Pub Date : 2026-02-01DOI: 10.1016/j.artd.2025.101940
Martin S. Davey MCh, MRCS, MD , Andrew J. Hughes FRCS Tr&Orth , Peter K. Sculco MD , Andrew M. Star MD
For many years, providing patients with a total knee arthroplasty (TKA) prosthesis which is stable with a neutrally aligned lower limb using a mechanical alignment philosophy has represented the primary technical goal of TKA. However, it has previously been reported that only 50% of patients have neutral mechanical axis. Furthermore, despite continuous engineering developments with respect to implants used in TKA, contemporary philosophies, computer-assisted navigation and robotic-assisted TKA, registry data suggest that 1 in 5 patients undergoing TKA report overall dissatisfaction with their procedure in the medium to long term. Therefore, the purpose of this review was to first describe and compare outcomes of current alignment philosophies in TKA. Additionally, the authors sought to review the outcomes of computer-assisted navigation and robotic-assisted TKA procedures, while also evaluating the role of sensors and tensioners with respect to TKA alignment. Finally, the authors aimed to review potential future developments within this ever-developing space in the literature.
{"title":"Alignment Philosophies in Total Knee Arthroplasty: A Comprehensive Narrative Review","authors":"Martin S. Davey MCh, MRCS, MD , Andrew J. Hughes FRCS Tr&Orth , Peter K. Sculco MD , Andrew M. Star MD","doi":"10.1016/j.artd.2025.101940","DOIUrl":"10.1016/j.artd.2025.101940","url":null,"abstract":"<div><div>For many years, providing patients with a total knee arthroplasty (TKA) prosthesis which is stable with a neutrally aligned lower limb using a mechanical alignment philosophy has represented the primary technical goal of TKA. However, it has previously been reported that only 50% of patients have neutral mechanical axis. Furthermore, despite continuous engineering developments with respect to implants used in TKA, contemporary philosophies, computer-assisted navigation and robotic-assisted TKA, registry data suggest that 1 in 5 patients undergoing TKA report overall dissatisfaction with their procedure in the medium to long term. Therefore, the purpose of this review was to first describe and compare outcomes of current alignment philosophies in TKA. Additionally, the authors sought to review the outcomes of computer-assisted navigation and robotic-assisted TKA procedures, while also evaluating the role of sensors and tensioners with respect to TKA alignment. Finally, the authors aimed to review potential future developments within this ever-developing space in the literature.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101940"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077945","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}
Pub Date : 2026-01-31DOI: 10.1016/j.artd.2026.101954
Daniel R. Baka BS , Cayla M. Kalani BS , Jong Hyun Choi MD , Nicholas D’Antonio MD , Pietro M. Gentile BS , Matthew L. Brown MD
Background
Total hip arthroplasty (THA) via the direct anterior approach (DAA) is favored for avoiding gluteal muscle disruption and promoting faster recovery. A known complication of DAA is greater trochanteric fracture (GTFX). This study compared patient-reported outcomes (PROs) between patients who sustained GTFX and those who did not following THA using DAA.
Methods
A retrospective review was conducted of patients who underwent THA via DAA. Primary outcomes included Mental and Physical Patient-Reported Outcomes Measurement Information System scores, Hip Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), and Forgotten Joint Score. Secondary outcomes included ambulation status, disposition, length of stay, complications, emergency department visits, and return to the operating room within 1 year. Patients without at least baseline and 6-month or 1-year PROs were excluded.
Results
Ninety-two THAs were analyzed; 13 patients (14%) sustained a GTFX. Baseline characteristics and preoperative PROs were similar between groups. At 6 months, the GTFX group had significantly lower HOOS JR scores (68.5 ± 18.1) compared to the non-GTFX group (79.8 ± 18.0; P = .0472). No significant differences in PROs were observed at 1-year. Two patients (15%) with GTFX and 2 (3%) without GTFX returned to the operating room (P = .0943). No other significant differences in secondary outcomes were noted.
Conclusions
GTFX following THA via DAA are associated with worse HOOS JR scores at 6 months, suggesting a temporary delay in recovery. However, these differences resolve by 1 year, indicating GTFX may not impact long-term functional outcomes.
{"title":"Effect of Greater Trochanteric Fractures on Patient Reported Outcomes After Direct Anterior Total Hip Arthroplasty","authors":"Daniel R. Baka BS , Cayla M. Kalani BS , Jong Hyun Choi MD , Nicholas D’Antonio MD , Pietro M. Gentile BS , Matthew L. Brown MD","doi":"10.1016/j.artd.2026.101954","DOIUrl":"10.1016/j.artd.2026.101954","url":null,"abstract":"<div><h3>Background</h3><div>Total hip arthroplasty (THA) via the direct anterior approach (DAA) is favored for avoiding gluteal muscle disruption and promoting faster recovery. A known complication of DAA is greater trochanteric fracture (GTFX). This study compared patient-reported outcomes (PROs) between patients who sustained GTFX and those who did not following THA using DAA.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of patients who underwent THA via DAA. Primary outcomes included Mental and Physical Patient-Reported Outcomes Measurement Information System scores, Hip Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), and Forgotten Joint Score. Secondary outcomes included ambulation status, disposition, length of stay, complications, emergency department visits, and return to the operating room within 1 year. Patients without at least baseline and 6-month or 1-year PROs were excluded.</div></div><div><h3>Results</h3><div>Ninety-two THAs were analyzed; 13 patients (14%) sustained a GTFX. Baseline characteristics and preoperative PROs were similar between groups. At 6 months, the GTFX group had significantly lower HOOS JR scores (68.5 ± 18.1) compared to the non-GTFX group (79.8 ± 18.0; <em>P</em> = .0472). No significant differences in PROs were observed at 1-year. Two patients (15%) with GTFX and 2 (3%) without GTFX returned to the operating room (<em>P</em> = .0943). No other significant differences in secondary outcomes were noted.</div></div><div><h3>Conclusions</h3><div>GTFX following THA via DAA are associated with worse HOOS JR scores at 6 months, suggesting a temporary delay in recovery. However, these differences resolve by 1 year, indicating GTFX may not impact long-term functional outcomes.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"38 ","pages":"Article 101954"},"PeriodicalIF":2.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081706","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}
Pub Date : 2026-01-31DOI: 10.1016/j.artd.2025.101949
Amy Y. Zhao BA , Alex Gu MD , Gireesh Reddy MD , Bryant M. Song MD , Ilya Bendich MD, MBA , Andrew M. Schneider MD
Background
Technology-assisted total hip arthroplasty (THA)—including computer-navigated and robotic-assisted techniques—has emerged as a strategy to enhance component alignment and potentially improve postoperative outcomes. Although prior studies have described increasing utilization, contemporary trends and associated complication rates remain underexplored.
Methods
A retrospective cohort study was conducted using a large national database to identify patients who underwent primary elective THA between 2010 and 2023. Patients were stratified into conventional vs technology-assisted THA groups, with the latter defined by the use of computer navigation or robotic assistance. Annual utilization trends were evaluated using linear regression, and 90-day postoperative complications were compared using multivariate logistic regression after adjusting for demographic, clinical, and regional factors.
Results
Among 1,062,597 patients undergoing primary elective THA, 4% received technology-assisted procedures. Utilization increased from 1.2% in 2010 to 12% in 2023—a 927% relative increase. Regional variation was notable, with highest utilization in the Northeast and the lowest in the Midwest. Technology-assisted THA was associated with lower odds of 90-day complications (5.36% vs 6.26%; adjusted odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.75-0.80), particularly reduced odds of dislocation (OR: 0.64; 95% CI: 0.60-0.69) and periprosthetic joint infection, though with higher odds of wound dehiscence (OR: 1.15; 95% CI: 1.07-1.23).
Conclusions
Utilization of technology-assisted THA has increased substantially across the United States, accompanied by improved short-term outcomes, most notably decreased dislocation. These findings support the potential clinical benefits of surgical technology in THA, while underscoring the need for ongoing evaluation of long-term results.
{"title":"Technology-assisted Total Hip Arthroplasty: A Contemporary Analysis of Regional Trends, National Trends, and 90-day Outcomes in a Nationwide Cohort","authors":"Amy Y. Zhao BA , Alex Gu MD , Gireesh Reddy MD , Bryant M. Song MD , Ilya Bendich MD, MBA , Andrew M. Schneider MD","doi":"10.1016/j.artd.2025.101949","DOIUrl":"10.1016/j.artd.2025.101949","url":null,"abstract":"<div><h3>Background</h3><div>Technology-assisted total hip arthroplasty (THA)—including computer-navigated and robotic-assisted techniques—has emerged as a strategy to enhance component alignment and potentially improve postoperative outcomes. Although prior studies have described increasing utilization, contemporary trends and associated complication rates remain underexplored.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using a large national database to identify patients who underwent primary elective THA between 2010 and 2023. Patients were stratified into conventional vs technology-assisted THA groups, with the latter defined by the use of computer navigation or robotic assistance. Annual utilization trends were evaluated using linear regression, and 90-day postoperative complications were compared using multivariate logistic regression after adjusting for demographic, clinical, and regional factors.</div></div><div><h3>Results</h3><div>Among 1,062,597 patients undergoing primary elective THA, 4% received technology-assisted procedures. Utilization increased from 1.2% in 2010 to 12% in 2023—a 927% relative increase. Regional variation was notable, with highest utilization in the Northeast and the lowest in the Midwest. Technology-assisted THA was associated with lower odds of 90-day complications (5.36% vs 6.26%; adjusted odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.75-0.80), particularly reduced odds of dislocation (OR: 0.64; 95% CI: 0.60-0.69) and periprosthetic joint infection, though with higher odds of wound dehiscence (OR: 1.15; 95% CI: 1.07-1.23).</div></div><div><h3>Conclusions</h3><div>Utilization of technology-assisted THA has increased substantially across the United States, accompanied by improved short-term outcomes, most notably decreased dislocation. These findings support the potential clinical benefits of surgical technology in THA, while underscoring the need for ongoing evaluation of long-term results.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"38 ","pages":"Article 101949"},"PeriodicalIF":2.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081707","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}
Pub Date : 2026-01-24DOI: 10.1016/j.artd.2025.101951
Paul B. Walker MD, Lisa Su MD, MS, Mathangi Sridharan MD, Murray Wong MD, MSc, Matthew Dipane BA, Guillermo Araujo-Espinoza MD, Kristofer J. Jones MD, Adam A. Sassoon MD, MS
Background
Isolated patellofemoral joint arthritis with patellar malalignment in young patients presents a unique challenge, as these patients typically wish to avoid early total knee arthroplasty. The purpose of this retrospective case series is to describe a standardized dual-surgeon technique for combined patellofemoral arthroplasty (PFA) with patellar realignment using medial patellofemoral ligament reconstruction or tibial tubercle osteotomy and to evaluate early clinical and patient-reported outcomes.
Methods
A retrospective review was conducted on patients who underwent combined PFA and patellar realignment by a fellowship-trained arthroplasty surgeon and fellowship-trained sports surgeon. Outcomes including implant survivorship, functional outcomes, complications, and patient-reported measures (Knee Injury and Osteoarthritis Outcome Score Joint Replacement, Patient Reported Outcomes Measurement Information System (PROMIS), Global Physical Health, PROMIS Global Mental Health, and Forgotten Joint Score) were assessed.
Results
Eleven knees in 9 patients were included (55.5% female; median age 41 ± 13.4 years; median body mass index 26 ± 6.2). All knees had isolated patellofemoral arthritis. Nine knees underwent PFA with medial patellofemoral ligament reconstruction for instability or dislocation, while 2 underwent PFA with tibial tubercle osteotomy for patella alta. Two patellae were chronically dislocated, additionally requiring lateral release. Six knees had prior failed stabilizing procedures. The mean operative time was 121 minutes (94–161), with a mean follow-up of 24.0 ± 11.5 months. One patient experienced a periprosthetic patellar fracture at 10 months, followed by a refracture at 14 months, requiring open reduction and internal fixation and extensor mechanism repair. No cases of re-dislocation, maltracking, infections, wound complications, or other medical issues occurred. Knee Injury and Osteoarthritis Outcome Score Joint Replacement scores improved by an average of 14.8 ± 11 points.
Conclusions
Combined PFA and patellar realignment surgery can be done efficiently and is associated with improved patient-reported outcomes, with complications limited to a single case of periprosthetic patellar fracture.
{"title":"Combined Patellofemoral Arthroplasty With Patellar Realignment: Surgical Technique and Clinical Outcomes in a Retrospective Case Series","authors":"Paul B. Walker MD, Lisa Su MD, MS, Mathangi Sridharan MD, Murray Wong MD, MSc, Matthew Dipane BA, Guillermo Araujo-Espinoza MD, Kristofer J. Jones MD, Adam A. Sassoon MD, MS","doi":"10.1016/j.artd.2025.101951","DOIUrl":"10.1016/j.artd.2025.101951","url":null,"abstract":"<div><h3>Background</h3><div>Isolated patellofemoral joint arthritis with patellar malalignment in young patients presents a unique challenge, as these patients typically wish to avoid early total knee arthroplasty. The purpose of this retrospective case series is to describe a standardized dual-surgeon technique for combined patellofemoral arthroplasty (PFA) with patellar realignment using medial patellofemoral ligament reconstruction or tibial tubercle osteotomy and to evaluate early clinical and patient-reported outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on patients who underwent combined PFA and patellar realignment by a fellowship-trained arthroplasty surgeon and fellowship-trained sports surgeon. Outcomes including implant survivorship, functional outcomes, complications, and patient-reported measures (Knee Injury and Osteoarthritis Outcome Score Joint Replacement, Patient Reported Outcomes Measurement Information System (PROMIS), Global Physical Health, PROMIS Global Mental Health, and Forgotten Joint Score) were assessed.</div></div><div><h3>Results</h3><div>Eleven knees in 9 patients were included (55.5% female; median age 41 ± 13.4 years; median body mass index 26 ± 6.2). All knees had isolated patellofemoral arthritis. Nine knees underwent PFA with medial patellofemoral ligament reconstruction for instability or dislocation, while 2 underwent PFA with tibial tubercle osteotomy for patella alta. Two patellae were chronically dislocated, additionally requiring lateral release. Six knees had prior failed stabilizing procedures. The mean operative time was 121 minutes (94–161), with a mean follow-up of 24.0 ± 11.5 months. One patient experienced a periprosthetic patellar fracture at 10 months, followed by a refracture at 14 months, requiring open reduction and internal fixation and extensor mechanism repair. No cases of re-dislocation, maltracking, infections, wound complications, or other medical issues occurred. Knee Injury and Osteoarthritis Outcome Score Joint Replacement scores improved by an average of 14.8 ± 11 points.</div></div><div><h3>Conclusions</h3><div>Combined PFA and patellar realignment surgery can be done efficiently and is associated with improved patient-reported outcomes, with complications limited to a single case of periprosthetic patellar fracture.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101951"},"PeriodicalIF":2.1,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037995","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}
Pub Date : 2026-01-14DOI: 10.1016/j.artd.2025.101929
Artsiom Klimko MD , Octavian Andronic MD, PhD , Victor Yan Zhe Lu MA MB BChir , Dominik Kaiser MD , Dimitris Dimitriou MD , Armando Hoch MD , Patrick O. Zingg MD
Background
Acetabular impaction bone grafting (IBG) is used to address bone loss in revision total hip arthroplasty (rTHA). We evaluated graft incorporation and cup migration after acetabular IBG in rTHA.
Methods
Systematic search of MEDLINE, EMBASE, and Scopus from inception to June 30, 2024 (PROSPERO CRD42024557047). Studies of acetabular IBG in rTHA with ≥12-month follow-up were included. Outcomes were graft incorporation and horizontal (i.e., lateral to medial axis) and vertical cup migration. Prespecified subgroup analyses assessed bone-loss severity, graft type, additional fixation, and age. Random-effects meta-analyses were used; heterogeneity was quantified with I2. Risk of bias was assessed with the Methodological Index for Non-Randomized Studies.
Results
Nineteen studies (1093 hips) were included; weighted follow-up was 8.0 years (range 2.0-16.9). Pooled graft incorporation was 89% (95% CI [confidence interval] 79-96; I2 85%). Mean lateral migration was 2.4 mm (95% CI 0.53-4.27) and mean superior migration 4.2 mm (95% CI 1.61-6.75); heterogeneity was high (I2 100% for both). Lateral migration was greater in cohorts with ≥5 years’ follow-up than <5 years (3.65 vs 1.16 mm; P = .018). No significant differences in incorporation were detected by bone-loss severity, graft type, or age; however, subgroup analyses were frequently underpowered and exploratory.
Conclusions
Acetabular IBG can achieve mid- to long-term graft incorporation of 89%, but estimates are imprecise due to heterogeneous (I2 = 85%), predominantly retrospective evidence. Migration occurs—most commonly cranial—and may accrue over time; values often remain within commonly accepted surveillance thresholds but warrant structured radiographic follow-up. Given high heterogeneity, variable outcome definitions, and potential small-study/publication bias, recommendations should be interpreted cautiously.
背景：髋臼嵌塞骨移植（IBG）用于修复全髋关节置换术（rTHA）中骨丢失的问题。我们评估了rTHA髋臼IBG术后移植物的结合和杯形迁移。方法系统检索MEDLINE、EMBASE和Scopus自成立至2024年6月30日（PROSPERO CRD42024557047）。纳入随访≥12个月的rTHA患者髋臼IBG研究。结果是移植物结合和水平（即向内轴外侧）和垂直杯迁移。预先指定的亚组分析评估骨丢失严重程度、移植物类型、附加固定和年龄。采用随机效应荟萃分析；用I2定量分析异质性。用非随机研究方法学指数评估偏倚风险。结果纳入19项研究（1093髋）；加权随访8.0年（范围2.0-16.9）。移植合并为89% （95% CI[置信区间]79-96；I2为85%）。平均横向迁移2.4 mm (95% CI 0.53-4.27)，平均横向迁移4.2 mm (95% CI 1.61-6.75)；异质性高（两者均为100%）。在随访≥5年的队列中，侧移大于随访≤5年的队列（3.65 vs 1.16 mm; P = 0.018）。骨丢失严重程度、移植物类型或年龄在骨融合方面无显著差异；然而，亚组分析往往是不足的和探索性的。结论髋臼IBG可实现89%的中长期移植物融合，但由于异质性（I2 = 85%），估计不准确，主要是回顾性证据。迁移会发生——最常见的是颅骨——并可能随着时间的推移而增加；数值通常保持在普遍接受的监测阈值范围内，但需要有组织的放射学随访。考虑到高异质性、可变的结果定义和潜在的小研究/发表偏倚，建议应谨慎解释。
{"title":"Graft Incorporation and Cup Migration in Acetabular Impaction Bone Grafting for Revision Hip Arthroplasty: A Systematic Review and Meta-Analysis of 1093 Hips","authors":"Artsiom Klimko MD , Octavian Andronic MD, PhD , Victor Yan Zhe Lu MA MB BChir , Dominik Kaiser MD , Dimitris Dimitriou MD , Armando Hoch MD , Patrick O. Zingg MD","doi":"10.1016/j.artd.2025.101929","DOIUrl":"10.1016/j.artd.2025.101929","url":null,"abstract":"<div><h3>Background</h3><div>Acetabular impaction bone grafting (IBG) is used to address bone loss in revision total hip arthroplasty (rTHA). We evaluated graft incorporation and cup migration after acetabular IBG in rTHA.</div></div><div><h3>Methods</h3><div>Systematic search of MEDLINE, EMBASE, and Scopus from inception to June 30, 2024 (PROSPERO CRD42024557047). Studies of acetabular IBG in rTHA with ≥12-month follow-up were included. Outcomes were graft incorporation and horizontal (i.e., lateral to medial axis) and vertical cup migration. Prespecified subgroup analyses assessed bone-loss severity, graft type, additional fixation, and age. Random-effects meta-analyses were used; heterogeneity was quantified with I<sup>2</sup>. Risk of bias was assessed with the Methodological Index for Non-Randomized Studies.</div></div><div><h3>Results</h3><div>Nineteen studies (1093 hips) were included; weighted follow-up was 8.0 years (range 2.0-16.9). Pooled graft incorporation was 89% (95% CI [confidence interval] 79-96; I<sup>2</sup> 85%). Mean lateral migration was 2.4 mm (95% CI 0.53-4.27) and mean superior migration 4.2 mm (95% CI 1.61-6.75); heterogeneity was high (I<sup>2</sup> 100% for both). Lateral migration was greater in cohorts with ≥5 years’ follow-up than <5 years (3.65 vs 1.16 mm; <em>P</em> = .018). No significant differences in incorporation were detected by bone-loss severity, graft type, or age; however, subgroup analyses were frequently underpowered and exploratory.</div></div><div><h3>Conclusions</h3><div>Acetabular IBG can achieve mid- to long-term graft incorporation of 89%, but estimates are imprecise due to heterogeneous (I<sup>2</sup> = 85%), predominantly retrospective evidence. Migration occurs—most commonly cranial—and may accrue over time; values often remain within commonly accepted surveillance thresholds but warrant structured radiographic follow-up. Given high heterogeneity, variable outcome definitions, and potential small-study/publication bias, recommendations should be interpreted cautiously.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101929"},"PeriodicalIF":2.1,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978538","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}
Conversion of knee arthrodesis to total knee arthroplasty is a technically demanding procedure, particularly in young patients with a history of trauma and infection. This report outlines the surgical strategy and 1-year functional outcome of a 24-year-old patient who underwent total knee arthroplasty 4 years after knee fusion. Management included soft tissue reconstruction, tibial tubercle osteotomy, gastrocnemius flap coverage, and rotating hinge knee implantation. At 1-year follow-up, the patient showed marked clinical improvement, with improved in KOOS and WOMAC scores, pain relief, and quality of life. Markerless 3D kinematic gait analysis was also performed post-conversion. This report describes key surgical considerations and preoperative work-up for the successful conversion of knee arthrodesis to arthroplasty.
{"title":"Managing Knee Arthrodesis Conversion to Arthroplasty in a Young Patient: Surgical Strategy, Challenges, and Functional Recovery After 1 Year","authors":"Aurimas Sirka MD, PhD , Gintare Lukoseviciute MD , Tomas Kadusauskas MD , Donatas Daublys PhD , Aurelijus Domeika PhD , Rimtautas Gudas PhD , Augustinas Rimkunas MD","doi":"10.1016/j.artd.2025.101943","DOIUrl":"10.1016/j.artd.2025.101943","url":null,"abstract":"<div><div>Conversion of knee arthrodesis to total knee arthroplasty is a technically demanding procedure, particularly in young patients with a history of trauma and infection. This report outlines the surgical strategy and 1-year functional outcome of a 24-year-old patient who underwent total knee arthroplasty 4 years after knee fusion. Management included soft tissue reconstruction, tibial tubercle osteotomy, gastrocnemius flap coverage, and rotating hinge knee implantation. At 1-year follow-up, the patient showed marked clinical improvement, with improved in KOOS and WOMAC scores, pain relief, and quality of life. Markerless 3D kinematic gait analysis was also performed post-conversion. This report describes key surgical considerations and preoperative work-up for the successful conversion of knee arthrodesis to arthroplasty.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101943"},"PeriodicalIF":2.1,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978536","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}
Pub Date : 2026-01-13DOI: 10.1016/j.artd.2025.101932
Mehmet Önüt MD , Olgun Bingöl MD , Güzelali Özdemir MD , Mehmet Fatih Savaş MD , Barış Yağbasan MD , Enver Kılıç MD , Utku Eren Özkaya MD
Background
The aim of this study was to investigate whether subcutaneous adipose tissue (SAT) length by radiograph and SAT area by computed tomography (CT) before femoral neck fracture surgery are associated with surgical wound drainage (SWD) in elderly female patients.
Methods
We prospectively evaluated 87 female patients who underwent hemiarthroplasty surgery at a level 1 trauma center between May 2024 and January 2025. The patients were classified into 2 groups: those with SWD within 90 days after surgery (group 1) and those without (group 2). SAT area and SAT length were evaluated using CT and hip radiograph imaging, respectively, and the differences between the 2 groups were analyzed. Additionally, we compared demographic data, body mass index, the Charlson comorbidity index, monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, neutrophil-to-albumin ratio, albumin values and surgical incision length.
Results
No statistically significant difference in the length of the peritrochanteric SAT was found between fractured and nonfractured hips across the groups. However, CT scans revealed that the SAT area around the greater trochanter was 102.5 cm2 (range: 25–175.4) in group 1 and 71.1 cm2 (range: 20–190) in group 2, indicating a statistically significant difference (P < .001). Similarly, the SAT area around the anterior superior iliac spine was found to be 132.4 cm2 (81.6–172 cm2) in group 1 and 82.3 cm2 (17–179 cm2) in group 2; this difference was also statistically significant (P < .001).
Conclusions
The area of SAT is an effective predictor of postoperative SWD in elderly female patients undergoing hemiarthroplasty due to a femoral neck fracture.
{"title":"The Effect of Subcutaneous Fat Tissue Length and Area on Postoperative Wound Drainage in Patients Undergoing Hemiarthroplasty for Femoral Neck Fracture","authors":"Mehmet Önüt MD , Olgun Bingöl MD , Güzelali Özdemir MD , Mehmet Fatih Savaş MD , Barış Yağbasan MD , Enver Kılıç MD , Utku Eren Özkaya MD","doi":"10.1016/j.artd.2025.101932","DOIUrl":"10.1016/j.artd.2025.101932","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to investigate whether subcutaneous adipose tissue (SAT) length by radiograph and SAT area by computed tomography (CT) before femoral neck fracture surgery are associated with surgical wound drainage (SWD) in elderly female patients.</div></div><div><h3>Methods</h3><div>We prospectively evaluated 87 female patients who underwent hemiarthroplasty surgery at a level 1 trauma center between May 2024 and January 2025. The patients were classified into 2 groups: those with SWD within 90 days after surgery (group 1) and those without (group 2). SAT area and SAT length were evaluated using CT and hip radiograph imaging, respectively, and the differences between the 2 groups were analyzed. Additionally, we compared demographic data, body mass index, the Charlson comorbidity index, monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, neutrophil-to-albumin ratio, albumin values and surgical incision length.</div></div><div><h3>Results</h3><div>No statistically significant difference in the length of the peritrochanteric SAT was found between fractured and nonfractured hips across the groups. However, CT scans revealed that the SAT area around the greater trochanter was 102.5 cm<sup>2</sup> (range: 25–175.4) in group 1 and 71.1 cm<sup>2</sup> (range: 20–190) in group 2, indicating a statistically significant difference (<em>P</em> < .001). Similarly, the SAT area around the anterior superior iliac spine was found to be 132.4 cm<sup>2</sup> (81.6–172 cm<sup>2</sup>) in group 1 and 82.3 cm<sup>2</sup> (17–179 cm<sup>2</sup>) in group 2; this difference was also statistically significant (<em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>The area of SAT is an effective predictor of postoperative SWD in elderly female patients undergoing hemiarthroplasty due to a femoral neck fracture.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101932"},"PeriodicalIF":2.1,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978535","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}
Pub Date : 2026-01-12DOI: 10.1016/j.artd.2025.101945
Jibanananda Satpathy MD , Laura Giambra PA-C , Brady Ernst MD , Brigitte Lieu BA , John Krumme MD , Gregory Golladay MD
While hip osteoarthritis (OA) is often diagnosed by plain films, posteromedial hip OA is harder to visualize, thus risking underdiagnosis among patients with symptomatic posteromedial hip OA but unremarkable plain hip and pelvis radiographs. The divergent sign, or apparent asymmetric widening of the superolateral joint space on anteroposterior view, may be a useful indicator of posteromedial OA. We present a case series of 19 patients with posteromedial hip OA diagnosable via the divergent sign and confirmed with magnetic resonance imaging and intraoperative findings. Seventeen of these patients underwent total hip arthroplasty with successful outcomes and minimal postoperative complications, while the other 2 elected conservative management. We propose this radiographic sign should prompt clinicians to better evaluate for posteromedial hip OA with advanced imaging to sooner diagnose this condition.
{"title":"Divergent Sign: a Case Series Describing a Novel Radiographic Finding of Posteromedial Hip Osteoarthritis","authors":"Jibanananda Satpathy MD , Laura Giambra PA-C , Brady Ernst MD , Brigitte Lieu BA , John Krumme MD , Gregory Golladay MD","doi":"10.1016/j.artd.2025.101945","DOIUrl":"10.1016/j.artd.2025.101945","url":null,"abstract":"<div><div>While hip osteoarthritis (OA) is often diagnosed by plain films, posteromedial hip OA is harder to visualize, thus risking underdiagnosis among patients with symptomatic posteromedial hip OA but unremarkable plain hip and pelvis radiographs. The divergent sign, or apparent asymmetric widening of the superolateral joint space on anteroposterior view, may be a useful indicator of posteromedial OA. We present a case series of 19 patients with posteromedial hip OA diagnosable via the divergent sign and confirmed with magnetic resonance imaging and intraoperative findings. Seventeen of these patients underwent total hip arthroplasty with successful outcomes and minimal postoperative complications, while the other 2 elected conservative management. We propose this radiographic sign should prompt clinicians to better evaluate for posteromedial hip OA with advanced imaging to sooner diagnose this condition.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101945"},"PeriodicalIF":2.1,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978539","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}
Pub Date : 2026-01-12DOI: 10.1016/j.artd.2025.101911
Todd C. Kelley MD, Andrew J. Webber Ph.D., MPAS, PA-C
Background
Impaction during total hip arthroplasty (THA) is physically demanding and places considerable stress on surgeons, contributing to fatigue and musculoskeletal injury. Automated impactor systems have emerged as a potential solution to reduce these physical demands. This study explores the dual benefits of such a system in THA, focusing on both surgeon well-being and patient recovery outcomes.
Methods
The research combines wearable sensing technology and mobile sensing applications across two complementary studies. The Surgeon Exertion arm of the study assessed surgeon exertion and well-being during THA procedures performed with a traditional mallet vs an automated impactor system, measuring physiological stress markers and recovery indicators with the use of wearable sensing technology. The Postoperative Patient Outcomes arm evaluated patient recovery outcomes, leveraging mobile sensing technology to passively collect real-world data on physical activity, pain, and mood pre- and post-THA.
Results
Surgeon Exertion results indicate significantly lower physiological stress markers and improved sleep quality for the surgeon when the automated impactor system was used for the day’s surgical cases compared to the traditional mallet (IMPACTOR: 108.8 bpm vs MALLET: 121.2 bpm; P < .0001; 7.6 h vs 6.3 h sleep; P < .0005). Postoperative Patient Outcomes demonstrated enhanced functional outcomes and increased daily mobility postoperatively in patients treated with the automated impactor system compared to patients treated with a traditional mallet THA (P = .03 for function and steps; P = .04 for walking distance), highlighting the device’s potential to improve patient recovery trajectories.
Conclusions
The integration of an automated impactor system in THA surgeries offers significant benefits for both surgeon well-being and patient outcomes, including improved hip function, greater daily mobility, and increased walking distance. The study’s innovative use of mobile sensing and wearable technologies provides a robust framework for understanding the impacts of surgical innovations in real-world settings.
背景全髋关节置换术（THA）期间的碰撞对身体的要求很高，给外科医生带来了相当大的压力，导致疲劳和肌肉骨骼损伤。自动化冲击系统已经成为减少这些物理需求的潜在解决方案。本研究探讨了这种系统在THA中的双重好处，重点是外科医生的福祉和患者的康复结果。方法本研究将可穿戴式传感技术与移动传感应用相结合，进行两个互补研究。该研究的外科医生运动臂评估了外科医生在使用传统木槌和自动冲击器系统进行THA手术时的运动和健康状况，使用可穿戴传感技术测量生理应激标志物和恢复指标。术后患者预后组评估患者恢复结果，利用移动传感技术被动收集tha前后身体活动、疼痛和情绪的真实数据。结果外科医生的运动结果表明，与传统的木槌相比，在当天的手术病例中使用自动冲击器系统时，外科医生的生理应激指标明显降低，睡眠质量得到改善（impactor: 108.8 bpm vs mallet: 121.2 bpm; P < 0.0001; 7.6 h vs 6.3 h睡眠；P < 0.0005）。术后患者结果显示，与传统木槌THA治疗的患者相比，使用自动冲击器系统治疗的患者术后功能改善，日常活动能力增加（功能和步骤P = 0.03，步行距离P = 0.04），突出了该设备改善患者康复轨迹的潜力。结论：在全髋关节置换术中集成自动冲击器系统对外科医生的健康和患者的预后都有显著的好处，包括改善髋关节功能、提高日常活动能力和增加步行距离。该研究对移动传感和可穿戴技术的创新应用为理解外科创新在现实环境中的影响提供了一个强大的框架。
{"title":"If I Had a Hammer: The Role of Automated Impactors in Transforming Total Hip Arthroplasty Procedures and Recovery","authors":"Todd C. Kelley MD, Andrew J. Webber Ph.D., MPAS, PA-C","doi":"10.1016/j.artd.2025.101911","DOIUrl":"10.1016/j.artd.2025.101911","url":null,"abstract":"<div><h3>Background</h3><div>Impaction during total hip arthroplasty (THA) is physically demanding and places considerable stress on surgeons, contributing to fatigue and musculoskeletal injury. Automated impactor systems have emerged as a potential solution to reduce these physical demands. This study explores the dual benefits of such a system in THA, focusing on both surgeon well-being and patient recovery outcomes.</div></div><div><h3>Methods</h3><div>The research combines wearable sensing technology and mobile sensing applications across two complementary studies. The Surgeon Exertion arm of the study assessed surgeon exertion and well-being during THA procedures performed with a traditional mallet vs an automated impactor system, measuring physiological stress markers and recovery indicators with the use of wearable sensing technology. The Postoperative Patient Outcomes arm evaluated patient recovery outcomes, leveraging mobile sensing technology to passively collect real-world data on physical activity, pain, and mood pre- and post-THA.</div></div><div><h3>Results</h3><div>Surgeon Exertion results indicate significantly lower physiological stress markers and improved sleep quality for the surgeon when the automated impactor system was used for the day’s surgical cases compared to the traditional mallet (IMPACTOR: 108.8 bpm vs MALLET: 121.2 bpm; <em>P</em> < .0001; 7.6 h vs 6.3 h sleep; <em>P</em> < .0005). Postoperative Patient Outcomes demonstrated enhanced functional outcomes and increased daily mobility postoperatively in patients treated with the automated impactor system compared to patients treated with a traditional mallet THA (<em>P</em> = .03 for function and steps; <em>P</em> = .04 for walking distance), highlighting the device’s potential to improve patient recovery trajectories.</div></div><div><h3>Conclusions</h3><div>The integration of an automated impactor system in THA surgeries offers significant benefits for both surgeon well-being and patient outcomes, including improved hip function, greater daily mobility, and increased walking distance. The study’s innovative use of mobile sensing and wearable technologies provides a robust framework for understanding the impacts of surgical innovations in real-world settings.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101911"},"PeriodicalIF":2.1,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978534","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}
Pub Date : 2026-01-12DOI: 10.1016/j.artd.2025.101934
Junyan Li MD , Shengqun Zhang MD , Weiliang Cai MD , Xianzhe Huang MD , Shuo Jie MD , Hui Li MD , Hongxing Li MD , Xinzhan Mao MD
Background
The cement-in-cement technique, which preserves the original cement mantle, has become a widely used surgical method in hip revision surgeries due to its ability to significantly simplify the procedure. Currently, no studies have directly compared the mid-term outcomes of using the cement-in-cement technique in patients with aseptic loosening vs those undergoing 1-stage revisions due to infection. We report the clinical and radiological outcomes of cement-in-cement femoral revisions performed for aseptic loosening and infection of hip.
Methods
We identified all patients undergoing cement-in-cement revision from January 2014 to October 2025. All cases were performed by the senior author using the Exeter Stem (Stryker Orthopaedics, Mahwah, New Jersey). Patients were followed-up annually with clinical and radiological assessment including survival rate, Oxford Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index scores, quality of cementation and component subsidence.
Results
A total of 13 patients matched the inclusion criteria (8 aseptic loosening and 5 infection). Mean follow-up was 3.5 years. A significant improvement in Oxford Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index scores was observed in both groups ((P < .001). No difference was found between the 2 groups in functional and radiological assessment. One patient in the aseptic loosening group underwent further operation for infection. No femoral components were revised for aseptic loosening in both groups.
Conclusions
The cement-in-cement technique may be a reasonable option for single-stage revision for infection when the existing cement mantle is intact, providing bone preservation and outcomes comparable to aseptic revisions.
水泥中水泥技术保留了原有的水泥套，由于其能够显著简化手术过程，已成为髋关节翻修手术中广泛使用的手术方法。目前，没有研究直接比较在无菌性松动患者中使用骨水泥-骨水泥技术与因感染而进行一期翻修的患者的中期结果。我们报告对无菌性松动和髋关节感染进行骨水泥-骨水泥股骨翻修的临床和放射学结果。方法选取2014年1月至2025年10月期间接受骨水泥内翻修术的所有患者。所有病例均由资深作者使用Exeter Stem （Stryker Orthopaedics, Mahwah, New Jersey）进行手术。每年随访患者的临床和放射学评估，包括生存率、牛津髋关节评分、西部安大略省和麦克马斯特大学骨关节炎指数评分、骨水泥质量和部件下沉。结果13例患者符合纳入标准（无菌性松动8例，感染5例）。平均随访时间为3.5年。两组患者的牛津髋关节评分、西安大略大学和麦克马斯特大学骨关节炎指数评分均有显著改善（P < .001）。两组在功能和放射学评价方面无差异。无菌松动组1例患者因感染进一步手术治疗。两组均未对无菌性松动股骨假体进行修改。结论在现有骨水泥套完整的情况下，骨水泥-骨水泥技术可能是治疗感染的单阶段翻修的合理选择，可提供骨保存和与无菌翻修相当的结果。
{"title":"Mid-Term Outcomes of Cement-In-Cement Revision for Aseptic Loosening Versus Infection: A Comparative Study in a Small Retrospective Cohort","authors":"Junyan Li MD , Shengqun Zhang MD , Weiliang Cai MD , Xianzhe Huang MD , Shuo Jie MD , Hui Li MD , Hongxing Li MD , Xinzhan Mao MD","doi":"10.1016/j.artd.2025.101934","DOIUrl":"10.1016/j.artd.2025.101934","url":null,"abstract":"<div><h3>Background</h3><div>The cement-in-cement technique, which preserves the original cement mantle, has become a widely used surgical method in hip revision surgeries due to its ability to significantly simplify the procedure. Currently, no studies have directly compared the mid-term outcomes of using the cement-in-cement technique in patients with aseptic loosening vs those undergoing 1-stage revisions due to infection. We report the clinical and radiological outcomes of cement-in-cement femoral revisions performed for aseptic loosening and infection of hip.</div></div><div><h3>Methods</h3><div>We identified all patients undergoing cement-in-cement revision from January 2014 to October 2025. All cases were performed by the senior author using the Exeter Stem (Stryker Orthopaedics, Mahwah, New Jersey). Patients were followed-up annually with clinical and radiological assessment including survival rate, Oxford Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index scores, quality of cementation and component subsidence.</div></div><div><h3>Results</h3><div>A total of 13 patients matched the inclusion criteria (8 aseptic loosening and 5 infection). Mean follow-up was 3.5 years. A significant improvement in Oxford Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index scores was observed in both groups ((<em>P</em> < .001). No difference was found between the 2 groups in functional and radiological assessment. One patient in the aseptic loosening group underwent further operation for infection. No femoral components were revised for aseptic loosening in both groups.</div></div><div><h3>Conclusions</h3><div>The cement-in-cement technique may be a reasonable option for single-stage revision for infection when the existing cement mantle is intact, providing bone preservation and outcomes comparable to aseptic revisions.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101934"},"PeriodicalIF":2.1,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978537","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}
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