1.90 vs 1.28 ± 1.24; P = .94). Higher knowledge scores regarding arthritis and TJA were seen in the postvideo group (71.52 ± 24.50 vs 54.92 ± 26.93; P = .01). This finding was consistent in primary Spanish speakers (66.40 ± 24.51 vs 49.60 ± 24.93; P = .04). There were no differences in preoperative anxiety and information requirement between the groups (16.00 ± 6.21 vs 16.88 ± 6.27; P = .31). The total low literacy version of the Decisional Conflict Scale score utilized to quantify patients’ decisional conflict in the setting of TJA were not different between the groups (11.44 ± 14.32 vs 10.40 ± 15.41; P = .40).
Conclusions
Patient knowledge about arthritis and TJA significantly improved as measured by the modified arthritis knowledge survey in the postvideo group compared to a discussion with their surgeon.
背景健康素养是影响健康结果的一个主要决定因素，低健康素养与术后并发症风险增加和患者报告的结果降低相关。本研究试图通过视频干预提高洛杉矶县即将接受全关节成形术（TJA）的部分患者的健康素养。结果根据最新生命体征调查，两组患者的基线健康素养无差异（1.88 ± 1.90 vs 1.28 ± 1.24；P = .94）。观看视频后组对关节炎和 TJA 的了解程度较高（71.52 ± 24.50 vs 54.92 ± 26.93；P = .01）。这一结果在主要讲西班牙语的人中是一致的（66.40 ± 24.51 vs 49.60 ± 24.93；P = .04）。两组患者在术前焦虑和信息需求方面没有差异（16.00 ± 6.21 vs 16.88 ± 6.27；P = .31）。结论与与外科医生讨论相比，通过改良的关节炎知识调查，视频后组患者对关节炎和 TJA 的了解显著提高。
{"title":"A Video-Based Intervention for Increasing Health Literacy in Total Joint Arthroplasty Patients at a Safety-Net Hospital: A Prospective Single-Blind Cohort Study","authors":"Sung Jun Son MD, MS , Justin Sedgewick MD , Geordie Lonza MD , Jose George MD , Julissa Li BS , John Andrawis MD","doi":"10.1016/j.artd.2024.101575","DOIUrl":"10.1016/j.artd.2024.101575","url":null,"abstract":"<div><h3>Background</h3><div>Health literacy is a major determinant of health outcomes, with low literacy correlated with increased risk of postoperative complications and lower patient-reported outcomes. This study sought to increase health literacy in a subset of Los Angeles County patients who would be undergoing total joint arthroplasty (TJA) using a video-based intervention.</div></div><div><h3>Methods</h3><div>We enrolled 51 patients scheduled to undergo TJA. The first 26 patients were allocated into the prevideo group who underwent the typical preoperative visit, and the next 25 patients were enrolled into the video-intervention (postvideo) group.</div></div><div><h3>Results</h3><div>No differences in baseline health literacy based on the Newest Vital Sign survey were noted between the groups (1.88 ± 1.90 vs 1.28 ± 1.24; <em>P</em> = .94). Higher knowledge scores regarding arthritis and TJA were seen in the postvideo group (71.52 ± 24.50 vs 54.92 ± 26.93; <em>P</em> = .01). This finding was consistent in primary Spanish speakers (66.40 ± 24.51 vs 49.60 ± 24.93; <em>P</em> = .04). There were no differences in preoperative anxiety and information requirement between the groups (16.00 ± 6.21 vs 16.88 ± 6.27; <em>P</em> = .31). The total low literacy version of the Decisional Conflict Scale score utilized to quantify patients’ decisional conflict in the setting of TJA were not different between the groups (11.44 ± 14.32 vs 10.40 ± 15.41; <em>P</em> = .40).</div></div><div><h3>Conclusions</h3><div>Patient knowledge about arthritis and TJA significantly improved as measured by the modified arthritis knowledge survey in the postvideo group compared to a discussion with their surgeon.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101575"},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653895","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}
Pub Date : 2024-11-12DOI: 10.1016/j.artd.2024.101573
Kyle L. McCormick MD, Michael A. Mastroianni MD, Carl H. Herndon MD, Nana O. Sarpong MD, MBA, Roshan P. Shah MD, H. John Cooper MD, Alexander L. Neuwirth MD, Jeffrey A. Geller MD
Background
The purpose of this study was to compare complication rates and clinical outcomes at 1 year or until death based on the surgical approach for total hip replacement in femoral neck fractures.
Methods
This retrospective study was performed on 101 patients with displaced femoral neck fractures at our institution between 2005 and 2022. All surgeries were performed by fellowship-trained arthroplasty surgeons via either a posterior Kocher-Langenbeck approach, an abductor sparing anterolateral approach, or a direct anterior approach. Demographics were collected, as well as intraoperative characteristics, discharge information, and complications.
Results
Thirty-seven patients underwent a direct anterior approach, 42 underwent an abductor sparing anterolateral approach, and 22 underwent a posterior approach, with no significant difference in demographics between the groups. Of patients, 43.3% were able to be discharged home, while 55.4% of patients went to subacute rehab or other nursing home facility. There was a 30.6% complication rate, a 7% reoperation rate, and a 0.9% dislocation rate. The posterior group was more likely to be discharged to rehab instead of home (82.0% compared to 48.6%, P = .0054) and had a significant increase in complication rate (P = .04). There was a 36.3% rate of transfusion in the posterior group compared to a 5.0% rate in the anterior group (P < .0001).
Conclusions
Anterior-based total hip arthroplasty for femoral neck fractures in our series demonstrated a significantly lower rate of postoperative complications, a lower rate of transfusion, and a significantly higher rate of being discharged home.
{"title":"Anterior Versus Posterior Approach for Total Hip Arthroplasty in Femoral Neck Fractures","authors":"Kyle L. McCormick MD, Michael A. Mastroianni MD, Carl H. Herndon MD, Nana O. Sarpong MD, MBA, Roshan P. Shah MD, H. John Cooper MD, Alexander L. Neuwirth MD, Jeffrey A. Geller MD","doi":"10.1016/j.artd.2024.101573","DOIUrl":"10.1016/j.artd.2024.101573","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to compare complication rates and clinical outcomes at 1 year or until death based on the surgical approach for total hip replacement in femoral neck fractures.</div></div><div><h3>Methods</h3><div>This retrospective study was performed on 101 patients with displaced femoral neck fractures at our institution between 2005 and 2022. All surgeries were performed by fellowship-trained arthroplasty surgeons via either a posterior Kocher-Langenbeck approach, an abductor sparing anterolateral approach, or a direct anterior approach. Demographics were collected, as well as intraoperative characteristics, discharge information, and complications.</div></div><div><h3>Results</h3><div>Thirty-seven patients underwent a direct anterior approach, 42 underwent an abductor sparing anterolateral approach, and 22 underwent a posterior approach, with no significant difference in demographics between the groups. Of patients, 43.3% were able to be discharged home, while 55.4% of patients went to subacute rehab or other nursing home facility. There was a 30.6% complication rate, a 7% reoperation rate, and a 0.9% dislocation rate. The posterior group was more likely to be discharged to rehab instead of home (82.0% compared to 48.6%, <em>P</em> = .0054) and had a significant increase in complication rate (<em>P</em> = .04). There was a 36.3% rate of transfusion in the posterior group compared to a 5.0% rate in the anterior group (<em>P</em> < .0001).</div></div><div><h3>Conclusions</h3><div>Anterior-based total hip arthroplasty for femoral neck fractures in our series demonstrated a significantly lower rate of postoperative complications, a lower rate of transfusion, and a significantly higher rate of being discharged home.</div></div><div><h3>Level of Evidence</h3><div>Level III.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101573"},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653763","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}
Pub Date : 2024-11-12DOI: 10.1016/j.artd.2024.101553
Elizabeth S. Kaji BA , Austin F. Grove BA , Eva Lehtonen MD , Kellen L. Mulford PhD , Pouria Rouzrokh MD, MPH, MHPE , Charles P. Hannon MD, MBA , Michael J. Taunton MD , Cody C. Wyles MD
Background
A fully automated artificial intelligence–based tool was developed to detect and quantify femoral component subsidence between serial radiographs. However, it did not account for measurement errors due to leg position differences, such as rotation or flexion, between comparative radiographs. If there are small differences in rotation or flexion of the leg between comparative radiographs, the impact on subsidence measurement is unclear.
Methods
Twenty-five primary total hip arthroplasty procedures were performed by 3 fellowship-trained arthroplasty surgeons using a direct anterior approach. A Hana table allowed precise changes in femur position. Final fluoroscopic images were collected with rotational and flexion changes applied to the femur without moving the C-arm. Subsidence values were manually measured and compared across different positions.
Results
Variations in greater trochanter to tip of the stem measurements between the neutral position and rotations were minimal, measuring <1 mm on an absolute scale and <1% on a relative scale. These differences decreased as the femur was rotated from an external rotation of 20° to an internal rotation of 20°. Notable variances exceeding 5 mm were observed in the 10° flexion position compared to neutral.
Conclusions
Minor changes (20° or less) in leg rotation between serial radiographs are unlikely to significantly affect the greater trochanter to tip of the stem measurement, whereas flexion is highly impactful. These findings suggest that the fully automated artificial intelligence–based tool for detecting and quantifying femoral component subsidence is robust against rotational variations but may be susceptible to significant measurement errors if there are considerable changes in leg flexion between comparative radiographs.
背景开发了一种基于人工智能的全自动工具，用于检测和量化序列X光片之间的股骨组件下沉。然而，它并没有考虑到由于腿部位置差异（如旋转或屈曲）而导致的对比X光片之间的测量误差。方法由3名受过研究培训的关节置换外科医生采用直接前路方法进行了25例初次全髋关节置换术。使用 Hana 台可精确改变股骨位置。在不移动 C 臂的情况下，采集股骨旋转和屈曲变化的最终透视图像。结果股骨大转子至股骨柄顶端的测量值在中立位和旋转位之间的差异极小，绝对值为1毫米，相对值为1%。当股骨从外旋20°旋转到内旋20°时，这些差异会减小。结论连续X光片之间腿部旋转的微小变化（20°或更小）不太可能显著影响大转子到柄尖的测量值，而屈曲则会产生很大影响。这些研究结果表明，基于人工智能的全自动股骨组件下沉检测和量化工具对旋转变化有很强的抵抗力，但如果腿部屈曲度在对比X光片之间有很大变化，则可能会出现明显的测量误差。
{"title":"Impact of Leg Position on Measurements Used to Detect Femoral Component Subsidence in THA","authors":"Elizabeth S. Kaji BA , Austin F. Grove BA , Eva Lehtonen MD , Kellen L. Mulford PhD , Pouria Rouzrokh MD, MPH, MHPE , Charles P. Hannon MD, MBA , Michael J. Taunton MD , Cody C. Wyles MD","doi":"10.1016/j.artd.2024.101553","DOIUrl":"10.1016/j.artd.2024.101553","url":null,"abstract":"<div><h3>Background</h3><div>A fully automated artificial intelligence–based tool was developed to detect and quantify femoral component subsidence between serial radiographs. However, it did not account for measurement errors due to leg position differences, such as rotation or flexion, between comparative radiographs. If there are small differences in rotation or flexion of the leg between comparative radiographs, the impact on subsidence measurement is unclear.</div></div><div><h3>Methods</h3><div>Twenty-five primary total hip arthroplasty procedures were performed by 3 fellowship-trained arthroplasty surgeons using a direct anterior approach. A Hana table allowed precise changes in femur position. Final fluoroscopic images were collected with rotational and flexion changes applied to the femur without moving the C-arm. Subsidence values were manually measured and compared across different positions.</div></div><div><h3>Results</h3><div>Variations in greater trochanter to tip of the stem measurements between the neutral position and rotations were minimal, measuring <1 mm on an absolute scale and <1% on a relative scale. These differences decreased as the femur was rotated from an external rotation of 20° to an internal rotation of 20°. Notable variances exceeding 5 mm were observed in the 10° flexion position compared to neutral.</div></div><div><h3>Conclusions</h3><div>Minor changes (20° or less) in leg rotation between serial radiographs are unlikely to significantly affect the greater trochanter to tip of the stem measurement, whereas flexion is highly impactful. These findings suggest that the fully automated artificial intelligence–based tool for detecting and quantifying femoral component subsidence is robust against rotational variations but may be susceptible to significant measurement errors if there are considerable changes in leg flexion between comparative radiographs.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101553"},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654039","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}
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