Pub Date : 2025-11-02DOI: 10.1016/j.artd.2025.101888
Poon Jerome Chi Wang MBBS, HKU, Qunn-jid Lee MB-ChB, CUHK, Kenneth Wing-kin Law MB-ChB, CUHK, Daniel Wai-yip Wong MBBS, HKU, Cho Pong Lo MB-ChB, CUHK
Background
The Coronal Plane Alignment of the Knee (CPAK) classification describes knee phenotypes based on limb alignment and joint-line obliquity (JLO). This study evaluates CPAK distribution in the Hong Kong population and assesses how prosthesis design affects CPAK reproducibility and clinical outcomes.
Methods
This retrospective study included patients who underwent navigated total knee arthroplasty (TKA) with adjusted mechanical alignment in a single institution in 2021. First, we analyzed the epidemiology of CPAK phenotypes in our population. Second, patients were divided into 2 propensity score-matched groups based on implant design: Journey II BCS TKA (JLO prothesis) vs Persona PS TKA (joint line neutral prothesis). Radiological outcomes (mechanical hip–knee–ankle angle, lateral distal femoral angle, medial proximal tibial angle) and clinical outcomes (range of motion, Knee Society Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index score, Forgotten Joint Score) assessed preoperatively and at 6 and 12 months postoperatively.
Results
Our CPAK distribution was comparable to that of other East Asian populations. The Journey II BCS TKA more effectively restored JLO and CPAK phenotypes compared to the Persona PS TKA. However, there was no statistically significant clinical correlation between the restoration of JLO, arithmetic HKA, and CPAK.
Conclusions
Although radiological restoration improves with JLO prostheses, short-term clinical outcomes remain unaffected.
膝关节冠状面对齐（CPAK）分类描述了基于肢体对齐和关节线倾角（JLO）的膝关节表型。本研究评估了CPAK在香港人群中的分布，并评估了假体设计如何影响CPAK的可重复性和临床结果。方法：本回顾性研究纳入了2021年在单一机构接受导航式全膝关节置换术（TKA）的患者。首先，我们分析了我国人群中CPAK表型的流行病学。其次，根据种植体设计将患者分为2个倾向评分匹配组：Journey II BCS TKA （JLO假体）和Persona PS TKA（关节线中性假体）。术前和术后6个月和12个月评估放射学结果（机械髋关节-膝关节-踝关节角、股骨外侧远端角、胫骨内侧近端角）和临床结果（活动范围、膝关节学会评分、西安大略和麦克马斯特大学骨关节炎指数评分、遗忘关节评分）。结果我们的CPAK分布与其他东亚人群相似。与Persona PS TKA相比，Journey II BCS TKA更有效地恢复了JLO和CPAK表型。然而，JLO的恢复、算数HKA和CPAK之间没有统计学意义的临床相关性。结论JLO假体虽能改善放射学修复，但短期临床效果不受影响。
{"title":"Effect of Anatomic Joint-Line Obliquity Prostheses on Coronal Plane Alignment of the Knee Alignment in a Chinese Population","authors":"Poon Jerome Chi Wang MBBS, HKU, Qunn-jid Lee MB-ChB, CUHK, Kenneth Wing-kin Law MB-ChB, CUHK, Daniel Wai-yip Wong MBBS, HKU, Cho Pong Lo MB-ChB, CUHK","doi":"10.1016/j.artd.2025.101888","DOIUrl":"10.1016/j.artd.2025.101888","url":null,"abstract":"<div><h3>Background</h3><div>The Coronal Plane Alignment of the Knee (CPAK) classification describes knee phenotypes based on limb alignment and joint-line obliquity (JLO). This study evaluates CPAK distribution in the Hong Kong population and assesses how prosthesis design affects CPAK reproducibility and clinical outcomes.</div></div><div><h3>Methods</h3><div>This retrospective study included patients who underwent navigated total knee arthroplasty (TKA) with adjusted mechanical alignment in a single institution in 2021. First, we analyzed the epidemiology of CPAK phenotypes in our population. Second, patients were divided into 2 propensity score-matched groups based on implant design: Journey II BCS TKA (JLO prothesis) vs Persona PS TKA (joint line neutral prothesis). Radiological outcomes (mechanical hip–knee–ankle angle, lateral distal femoral angle, medial proximal tibial angle) and clinical outcomes (range of motion, Knee Society Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index score, Forgotten Joint Score) assessed preoperatively and at 6 and 12 months postoperatively.</div></div><div><h3>Results</h3><div>Our CPAK distribution was comparable to that of other East Asian populations. The Journey II BCS TKA more effectively restored JLO and CPAK phenotypes compared to the Persona PS TKA. However, there was no statistically significant clinical correlation between the restoration of JLO, arithmetic HKA, and CPAK.</div></div><div><h3>Conclusions</h3><div>Although radiological restoration improves with JLO prostheses, short-term clinical outcomes remain unaffected.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101888"},"PeriodicalIF":2.1,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466855","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 : 2025-10-31DOI: 10.1016/j.artd.2025.101889
Mallery Zeiman BS, Athena Makrides, Jason Lee DO, Richard S. Yoon MD
Background
Femoral nerve palsy (FNP) is a rare but debilitating complication of total hip arthroplasty (THA). The direct anterior approach (DAA) has been gaining popularity in recent years. Concerns regarding the risk of FNP after DAA THA have been rising due to the anatomical proximity of the femoral nerve. This systematic review evaluates the risk and incidence of FNP after DAA THA.
Methods
A search was conducted using PubMed, Cochrane, Ovid Medline, and Scopus databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Data were extracted pertaining to incidence, comparison to other approaches and recovery. A qualitative analysis was done.
Results
Our study included 9 studies—1 randomized control trial, 3 retrospective reviews, 4 case series, and 1 case report. The total sample size of DAA THA patients was 16,258 with an incidence of 0.36% (95% confidence interval (CI), 0.28-0.47%). The 3 studies that compared DAA to other approaches reported a higher incidence of FNP with the DAA. Of the studies that included recovery, most cases of FNP demonstrated full motor recovery in 3-15 months.
Conclusions
FNP is a rare complication of THA that occurs more frequently in the DAA. Retractor placement, patient positioning, and patient related risk factors play a key role in increasing risk. Further high quality studies are needed to assess the risk and preventative measures.
{"title":"Femoral Nerve Palsy After Anterior Total Hip Arthroplasty: A Systematic Review","authors":"Mallery Zeiman BS, Athena Makrides, Jason Lee DO, Richard S. Yoon MD","doi":"10.1016/j.artd.2025.101889","DOIUrl":"10.1016/j.artd.2025.101889","url":null,"abstract":"<div><h3>Background</h3><div>Femoral nerve palsy (FNP) is a rare but debilitating complication of total hip arthroplasty (THA). The direct anterior approach (DAA) has been gaining popularity in recent years. Concerns regarding the risk of FNP after DAA THA have been rising due to the anatomical proximity of the femoral nerve. This systematic review evaluates the risk and incidence of FNP after DAA THA.</div></div><div><h3>Methods</h3><div>A search was conducted using PubMed, Cochrane, Ovid Medline, and Scopus databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Data were extracted pertaining to incidence, comparison to other approaches and recovery. A qualitative analysis was done.</div></div><div><h3>Results</h3><div>Our study included 9 studies—1 randomized control trial, 3 retrospective reviews, 4 case series, and 1 case report. The total sample size of DAA THA patients was 16,258 with an incidence of 0.36% (95% confidence interval (CI), 0.28-0.47%). The 3 studies that compared DAA to other approaches reported a higher incidence of FNP with the DAA. Of the studies that included recovery, most cases of FNP demonstrated full motor recovery in 3-15 months.</div></div><div><h3>Conclusions</h3><div>FNP is a rare complication of THA that occurs more frequently in the DAA. Retractor placement, patient positioning, and patient related risk factors play a key role in increasing risk. Further high quality studies are needed to assess the risk and preventative measures.</div></div><div><h3>Level of Evidence</h3><div>V.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101889"},"PeriodicalIF":2.1,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418297","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 : 2025-10-29DOI: 10.1016/j.artd.2025.101887
Martin S. Davey MCh, MRCS, MD , Peter K. Sculco MD
{"title":"The Routine Use of Femoral Heads Sized 40 mm or Greater in Primary Total Hip Arthroplasty: A Review of Current Practice","authors":"Martin S. Davey MCh, MRCS, MD , Peter K. Sculco MD","doi":"10.1016/j.artd.2025.101887","DOIUrl":"10.1016/j.artd.2025.101887","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101887"},"PeriodicalIF":2.1,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418299","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 : 2025-10-27DOI: 10.1016/j.artd.2025.101880
Chloe Dlott MD , Sebastian Romero BS , Claire A. Donnelley MD , Stephanie Kaszuba MD , Daniel Wiznia MD
Background
Total joint arthroplasty is an effective intervention for end-stage joint disease, but carries elevated risks for patients with comorbidities and those from historically marginalized populations. Preoperative risk management programs are designed to mitigate these risks by optimizing patient health prior to surgery. This study evaluated the impact of such a program on postoperative outcomes at a single academic institution, with attention to racial and ethnic minorities and patients with public insurance.
Methods
We conducted a retrospective cohort study of 2748 patients who underwent total hip or knee arthroplasty between 2019 and 2021 at a single academic institution. Of these, 1548 patients received preoperative optimization targeting modifiable risk factors such as diabetes, obesity, and anemia, while 1200 followed standard preoperative protocols. Outcomes assessed included length of stay, prosthetic joint infection, 30- and 90-day readmissions, and emergency department (ED) visits. Patients were stratified by race/ethnicity, insurance type, and American Society of Anesthesiology physical classification.
Results
The optimized cohort had a higher average Charlson Comorbidity Index (1.1 vs 0.9; P = .01). There were no significant differences between groups in length of stay, readmissions, or overall ED visit rates. Black patients experienced higher ED utilization within 90 days postoperatively, regardless of optimization status. Medicaid patients with severe systemic disease had the highest rates of prosthetic joint infection (3.8%), and optimization was not associated with improved outcomes in this group. Patients with American Society of Anesthesiology physical classification ≥3 had increased ED visits postoperatively despite optimization.
Conclusions
Preoperative risk management did not consistently improve outcomes, particularly among patients with greater comorbidity burdens or those facing socioeconomic disadvantage. These findings support the need for tailored optimization strategies that address both clinical risk and social determinants of health.
背景：全关节置换术是治疗终末期关节疾病的有效干预手段，但对于有合并症的患者和历史上处于边缘地位的人群，风险较高。术前风险管理程序旨在通过在手术前优化患者健康来减轻这些风险。本研究在单一学术机构评估了此类项目对术后结果的影响，并关注了种族和少数民族以及有公共保险的患者。方法：我们对2019年至2021年在单一学术机构接受全髋关节或膝关节置换术的2748例患者进行了回顾性队列研究。其中，1548例患者接受了针对糖尿病、肥胖和贫血等可改变危险因素的术前优化，1200例患者遵循标准术前方案。评估的结果包括住院时间、假体关节感染、30天和90天再入院以及急诊（ED）就诊。患者按种族/民族、保险类型和美国麻醉学会物理分类进行分层。结果优化后的队列平均Charlson合并症指数较高（1.1 vs 0.9; P = 0.01）。两组患者在住院时间、再入院率或总体急诊科就诊率方面没有显著差异。无论优化状态如何，黑人患者在术后90天内ED使用率较高。患有严重全身性疾病的医疗补助患者的假体关节感染率最高（3.8%），优化与该组预后改善无关。尽管进行了优化，但美国麻醉学会物理分类≥3的患者术后急诊次数增加。结论：术前风险管理并不能持续改善预后，特别是在合并症负担更重或面临社会经济劣势的患者中。这些发现支持需要量身定制的优化策略，以解决临床风险和健康的社会决定因素。
{"title":"Evaluating the Impact of a Preoperative Risk Management Program on Outcomes Following Total Joint Arthroplasty: A Retrospective Cohort Study","authors":"Chloe Dlott MD , Sebastian Romero BS , Claire A. Donnelley MD , Stephanie Kaszuba MD , Daniel Wiznia MD","doi":"10.1016/j.artd.2025.101880","DOIUrl":"10.1016/j.artd.2025.101880","url":null,"abstract":"<div><h3>Background</h3><div>Total joint arthroplasty is an effective intervention for end-stage joint disease, but carries elevated risks for patients with comorbidities and those from historically marginalized populations. Preoperative risk management programs are designed to mitigate these risks by optimizing patient health prior to surgery. This study evaluated the impact of such a program on postoperative outcomes at a single academic institution, with attention to racial and ethnic minorities and patients with public insurance.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 2748 patients who underwent total hip or knee arthroplasty between 2019 and 2021 at a single academic institution. Of these, 1548 patients received preoperative optimization targeting modifiable risk factors such as diabetes, obesity, and anemia, while 1200 followed standard preoperative protocols. Outcomes assessed included length of stay, prosthetic joint infection, 30- and 90-day readmissions, and emergency department (ED) visits. Patients were stratified by race/ethnicity, insurance type, and American Society of Anesthesiology physical classification.</div></div><div><h3>Results</h3><div>The optimized cohort had a higher average Charlson Comorbidity Index (1.1 vs 0.9; <em>P</em> = .01). There were no significant differences between groups in length of stay, readmissions, or overall ED visit rates. Black patients experienced higher ED utilization within 90 days postoperatively, regardless of optimization status. Medicaid patients with severe systemic disease had the highest rates of prosthetic joint infection (3.8%), and optimization was not associated with improved outcomes in this group. Patients with American Society of Anesthesiology physical classification ≥3 had increased ED visits postoperatively despite optimization.</div></div><div><h3>Conclusions</h3><div>Preoperative risk management did not consistently improve outcomes, particularly among patients with greater comorbidity burdens or those facing socioeconomic disadvantage. These findings support the need for tailored optimization strategies that address both clinical risk and social determinants of health.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101880"},"PeriodicalIF":2.1,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418298","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 : 2025-10-23DOI: 10.1016/j.artd.2025.101879
Ramesh B. Ghanta MD, Jeffrey Barry MD, Jeffrey Kwong MD, Hunter Warwick MD, Erik Hansen MD, Claudio Diaz-Ledezma MD
Background
Dual-mobility (DM) articulations are increasingly used in revision total hip arthroplasty (THA) to reduce instability, but their effectiveness in conjunction with jumbo cups is unclear. This study evaluated the risk of all-cause and instability-related re-revision when DM articulations were used with jumbo vs standard cups in revision THA.
Methods
A retrospective review included 199 revision THA patients with DM articulations: 156 with regular cups and 43 with jumbo cups (≥62 mm for females, ≥66 mm for males). Exclusion criteria were cup-cage constructs, cemented DM liners in pre-existing cups, and tumor cases. The primary outcome was re-revision, with focus on instability. Student's t-test compared revision rates, and multivariable logistic regression with backward selection was used to assess the relationship between cup size and re-revision risk.
Results
At a mean 4.6-year follow-up, re-revision rates were similar between groups (10.3% regular vs 11.6% jumbo, P = .79). Instability-related re-revisions were also comparable (5.1% regular vs 7% jumbo; P = .64). Logistic regression demonstrated that jumbo cup utilization was not associated with risk of all-cause revision (P = .99) or instability-related re-revision (P = .77). However, the number of prior surgeries increased risk for both all-cause (OR: 1.32 [1.07, 1.63], P = .009) and instability-related (OR: 1.46 [1.13, 1.87], P = .003) re-revisions.
Conclusions
Our results demonstrate satisfactory midterm outcomes in both jumbo and regular cup patients implanted with DM systems. These findings demonstrate that the use of DM liners in jumbo cups does not portend increased risk of re-revision compared to use of DM in regular sized cups.
{"title":"Utilization of Jumbo-Sized Cups in Conjunction With Dual-Mobility Constructs Does Not Increase Risk of Re-Revision in Revision Hip Arthroplasty","authors":"Ramesh B. Ghanta MD, Jeffrey Barry MD, Jeffrey Kwong MD, Hunter Warwick MD, Erik Hansen MD, Claudio Diaz-Ledezma MD","doi":"10.1016/j.artd.2025.101879","DOIUrl":"10.1016/j.artd.2025.101879","url":null,"abstract":"<div><h3>Background</h3><div>Dual-mobility (DM) articulations are increasingly used in revision total hip arthroplasty (THA) to reduce instability, but their effectiveness in conjunction with jumbo cups is unclear. This study evaluated the risk of all-cause and instability-related re-revision when DM articulations were used with jumbo vs standard cups in revision THA.</div></div><div><h3>Methods</h3><div>A retrospective review included 199 revision THA patients with DM articulations: 156 with regular cups and 43 with jumbo cups (≥62 mm for females, ≥66 mm for males). Exclusion criteria were cup-cage constructs, cemented DM liners in pre-existing cups, and tumor cases. The primary outcome was re-revision, with focus on instability. Student's <em>t</em>-test compared revision rates, and multivariable logistic regression with backward selection was used to assess the relationship between cup size and re-revision risk.</div></div><div><h3>Results</h3><div>At a mean 4.6-year follow-up, re-revision rates were similar between groups (10.3% regular vs 11.6% jumbo, <em>P</em> = .79). Instability-related re-revisions were also comparable (5.1% regular vs 7% jumbo; <em>P</em> = .64). Logistic regression demonstrated that jumbo cup utilization was not associated with risk of all-cause revision (<em>P</em> = .99) or instability-related re-revision (<em>P</em> = .77). However, the number of prior surgeries increased risk for both all-cause (OR: 1.32 [1.07, 1.63], <em>P</em> = .009) and instability-related (OR: 1.46 [1.13, 1.87], <em>P</em> = .003) re-revisions.</div></div><div><h3>Conclusions</h3><div>Our results demonstrate satisfactory midterm outcomes in both jumbo and regular cup patients implanted with DM systems. These findings demonstrate that the use of DM liners in jumbo cups does not portend increased risk of re-revision compared to use of DM in regular sized cups.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101879"},"PeriodicalIF":2.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365284","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 : 2025-10-23DOI: 10.1016/j.artd.2025.101881
Brandon K. Couch MD, Allyson N. Pfeil BS, Corey F. Hryc PhD, Robin Goytia MD, Vasilios Mathews MD
Background
Preoperative templating in total hip arthroplasty (THA) improves surgical accuracy and predictability. Recently, prosthesis manufacturers (PMs) have introduced industry-generated templating systems, but their accuracy compared to surgeon-generated templates has yet to be evaluated.
Methods
A retrospective review was conducted on THAs performed by 2 surgeons between October 2023 and September 2024. Surgeon-generated and PM-generated templates were compared to actual implanted components. Accuracy of acetabular and femoral component sizing, as well as femoral offset prediction, was assessed using χ2 analysis (P < .05). Subgroup analyses examined the influence of patient sex and body mass index on accuracy.
Results
A total of 306 surgeon templates and 240 PM templates were analyzed. Surgeons correctly predicted acetabular and femoral component sizes in 45.1% and 28.4% of cases, respectively, while PM templates achieved 33.8% and 35.0%. No significant difference was found between groups in component size accuracy (acetabular: P = .09; femoral: P = .08). However, surgeons demonstrated significantly greater accuracy in offset prediction (83.7% vs 73.3%, P = .003). Additionally, surgeon-generated femoral component accuracy was significantly associated with patient body mass index (P < .001).
Conclusions
PM templating demonstrated a reasonable ability to predict implant sizes in THA, with comparable performance to high-volume, fellowship-trained arthroplasty surgeons. While surgeon-generated templates outperformed PM templates in offset prediction, these findings suggest that industry-generated templates could be a valuable tool for surgical planning and inventory management in hospitals.
背景全髋关节置换术（THA）的术前模板可提高手术的准确性和可预测性。最近，假体制造商（pm）已经引入了工业生成的模板系统，但与外科医生生成的模板相比，它们的准确性尚未得到评估。方法回顾性分析2023年10月至2024年9月间2例外科医生行tha手术的资料。将外科医生生成的和pm生成的模板与实际植入的组件进行比较。采用χ2分析评估髋臼和股骨假体尺寸以及股骨偏移预测的准确性（P < 0.05）。亚组分析检验了患者性别和体重指数对准确性的影响。结果共分析外科医生模板306份，PM模板240份。外科医生正确预测髋臼和股骨假体大小的比例分别为45.1%和28.4%，而PM模板分别为33.8%和35.0%。各组间假体尺寸准确性无显著差异（髋臼：P = 0.09；股骨：P = 0.08）。然而，外科医生在偏移预测方面的准确性明显更高（83.7% vs 73.3%, P = 0.003）。此外，手术生成的股骨成分准确性与患者体重指数显著相关（P < .001）。结论spm模板在THA中具有合理的预测假体大小的能力，其性能可与大容量、培训过的关节置换外科医生相媲美。虽然外科医生生成的模板在偏移量预测方面优于PM模板，但这些发现表明，行业生成的模板可能是医院手术计划和库存管理的有价值的工具。
{"title":"Comparative Analysis and Accuracy of Surgeon- and Prosthesis Manufacturer–Generated Radiographic Templates in Total Hip Arthroplasty","authors":"Brandon K. Couch MD, Allyson N. Pfeil BS, Corey F. Hryc PhD, Robin Goytia MD, Vasilios Mathews MD","doi":"10.1016/j.artd.2025.101881","DOIUrl":"10.1016/j.artd.2025.101881","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative templating in total hip arthroplasty (THA) improves surgical accuracy and predictability. Recently, prosthesis manufacturers (PMs) have introduced industry-generated templating systems, but their accuracy compared to surgeon-generated templates has yet to be evaluated.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on THAs performed by 2 surgeons between October 2023 and September 2024. Surgeon-generated and PM-generated templates were compared to actual implanted components. Accuracy of acetabular and femoral component sizing, as well as femoral offset prediction, was assessed using χ<sup>2</sup> analysis (<em>P</em> < .05). Subgroup analyses examined the influence of patient sex and body mass index on accuracy.</div></div><div><h3>Results</h3><div>A total of 306 surgeon templates and 240 PM templates were analyzed. Surgeons correctly predicted acetabular and femoral component sizes in 45.1% and 28.4% of cases, respectively, while PM templates achieved 33.8% and 35.0%. No significant difference was found between groups in component size accuracy (acetabular: <em>P</em> = .09; femoral: <em>P</em> = .08). However, surgeons demonstrated significantly greater accuracy in offset prediction (83.7% vs 73.3%, <em>P</em> = .003). Additionally, surgeon-generated femoral component accuracy was significantly associated with patient body mass index (<em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>PM templating demonstrated a reasonable ability to predict implant sizes in THA, with comparable performance to high-volume, fellowship-trained arthroplasty surgeons. While surgeon-generated templates outperformed PM templates in offset prediction, these findings suggest that industry-generated templates could be a valuable tool for surgical planning and inventory management in hospitals.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101881"},"PeriodicalIF":2.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365285","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 : 2025-10-23DOI: 10.1016/j.artd.2025.101883
Kiran Kittur BS , Josue G. Layuno-Matos Ba , Matthew Nester BS , Connor C. Diaz MD , Michael Miranda DO , Thomas Bernasek MD
Background
Knee resection arthroplasty (KRA) is performed as definitive treatment for recurrent periprosthetic joint infection (PJI). This study aims to evaluate infection eradication and functional outcomes following KRA as a definitive treatment of PJI.
Methods
We reviewed all KRAs performed between 2002 and 2022. We identified 28 knees (27 patients) treated with definitive KRA for recurrent PJI. Primary outcomes included infection eradication, ambulatory status, and ambulatory aid use. Failure to eradicate infection was defined as any reoperation for infection. Ambulation was defined as any level of weight-bearing mobility using assistive devices, such as a walker.
Results
The mean age at KRA was 72 years and average follow-up was 22 months. Patients had on average 3 knee operations prior to KRA. Of the 28 infections, 79% were eradicated by KRA. Of the remaining 6 persistently infected knees, 4 required an average of 4 irrigation and debridement to eventually control infection, resulting in 93% of infections eradicated overall. At latest visit, 33% of patients were on chronic antibiotic suppression. A total of 67% of patients could ambulate. Most patients (85%) required knee–ankle–foot orthoses for instability. Subsequent knee fusion was chosen by 3 patients. A patient with bilateral KRAs died within 90 days of surgery. The overall reoperation rate for KRA patients was 29%, and the overall mortality rate was 15%.
Conclusions
Definitive treatment with KRA demonstrated effectiveness in eradicating infection, although with moderate rate of reoperation. Postoperatively, most patients could ambulate with assistive devices. The KRA is an effective alternative for knee salvage when managing chronic, recalcitrant PJI.
{"title":"Outcomes After Definitive Knee Resection Arthroplasty for Recurrent Periprosthetic Joint Infection","authors":"Kiran Kittur BS , Josue G. Layuno-Matos Ba , Matthew Nester BS , Connor C. Diaz MD , Michael Miranda DO , Thomas Bernasek MD","doi":"10.1016/j.artd.2025.101883","DOIUrl":"10.1016/j.artd.2025.101883","url":null,"abstract":"<div><h3>Background</h3><div>Knee resection arthroplasty (KRA) is performed as definitive treatment for recurrent periprosthetic joint infection (PJI). This study aims to evaluate infection eradication and functional outcomes following KRA as a definitive treatment of PJI.</div></div><div><h3>Methods</h3><div>We reviewed all KRAs performed between 2002 and 2022. We identified 28 knees (27 patients) treated with definitive KRA for recurrent PJI. Primary outcomes included infection eradication, ambulatory status, and ambulatory aid use. Failure to eradicate infection was defined as any reoperation for infection. Ambulation was defined as any level of weight-bearing mobility using assistive devices, such as a walker.</div></div><div><h3>Results</h3><div>The mean age at KRA was 72 years and average follow-up was 22 months. Patients had on average 3 knee operations prior to KRA. Of the 28 infections, 79% were eradicated by KRA. Of the remaining 6 persistently infected knees, 4 required an average of 4 irrigation and debridement to eventually control infection, resulting in 93% of infections eradicated overall. At latest visit, 33% of patients were on chronic antibiotic suppression. A total of 67% of patients could ambulate. Most patients (85%) required knee–ankle–foot orthoses for instability. Subsequent knee fusion was chosen by 3 patients. A patient with bilateral KRAs died within 90 days of surgery. The overall reoperation rate for KRA patients was 29%, and the overall mortality rate was 15%.</div></div><div><h3>Conclusions</h3><div>Definitive treatment with KRA demonstrated effectiveness in eradicating infection, although with moderate rate of reoperation. Postoperatively, most patients could ambulate with assistive devices. The KRA is an effective alternative for knee salvage when managing chronic, recalcitrant PJI.</div></div><div><h3>Level of evidence</h3><div>IV, case series.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101883"},"PeriodicalIF":2.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365247","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 : 2025-10-22DOI: 10.1016/j.artd.2025.101878
Troy B. Puga DO , Vincent Dieu MS , Kyle P. O’Connor MD , Logan Tackett BS , McKenna W. Box MD , John T. Riehl MD
Background
Prosthetic joint infections (PJIs) are a major concern in total knee arthroplasty (TKA). One recent measure of interest has been the use of intraosseous vancomycin (IOV). This systematic review aims to evaluate the efficacy of IOV to prevent infection in TKA.
Methods
A search was conducted across MEDLINE/Pubmed, Wiley Central, Google Scholar, Web of Science, and Embase databases. Demographics and results of the studies were extracted from the articles that met inclusion criteria. Meta-analysis was conducted on primary TKA studies.
Results
Eight studies were included in this systematic review. IOV correlated with decreased odds of infection in primary TKA (odds ratio: 0.31, P = .02) when compared with controls of intravenous antibiotic and no regional IOV. IOV showed no increase in AKI or creatinine concentration in primary TKA when compared with controls. IOV and increased concentration of vancomycin in fat and subcutaneous tissues had a strong correlation (Cohen’s d = 0.9, P = .01). IOV and increased concentration of vancomycin in bone had a moderate correlation (Cohen’s d = 0.59, P = .01). No patients where IOV was used across all studies developed Red Man Syndrome.
Conclusions
IOV is an effective adjunctive treatment for preventing infection in primary TKA, with this study showing a 69% decreased odds of infection when compared with controls of intravenous antibiotic and no regional IOV. IOV also appears to be a safe treatment, and with limited data there seems to not be an increase in AKI or creatinine concentration.
Level of Evidence
Level IV; Therapeutic.
假体关节感染（PJIs）是全膝关节置换术（TKA）中的主要问题。最近的一项措施是使用骨内万古霉素（IOV）。本系统综述旨在评价IOV预防TKA感染的疗效。方法检索MEDLINE/Pubmed、Wiley Central、谷歌Scholar、Web of Science和Embase数据库。从符合纳入标准的文章中提取研究的人口统计学和结果。对主要TKA研究进行meta分析。结果本系统综述纳入8项研究。与静脉注射抗生素和无局部静脉注射的对照组相比，静脉注射与原发性TKA感染几率降低相关（优势比：0.31,P = 0.02）。与对照组相比，IOV未显示原发性TKA患者AKI或肌酐浓度增加。IOV与万古霉素在脂肪和皮下组织中的浓度升高有很强的相关性（Cohen’s d = 0.9, P = 0.01）。骨内万古霉素浓度升高与IOV有中等相关性（Cohen’s d = 0.59, P = 0.01）。在所有研究中使用IOV的患者均未出现红人综合征。结论siv是预防原发性TKA感染的有效辅助治疗方法，本研究显示，与静脉注射抗生素和不注射局部IOV的对照组相比，siv可使TKA感染的几率降低69%。IOV似乎也是一种安全的治疗方法，根据有限的数据，似乎没有AKI或肌酐浓度的增加。证据等级：IV级；治疗。
{"title":"Intraosseous Vancomycin in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis","authors":"Troy B. Puga DO , Vincent Dieu MS , Kyle P. O’Connor MD , Logan Tackett BS , McKenna W. Box MD , John T. Riehl MD","doi":"10.1016/j.artd.2025.101878","DOIUrl":"10.1016/j.artd.2025.101878","url":null,"abstract":"<div><h3>Background</h3><div>Prosthetic joint infections (PJIs) are a major concern in total knee arthroplasty (TKA). One recent measure of interest has been the use of intraosseous vancomycin (IOV). This systematic review aims to evaluate the efficacy of IOV to prevent infection in TKA.</div></div><div><h3>Methods</h3><div>A search was conducted across MEDLINE/Pubmed, Wiley Central, Google Scholar, Web of Science, and Embase databases. Demographics and results of the studies were extracted from the articles that met inclusion criteria. Meta-analysis was conducted on primary TKA studies.</div></div><div><h3>Results</h3><div>Eight studies were included in this systematic review. IOV correlated with decreased odds of infection in primary TKA (odds ratio: 0.31, <em>P</em> = .02) when compared with controls of intravenous antibiotic and no regional IOV. IOV showed no increase in AKI or creatinine concentration in primary TKA when compared with controls. IOV and increased concentration of vancomycin in fat and subcutaneous tissues had a strong correlation (Cohen’s d = 0.9, <em>P</em> = .01). IOV and increased concentration of vancomycin in bone had a moderate correlation (Cohen’s d = 0.59, <em>P</em> = .01). No patients where IOV was used across all studies developed Red Man Syndrome.</div></div><div><h3>Conclusions</h3><div>IOV is an effective adjunctive treatment for preventing infection in primary TKA, with this study showing a 69% decreased odds of infection when compared with controls of intravenous antibiotic and no regional IOV. IOV also appears to be a safe treatment, and with limited data there seems to not be an increase in AKI or creatinine concentration.</div></div><div><h3>Level of Evidence</h3><div>Level IV; Therapeutic.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101878"},"PeriodicalIF":2.1,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145364734","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}
It is important for surgeons to consider the pelvic position at cup placement for accurate cup placement. This position depends on both the pelvic position at set-up and the degree of intraoperative pelvic motion from set-up to cup placement. The present study aimed to characterize and compare the pelvic position at cup placement with intraoperative pelvic motion during primary total hip arthroplasty in the lateral decubitus position. This study also investigated whether the pelvic position at set-up or intraoperative pelvic motion had a greater impact on the pelvic position at cup placement.
Methods
Pelvic positions were measured in 86 hips using an augmented reality-based portable hip navigation system. The pelvic reference plane was registered in the supine position, and patients were then positioned in the lateral decubitus position for surgery. Pelvic positions were recorded at set-up and at the time of cup placement.
Results
Mean pitch and roll angles at cup placement were significantly different from those of intraoperative pelvic motion (P < .001, .009), with greater variations in pitch and roll angles at cup placement. Directional differences in pitch and roll were also observed. Comparison of means showed that the pelvic position at set-up was close to the pelvic position at cup placement for pitch, whereas intraoperative pelvic motion was close to the pelvic position at cup placement for roll.
Conclusions
The pelvic position at cup placement differed from intraoperative pelvic motion. The pelvic position at set-up and intraoperative pelvic motion contributed differently to the pelvic position at cup placement.
背景：对于外科医生来说，考虑盆腔位置对于准确放置杯子是很重要的。这个位置取决于盆腔放置时的位置和术中盆腔从放置到放置的运动程度。本研究旨在描述和比较初次全髋关节置换术中侧卧位盆腔运动与置换术中盆腔位置。本研究还调查了盆腔放置时盆腔位置或术中盆腔运动对盆腔放置时的位置有更大的影响。方法采用基于增强现实的便携式髋关节导航系统测量86例髋关节的骨盆位置。将骨盆参考平面登记为仰卧位，然后将患者定位为侧卧位进行手术。盆腔位置记录在安装时和放置杯时。结果置杯时的平均俯仰角和侧滚角与术中盆腔运动时的平均俯仰角和侧滚角差异有统计学意义（P < 0.001, P < 0.05）。009)，在杯的位置有较大的俯仰角和滚转角变化。俯仰和横摇的方向性差异也被观察到。均数比较显示，术中盆腔运动接近于置杯时的骨盆位置，而术中盆腔运动接近于置杯时的骨盆位置。结论盆腔杯放置时盆腔位置与术中盆腔运动不同。盆腔放置时的位置和术中盆腔运动对盆腔放置时的位置影响不同。
{"title":"Pelvic Position at Cup Placement Compared With Intraoperative Pelvic Motion in the Lateral Decubitus Position","authors":"Hiromasa Tanino MD, PhD, Ryo Mitsutake MD, PhD, Hiroshi Ito MD, PhD","doi":"10.1016/j.artd.2025.101877","DOIUrl":"10.1016/j.artd.2025.101877","url":null,"abstract":"<div><h3>Background</h3><div>It is important for surgeons to consider the pelvic position at cup placement for accurate cup placement. This position depends on both the pelvic position at set-up and the degree of intraoperative pelvic motion from set-up to cup placement. The present study aimed to characterize and compare the pelvic position at cup placement with intraoperative pelvic motion during primary total hip arthroplasty in the lateral decubitus position. This study also investigated whether the pelvic position at set-up or intraoperative pelvic motion had a greater impact on the pelvic position at cup placement.</div></div><div><h3>Methods</h3><div>Pelvic positions were measured in 86 hips using an augmented reality-based portable hip navigation system. The pelvic reference plane was registered in the supine position, and patients were then positioned in the lateral decubitus position for surgery. Pelvic positions were recorded at set-up and at the time of cup placement.</div></div><div><h3>Results</h3><div>Mean pitch and roll angles at cup placement were significantly different from those of intraoperative pelvic motion (<em>P</em> < .001, .009), with greater variations in pitch and roll angles at cup placement. Directional differences in pitch and roll were also observed. Comparison of means showed that the pelvic position at set-up was close to the pelvic position at cup placement for pitch, whereas intraoperative pelvic motion was close to the pelvic position at cup placement for roll.</div></div><div><h3>Conclusions</h3><div>The pelvic position at cup placement differed from intraoperative pelvic motion. The pelvic position at set-up and intraoperative pelvic motion contributed differently to the pelvic position at cup placement.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101877"},"PeriodicalIF":2.1,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365246","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 : 2025-10-15DOI: 10.1016/j.artd.2025.101775
Roger Quesada-Jimenez MD , Yasemin E. Kingham BA , Tyler R. McCarroll MD , Jessica C. Keane BS , Ady H. Kahana-Rojkind MD , Benjamin G. Domb MD
Background
Patients who undergo total hip arthroplasty (THA) without addressing gluteus medius (GM) pathology tend to experience inferior outcomes. The study aims to evaluate mid-term outcomes in patients who underwent a primary THA with concomitant GM tear repair, as compared to a benchmark control group of primary THA patients that did not have GM pathology.
Methods
Data were retrospectively analyzed from patients who underwent a primary THA with a concomitant GM repair between 2015 and 2018. Included patients completed preoperative and minimum 5-year questionnaires for Harris Hip Score, visual analog scale, Veteran's Rand 12-item (VR-12) health survey, 12-item Short Form (SF-12) heath surveys, Forgotten Joint Score, and the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement. The GM cohort was matched in a 1:3 ratio based on age at surgery, body mass index, sex, approach, and robotic-assisted surgery to a control group of primary THAs without GM pathology. Thresholds for functional outcomes were included.
Results
Forty patients who underwent primary THA with GM repair were included successfully match to 120 control patients. There were significant improvements in the reported Harris Hip Score, visual analog scale, VR-12 Physical, VR-12 Mental, SF-12 Physical, and SF-12 Mental scores in the study group. Despite their gluteus medius pathology, with concomitant repair, the study group achieved patient-reported outcomes improvements and rates of minimal clinically important difference and patient acceptable symptom state that were comparable to the control group.
Conclusions
THA with concomitant GM repair yielded significant improvement in functional status and clinical outcomes, which compared favorably to a benchmark control group without GM tears. Surgeons may consider addressing GM tears during a primary THA.
{"title":"Primary Total Hip Arthroplasty With Concomitant Gluteus Medius Repair: Mid-term Outcomes With Nested Propensity-Matched Benchmark Control","authors":"Roger Quesada-Jimenez MD , Yasemin E. Kingham BA , Tyler R. McCarroll MD , Jessica C. Keane BS , Ady H. Kahana-Rojkind MD , Benjamin G. Domb MD","doi":"10.1016/j.artd.2025.101775","DOIUrl":"10.1016/j.artd.2025.101775","url":null,"abstract":"<div><h3>Background</h3><div>Patients who undergo total hip arthroplasty (THA) without addressing gluteus medius (GM) pathology tend to experience inferior outcomes. The study aims to evaluate mid-term outcomes in patients who underwent a primary THA with concomitant GM tear repair, as compared to a benchmark control group of primary THA patients that did not have GM pathology.</div></div><div><h3>Methods</h3><div>Data were retrospectively analyzed from patients who underwent a primary THA with a concomitant GM repair between 2015 and 2018. Included patients completed preoperative and minimum 5-year questionnaires for Harris Hip Score, visual analog scale, Veteran's Rand 12-item (VR-12) health survey, 12-item Short Form (SF-12) heath surveys, Forgotten Joint Score, and the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement. The GM cohort was matched in a 1:3 ratio based on age at surgery, body mass index, sex, approach, and robotic-assisted surgery to a control group of primary THAs without GM pathology. Thresholds for functional outcomes were included.</div></div><div><h3>Results</h3><div>Forty patients who underwent primary THA with GM repair were included successfully match to 120 control patients. There were significant improvements in the reported Harris Hip Score, visual analog scale, VR-12 Physical, VR-12 Mental, SF-12 Physical, and SF-12 Mental scores in the study group. Despite their gluteus medius pathology, with concomitant repair, the study group achieved patient-reported outcomes improvements and rates of minimal clinically important difference and patient acceptable symptom state that were comparable to the control group.</div></div><div><h3>Conclusions</h3><div>THA with concomitant GM repair yielded significant improvement in functional status and clinical outcomes, which compared favorably to a benchmark control group without GM tears. Surgeons may consider addressing GM tears during a primary THA.</div></div><div><h3>Level of Evidence</h3><div>Level III.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101775"},"PeriodicalIF":2.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145322866","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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