Pub Date : 2024-06-01DOI: 10.1016/j.artd.2024.101328
David E. DeMik MD, PharmD , Anna Cohen-Rosenblum MD , David C. Landy MD, PhD , Joshua Kerr MA , Justin T. Deen MD , Prem N. Ramkumar MD, MBA , Jenna Bernstein MD
Background
As demand for total hip arthroplasty and total knee arthroplasty increases, more surgeons have pursued subspecialty training in adult reconstruction. However, little information is available regarding the practice environment in which these fellowship-trained surgeons practice. The purpose of this study was to describe the practice environments of contemporary adult reconstruction surgeons.
Methods
A survey was developed and distributed to members of the American Association of Hip and Knee Surgeons from December 2022 to January 2023. Information was collected on surgeon demographics, practice setting, call requirements, and educational debt. Responses were recorded using frequencies and proportions.
Results
A total of 886 of 2471 (36%) surgeons completed the survey, with 93% identifying as male and 81% as white. The primary surgical practice locations were: community hospital 53%, academic/tertiary hospital 24%, specialty orthopedic hospital 17%, and ambulatory surgery center 7%. Nearly half (49%) of the respondents practiced in orthopedic specialty groups, and 60% spent 50%-66% of their clinical time in the office. The majority of surgeons performed between 101-250 (20%) and 251-400 (31%) arthroplasty cases per year, though this varied considerably. Call was taken by 77% of surgeons, yet only 54% received compensation.
Conclusions
The most common practice setting for adult reconstruction surgeons was in a community-based hospital as part of a large orthopedic specialty group. Despite the considerable variability in annual procedure volume, the majority of surgeons spent over half their clinical time in office and had call obligations with variable compensation models.
{"title":"The Practice Experience of an Adult Reconstruction Surgeon: A Cross-Sectional Analysis and Survey of the American Association of Hip and Knee Surgeons Membership","authors":"David E. DeMik MD, PharmD , Anna Cohen-Rosenblum MD , David C. Landy MD, PhD , Joshua Kerr MA , Justin T. Deen MD , Prem N. Ramkumar MD, MBA , Jenna Bernstein MD","doi":"10.1016/j.artd.2024.101328","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101328","url":null,"abstract":"<div><h3>Background</h3><p>As demand for total hip arthroplasty and total knee arthroplasty increases, more surgeons have pursued subspecialty training in adult reconstruction. However, little information is available regarding the practice environment in which these fellowship-trained surgeons practice. The purpose of this study was to describe the practice environments of contemporary adult reconstruction surgeons.</p></div><div><h3>Methods</h3><p>A survey was developed and distributed to members of the American Association of Hip and Knee Surgeons from December 2022 to January 2023. Information was collected on surgeon demographics, practice setting, call requirements, and educational debt. Responses were recorded using frequencies and proportions.</p></div><div><h3>Results</h3><p>A total of 886 of 2471 (36%) surgeons completed the survey, with 93% identifying as male and 81% as white. The primary surgical practice locations were: community hospital 53%, academic/tertiary hospital 24%, specialty orthopedic hospital 17%, and ambulatory surgery center 7%. Nearly half (49%) of the respondents practiced in orthopedic specialty groups, and 60% spent 50%-66% of their clinical time in the office. The majority of surgeons performed between 101-250 (20%) and 251-400 (31%) arthroplasty cases per year, though this varied considerably. Call was taken by 77% of surgeons, yet only 54% received compensation.</p></div><div><h3>Conclusions</h3><p>The most common practice setting for adult reconstruction surgeons was in a community-based hospital as part of a large orthopedic specialty group. Despite the considerable variability in annual procedure volume, the majority of surgeons spent over half their clinical time in office and had call obligations with variable compensation models.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S235234412400013X/pdfft?md5=f555a0e10fae434cf56395f0819fd16e&pid=1-s2.0-S235234412400013X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141485260","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 : 2024-06-01DOI: 10.1016/j.artd.2024.101330
Bahar Entezari BMSc , Johnathan R. Lex MBChB, MASc , Jonathan Peck MD, FRCSC , Emmanuel N. Igbokwe HBSc, MD , Jeremy F. Kubik MD, FRCSC , David J. Backstein MD, MEd, FRCSC , Jesse I. Wolfstadt MD, MSc, FRCSC, FAAOS
Background
Previous anterior cruciate ligament (ACL) injury is a risk factor for the development of knee osteoarthritis. Despite advances in ACL reconstruction (ACLR) techniques, many patients with history of ACLR develop end-stage osteoarthritis necessitating total knee arthroplasty (TKA). The purpose of this study was to investigate the impact of prior ACLR on intraoperative and postoperative outcomes of TKA.
Methods
This was a single-centre matched cohort study of all patients with prior ACLR undergoing primary TKA from January 2000 to May 2022. Patients were matched 1:1 to patients undergoing TKA with no prior ACL injury based on age, sex, and body mass index. Outcomes investigated included TKA procedure duration, soft-tissue releases, implant design, and complications requiring reoperation.
Results
Forty-two ACLR patients were identified and matched to controls. Mean follow-up was 6.8 years and 5.0 years in the ACLR and control cohorts, respectively (P = .115). ACLR patients demonstrated longer procedure durations (122.8 minutes vs 87.0 minutes, P < .001) and more frequently required soft-tissue releases (40.5% vs 14.3%, P = .007), stemmed implants (23.8% vs 4.8%, P = .013), and patellar resurfacing (59.5% vs 26.2%, P = .002). There were no significant differences in postoperative clinical or surgical outcomes between groups. Ten-year implant survivorship was 92% and 95% in the ACLR and control cohorts, respectively (P = .777).
Conclusions
TKA is an effective procedure for the management of end-stage osteoarthritis with prior ACLR. The care team should be prepared for longer operative times and the utilization of advanced techniques to achieve satisfactory soft-tissue balance and implant stability.
{"title":"Intraoperative and Postoperative Outcomes of Patients Undergoing Total Knee Arthroplasty With Prior Anterior Cruciate Ligament Reconstruction: A Matched Cohort Analysis","authors":"Bahar Entezari BMSc , Johnathan R. Lex MBChB, MASc , Jonathan Peck MD, FRCSC , Emmanuel N. Igbokwe HBSc, MD , Jeremy F. Kubik MD, FRCSC , David J. Backstein MD, MEd, FRCSC , Jesse I. Wolfstadt MD, MSc, FRCSC, FAAOS","doi":"10.1016/j.artd.2024.101330","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101330","url":null,"abstract":"<div><h3>Background</h3><p>Previous anterior cruciate ligament (ACL) injury is a risk factor for the development of knee osteoarthritis. Despite advances in ACL reconstruction (ACLR) techniques, many patients with history of ACLR develop end-stage osteoarthritis necessitating total knee arthroplasty (TKA). The purpose of this study was to investigate the impact of prior ACLR on intraoperative and postoperative outcomes of TKA.</p></div><div><h3>Methods</h3><p>This was a single-centre matched cohort study of all patients with prior ACLR undergoing primary TKA from January 2000 to May 2022. Patients were matched 1:1 to patients undergoing TKA with no prior ACL injury based on age, sex, and body mass index. Outcomes investigated included TKA procedure duration, soft-tissue releases, implant design, and complications requiring reoperation.</p></div><div><h3>Results</h3><p>Forty-two ACLR patients were identified and matched to controls. Mean follow-up was 6.8 years and 5.0 years in the ACLR and control cohorts, respectively (<em>P</em> = .115). ACLR patients demonstrated longer procedure durations (122.8 minutes vs 87.0 minutes, <em>P</em> < .001) and more frequently required soft-tissue releases (40.5% vs 14.3%, <em>P</em> = .007), stemmed implants (23.8% vs 4.8%, <em>P</em> = .013), and patellar resurfacing (59.5% vs 26.2%, <em>P</em> = .002). There were no significant differences in postoperative clinical or surgical outcomes between groups. Ten-year implant survivorship was 92% and 95% in the ACLR and control cohorts, respectively (<em>P</em> = .777).</p></div><div><h3>Conclusions</h3><p>TKA is an effective procedure for the management of end-stage osteoarthritis with prior ACLR. The care team should be prepared for longer operative times and the utilization of advanced techniques to achieve satisfactory soft-tissue balance and implant stability.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124000153/pdfft?md5=f7129adc4eb5856eeeccd281e3c832a4&pid=1-s2.0-S2352344124000153-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141485235","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 : 2024-06-01DOI: 10.1016/j.artd.2024.101389
Robert Koucheki MD, MEng , Jesse I. Wolfstadt MD, MSc, FRCSC, FAAOS , Justin S. Chang MD, FRCSC , David J. Backstein MD, MED, FRCSC , Johnathan R. Lex MBChB
Background
Total knee arthroplasty (TKA) is a commonly performed procedure that has traditionally utilized reproducible steps using a set of mechanical instruments. The number of TKAs performed using robotic assistance is increasing, and augmented reality (AR) navigation systems are being developed. Hierarchical task analysis (HTA) aims to describe the steps of a specific task in detail to reduce errors and ensure reproducibility. The objective of this study was to develop and validate HTAs for conventional, robotic-assisted, and AR-navigated TKA.
Methods
The development of HTAs for conventional TKA involved an iterative review process that incorporated the input of 4 experienced arthroplasty surgeons. The HTAs were then adapted for robotic-assisted and AR-navigated TKA by incorporating specific steps associated with the use of these systems. The accuracy and completeness of the HTAs were validated by observing 10 conventional and 10 robotic-assisted TKA procedures.
Results
HTAs for conventional, robotic-assisted, and AR-navigated TKA were developed and validated. The resulting HTAs provide a comprehensive and standardized plan for each procedure and can aid in the identification of potential areas of inefficiency and risk. Robotic-assisted and AR-navigated approaches require additional steps, and there are an increased number of instances where complications may occur.
Conclusions
The HTAs developed in this study can provide valuable insights into the potential pitfalls of robotic-assisted and AR-navigated TKA procedures. As AR-navigation systems are developed, they should be optimized by critical analysis using the developed HTAs to ensure maximum efficiency, reliability, accessibility, reduction of human error, and costs.
背景全膝关节置换术(TKA)是一种常用的手术,传统上使用一套机械器械进行可重复的步骤。使用机器人辅助进行全膝关节置换术的数量正在增加,增强现实(AR)导航系统也正在开发中。分层任务分析(HTA)旨在详细描述特定任务的步骤,以减少错误并确保可重复性。本研究的目的是为传统、机器人辅助和 AR 导航的 TKA 制定和验证 HTA。方法为传统 TKA 制定 HTA 的过程涉及反复审查,其中包括 4 位经验丰富的关节成形外科医生的意见。然后,通过纳入与使用机器人辅助和 AR 导航 TKA 系统相关的特定步骤,对 HTA 进行了调整。通过观察 10 例传统 TKA 手术和 10 例机器人辅助 TKA 手术,验证了 HTA 的准确性和完整性。由此产生的 HTA 为每种手术提供了全面的标准化计划,有助于识别潜在的低效和风险领域。本研究中开发的 HTA 可为机器人辅助和 AR 导航 TKA 手术的潜在隐患提供有价值的见解。随着 AR 导航系统的开发,应通过使用所开发的 HTA 进行批判性分析来对其进行优化,以确保最高的效率、可靠性、可及性、减少人为错误和成本。
{"title":"Total Knee Arthroplasty With Robotic and Augmented Reality Guidance: A Hierarchical Task Analysis","authors":"Robert Koucheki MD, MEng , Jesse I. Wolfstadt MD, MSc, FRCSC, FAAOS , Justin S. Chang MD, FRCSC , David J. Backstein MD, MED, FRCSC , Johnathan R. Lex MBChB","doi":"10.1016/j.artd.2024.101389","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101389","url":null,"abstract":"<div><h3>Background</h3><p>Total knee arthroplasty (TKA) is a commonly performed procedure that has traditionally utilized reproducible steps using a set of mechanical instruments. The number of TKAs performed using robotic assistance is increasing, and augmented reality (AR) navigation systems are being developed. Hierarchical task analysis (HTA) aims to describe the steps of a specific task in detail to reduce errors and ensure reproducibility. The objective of this study was to develop and validate HTAs for conventional, robotic-assisted, and AR-navigated TKA.</p></div><div><h3>Methods</h3><p>The development of HTAs for conventional TKA involved an iterative review process that incorporated the input of 4 experienced arthroplasty surgeons. The HTAs were then adapted for robotic-assisted and AR-navigated TKA by incorporating specific steps associated with the use of these systems. The accuracy and completeness of the HTAs were validated by observing 10 conventional and 10 robotic-assisted TKA procedures.</p></div><div><h3>Results</h3><p>HTAs for conventional, robotic-assisted, and AR-navigated TKA were developed and validated. The resulting HTAs provide a comprehensive and standardized plan for each procedure and can aid in the identification of potential areas of inefficiency and risk. Robotic-assisted and AR-navigated approaches require additional steps, and there are an increased number of instances where complications may occur.</p></div><div><h3>Conclusions</h3><p>The HTAs developed in this study can provide valuable insights into the potential pitfalls of robotic-assisted and AR-navigated TKA procedures. As AR-navigation systems are developed, they should be optimized by critical analysis using the developed HTAs to ensure maximum efficiency, reliability, accessibility, reduction of human error, and costs.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124000748/pdfft?md5=35deeaf1acad76e959149a5fb8dba788&pid=1-s2.0-S2352344124000748-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141482207","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 : 2024-05-27DOI: 10.1016/j.artd.2024.101410
Justin M. Cardenas MD , Dan Gordon MD , Bradford S. Waddell MD , Kurt J. Kitziger MD , Paul C. Peters Jr. MD , Brian P. Gladnick MD
Background
Successful total hip arthroplasty (THA) relies on the correct implant position. THA accuracy can be improved with the use of intraoperative fluoroscopic-assisted computer navigation. Artificial intelligence (AI) software may enhance fluoroscopic navigation; however, the accuracy of the AI compared to human-controlled software in assessing acetabular component position and leg length discrepancy (LLD) has not been studied.
Methods
We analyzed 420 consecutive primary THAs performed by a single surgeon using fluoroscopic-assisted computer navigation software. The first cohort of 211 patients required inputs from a human technician (manual), while the second cohort of 209 patients used an automated version of the software controlled by AI. The intraoperative acetabular component placement (inclination and anteversion) and LLD were recorded and compared to the 2-week postoperative standing anterior-posterior pelvis radiograph.
Results
Ninety-four percent (199/211) of cups in the manual cohort and 95% (198/209) of cups in the AI cohort were within the Lewinnek “safe-zone” (P = 1.0). In the manual cohort, 69% (146/211) of THAs had a final LLD within ±2 mm of the intraoperatively navigated LLD (ie, ΔLLD ≤2 mm). In the AI cohort, 66% (137/209) of THAs had a final LLD within ±2 mm of the intraoperatively navigated LLD (P = .47). Ninety-nine percent (209/211) of hips in the manual cohort and 98% (205/209) of hips in the AI cohort had a final LLD within ±5 mm of the intraoperatively navigated LLD (P = .45).
Conclusions
Both AI and human-controlled versions of the same navigation platform were similarly accurate for navigating cup position within the Lewinnek “safe zone” and LLD accuracy.
{"title":"Does Artificial Intelligence Outperform Humans Using Fluoroscopic-Assisted Computer Navigation for Total Hip Arthroplasty?","authors":"Justin M. Cardenas MD , Dan Gordon MD , Bradford S. Waddell MD , Kurt J. Kitziger MD , Paul C. Peters Jr. MD , Brian P. Gladnick MD","doi":"10.1016/j.artd.2024.101410","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101410","url":null,"abstract":"<div><h3>Background</h3><p>Successful total hip arthroplasty (THA) relies on the correct implant position. THA accuracy can be improved with the use of intraoperative fluoroscopic-assisted computer navigation. Artificial intelligence (AI) software may enhance fluoroscopic navigation; however, the accuracy of the AI compared to human-controlled software in assessing acetabular component position and leg length discrepancy (LLD) has not been studied.</p></div><div><h3>Methods</h3><p>We analyzed 420 consecutive primary THAs performed by a single surgeon using fluoroscopic-assisted computer navigation software. The first cohort of 211 patients required inputs from a human technician (manual), while the second cohort of 209 patients used an automated version of the software controlled by AI. The intraoperative acetabular component placement (inclination and anteversion) and LLD were recorded and compared to the 2-week postoperative standing anterior-posterior pelvis radiograph.</p></div><div><h3>Results</h3><p>Ninety-four percent (199/211) of cups in the manual cohort and 95% (198/209) of cups in the AI cohort were within the Lewinnek “safe-zone” (<em>P</em> = 1.0). In the manual cohort, 69% (146/211) of THAs had a final LLD within ±2 mm of the intraoperatively navigated LLD (ie, ΔLLD ≤2 mm). In the AI cohort, 66% (137/209) of THAs had a final LLD within ±2 mm of the intraoperatively navigated LLD (<em>P</em> = .47). Ninety-nine percent (209/211) of hips in the manual cohort and 98% (205/209) of hips in the AI cohort had a final LLD within ±5 mm of the intraoperatively navigated LLD (<em>P</em> = .45).</p></div><div><h3>Conclusions</h3><p>Both AI and human-controlled versions of the same navigation platform were similarly accurate for navigating cup position within the Lewinnek “safe zone” and LLD accuracy.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124000955/pdfft?md5=6053fc47a34bc564e5b763ed90576bb0&pid=1-s2.0-S2352344124000955-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141156240","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 : 2024-05-21DOI: 10.1016/j.artd.2024.101401
Samo Roškar MD , Ingrid Milošev PhD , René Mihalič MD, PhD , Ema Žagar PhD , Rihard Trebše MD, PhD
A 68-year-old man was referred due to bilateral hip pain and gradual deterioration of walking. He had mold arthroplasties on both hips at the age of 7 years and has been functioning well for more than 5 decades. However, the original data on operative report and the prostheses were missing. The radiological examination revealed bilateral broken prosthetic material. Thus, stage bilateral revision total hip arthroplasty was performed. A detailed chemical analysis of retrieved mold arthroplasty implants proved that the acrylic material was noted to be the same composition with the difference in appearance likely being related to different thermal treatments originally applied to the implants. As presented in our clinical case, even obsolete implants may have good survivorship. According to the case presented, total hip arthroplasty could be considered an effective option with the desired functional outcome when conservative and joint-preserving measures are exhausted.
{"title":"Bilateral Acrylic Hip Mold Arthroplasty in a Child With a Revision 60 years After Implantation: Clinical Case and Chemical Analysis of Endoprosthetic Material","authors":"Samo Roškar MD , Ingrid Milošev PhD , René Mihalič MD, PhD , Ema Žagar PhD , Rihard Trebše MD, PhD","doi":"10.1016/j.artd.2024.101401","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101401","url":null,"abstract":"<div><p>A 68-year-old man was referred due to bilateral hip pain and gradual deterioration of walking. He had mold arthroplasties on both hips at the age of 7 years and has been functioning well for more than 5 decades. However, the original data on operative report and the prostheses were missing. The radiological examination revealed bilateral broken prosthetic material. Thus, stage bilateral revision total hip arthroplasty was performed. A detailed chemical analysis of retrieved mold arthroplasty implants proved that the acrylic material was noted to be the same composition with the difference in appearance likely being related to different thermal treatments originally applied to the implants. As presented in our clinical case, even obsolete implants may have good survivorship. According to the case presented, total hip arthroplasty could be considered an effective option with the desired functional outcome when conservative and joint-preserving measures are exhausted.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124000864/pdfft?md5=555c8cdaa4dcac37257b8cb8cec876a9&pid=1-s2.0-S2352344124000864-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141073106","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 : 2024-05-21DOI: 10.1016/j.artd.2024.101386
T. Jacob Selph Jr. BS , Linda I. Suleiman MD , Manasa S. Pagadala BS , Rachel Bergman MD , Patricia D. Franklin MD, MBA, MPH , Adam I. Edelstein MD
Background
The American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria (AUC) for Surgical Management of Osteoarthritis of the Knee (2016) and Management of Osteoarthritis of the Hip (2017) are intended to provide treatment recommendations for osteoarthritis (OA). This study examined the agreement of AUC appropriateness classifications with arthroplasty surgeon recommendations for total knee arthroplasty (TKA) and total hip arthroplasty (THA).
Methods
The cohort included 558 OA patients (397 knee, 161 hip) referred to a specialty arthroplasty clinic. Surgeons completed the online AAOS AUC patient profiles to generate appropriateness ratings. Surgeons’ recommendations for treatment were recorded. We performed univariate and bivariate analyses to evaluate relationships between AUC appropriateness and surgeon recommendations.
Results
The knee OA AUC classified TKA as “appropriate” for 309 (77.8%) of the 397 knee OA patients. Surgeons recommended TKA for 123 (31.0%), resulting in 46.8% (n = 186) higher rate of “appropriate” classification by AUC than TKA recommendation by surgeons. Weighted Cohen’s κ demonstrated slight agreement (κ = 0.06, 95% confidence interval: 0.04, 0.09) between AUC appropriateness and surgeon TKA recommendation. The hip OA AUC classified THA as “appropriate” for 98 (60.9%) of the 161 hip OA patients. Surgeons recommended THA for 76 (47.2%), resulting in 13.7% (n = 22) higher rate of “appropriate” classification by AUC than THA recommendation by surgeons. Weighted Cohen’s κ demonstrated moderate agreement (κ = 0.47, 95% confidence interval: 0.37, 0.57) between the AUC appropriateness classification and the surgeon’s THA recommendation.
Conclusions
AAOS AUC guidelines indicated surgical appropriateness significantly more than arthroplasty surgeons. AUC agreed slightly with surgeons for TKA and moderately for THA.
{"title":"Agreement of the American Academy of Orthopaedic Surgeons Appropriate Use Criteria With Treatment Recommendations From Arthroplasty Surgeons","authors":"T. Jacob Selph Jr. BS , Linda I. Suleiman MD , Manasa S. Pagadala BS , Rachel Bergman MD , Patricia D. Franklin MD, MBA, MPH , Adam I. Edelstein MD","doi":"10.1016/j.artd.2024.101386","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101386","url":null,"abstract":"<div><h3>Background</h3><p>The American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria (AUC) for Surgical Management of Osteoarthritis of the Knee (2016) and Management of Osteoarthritis of the Hip (2017) are intended to provide treatment recommendations for osteoarthritis (OA). This study examined the agreement of AUC appropriateness classifications with arthroplasty surgeon recommendations for total knee arthroplasty (TKA) and total hip arthroplasty (THA).</p></div><div><h3>Methods</h3><p>The cohort included 558 OA patients (397 knee, 161 hip) referred to a specialty arthroplasty clinic. Surgeons completed the online AAOS AUC patient profiles to generate appropriateness ratings. Surgeons’ recommendations for treatment were recorded. We performed univariate and bivariate analyses to evaluate relationships between AUC appropriateness and surgeon recommendations.</p></div><div><h3>Results</h3><p>The knee OA AUC classified TKA as “appropriate” for 309 (77.8%) of the 397 knee OA patients. Surgeons recommended TKA for 123 (31.0%), resulting in 46.8% (n = 186) higher rate of “appropriate” classification by AUC than TKA recommendation by surgeons. Weighted Cohen’s κ demonstrated slight agreement (κ = 0.06, 95% confidence interval: 0.04, 0.09) between AUC appropriateness and surgeon TKA recommendation. The hip OA AUC classified THA as “appropriate” for 98 (60.9%) of the 161 hip OA patients. Surgeons recommended THA for 76 (47.2%), resulting in 13.7% (n = 22) higher rate of “appropriate” classification by AUC than THA recommendation by surgeons. Weighted Cohen’s κ demonstrated moderate agreement (κ = 0.47, 95% confidence interval: 0.37, 0.57) between the AUC appropriateness classification and the surgeon’s THA recommendation.</p></div><div><h3>Conclusions</h3><p>AAOS AUC guidelines indicated surgical appropriateness significantly more than arthroplasty surgeons. AUC agreed slightly with surgeons for TKA and moderately for THA.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124000712/pdfft?md5=25df77522a254a9b2b8396efd369da50&pid=1-s2.0-S2352344124000712-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141073105","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 : 2024-05-18DOI: 10.1016/j.artd.2024.101404
Justin E. Hellwinkel MD , Anastasia Gazgalis MD , Chima D. Nwankwo MD
Reconstruction of the hip joint in the setting of metastatic lesions of the acetabulum is particularly challenging and can carry significant morbidity for patients who are already medically frail. Novel techniques to minimize morbidity and optimize function warrant exploration for these patients. Here, we present a 50-year-old woman was unable to walk secondary to metastatic breast cancer involving the acetabulum with articular disruption. A primary reconstruction technique was used that combined percutaneous stabilization of the acetabulum and cemented total hip arthroplasty using primary components. Existing reconstructive techniques for metastatic lesions of the acetabulum often require extensive open surgical approaches and revision components. Percutaneous acetabular stabilization combined with cemented total hip replacement may be a less-morbid and equally durable option.
{"title":"Percutaneous Screws for Column Support During Total Hip Reconstruction of Metastatic Disease of the Acetabulum","authors":"Justin E. Hellwinkel MD , Anastasia Gazgalis MD , Chima D. Nwankwo MD","doi":"10.1016/j.artd.2024.101404","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101404","url":null,"abstract":"<div><p>Reconstruction of the hip joint in the setting of metastatic lesions of the acetabulum is particularly challenging and can carry significant morbidity for patients who are already medically frail. Novel techniques to minimize morbidity and optimize function warrant exploration for these patients. Here, we present a 50-year-old woman was unable to walk secondary to metastatic breast cancer involving the acetabulum with articular disruption. A primary reconstruction technique was used that combined percutaneous stabilization of the acetabulum and cemented total hip arthroplasty using primary components. Existing reconstructive techniques for metastatic lesions of the acetabulum often require extensive open surgical approaches and revision components. Percutaneous acetabular stabilization combined with cemented total hip replacement may be a less-morbid and equally durable option.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S235234412400089X/pdfft?md5=8dafef304b7c9598f38bb34023e523a3&pid=1-s2.0-S235234412400089X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141068246","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 : 2024-05-15DOI: 10.1016/j.artd.2024.101391
Steven B. Porter MD , Jessica R. Wilson MD , Courtney E. Sherman MD , Launia J. White BS , Shalmali R. Borkar MPH , Aaron C. Spaulding PhD
Background
Dexamethasone (DEX) has been shown to reduce pain and postoperative nausea and vomiting for patients undergoing elective total joint arthroplasty (TJA). We investigated the impact of DEX on glycemic control and outcomes in patients with type 2 diabetes mellitus undergoing elective primary TJA.
Methods
All patients with type 2 diabetes mellitus undergoing primary elective TJA between January 2016 and December 2021 at 4 sites within 1 hospital system were identified. Propensity scores were calculated to match patients receiving or not receiving DEX. Primary outcomes were perioperative blood glucose levels and the incidence of hyperglycemia. Secondary outcomes were the amount of insulin administered, the occurrence of 30-day postoperative surgical site infections, hospital readmission, and mortality.
Results
After matching, we identified 1372 patients. DEX administration was associated with a significant increase in mean blood glucose levels in mg/dL on postoperative days (PODs) 0 to 2: POD 0 (28.4, 95% confidence interval [CI]: 24.6-32.1), POD 1 (14.4, 95% CI: 10.1-18.8), POD 2 (12.4, 95% CI: 7.5-17.2) when comparing patients who did or did not receive DEX. Additionally, patients receiving DEX, compared to patients who did not receive DEX, had increased odds of experiencing hyperglycemia on POD 0 (odds ratio: 4.0, 95% CI: 3.1-5.2). DEX was not associated with a significant difference in insulin administration, surgical site infections, hospital readmission, or mortality.
Conclusions
In our review of 1372 patients with propensity-matched type 2 diabetes mellitus undergoing elective, primary TJA, we found that DEX administration was associated with an increased risk of elevated mean glucose on POD 0-2, hyperglycemia on POD 0, but was not associated with an increase in total insulin dose administered nor occurrence of surgical site infections, hospital readmission, or mortality within 30 days of surgery in patients who received DEX compared to patients who did not receive DEX.
{"title":"Dexamethasone, Glycemic Control, and Outcomes in Patients With Type 2 Diabetes Mellitus Undergoing Elective, Primary Total Joint Arthroplasty","authors":"Steven B. Porter MD , Jessica R. Wilson MD , Courtney E. Sherman MD , Launia J. White BS , Shalmali R. Borkar MPH , Aaron C. Spaulding PhD","doi":"10.1016/j.artd.2024.101391","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101391","url":null,"abstract":"<div><h3>Background</h3><p>Dexamethasone (DEX) has been shown to reduce pain and postoperative nausea and vomiting for patients undergoing elective total joint arthroplasty (TJA). We investigated the impact of DEX on glycemic control and outcomes in patients with type 2 diabetes mellitus undergoing elective primary TJA.</p></div><div><h3>Methods</h3><p>All patients with type 2 diabetes mellitus undergoing primary elective TJA between January 2016 and December 2021 at 4 sites within 1 hospital system were identified. Propensity scores were calculated to match patients receiving or not receiving DEX. Primary outcomes were perioperative blood glucose levels and the incidence of hyperglycemia. Secondary outcomes were the amount of insulin administered, the occurrence of 30-day postoperative surgical site infections, hospital readmission, and mortality.</p></div><div><h3>Results</h3><p>After matching, we identified 1372 patients. DEX administration was associated with a significant increase in mean blood glucose levels in mg/dL on postoperative days (PODs) 0 to 2: POD 0 (28.4, 95% confidence interval [CI]: 24.6-32.1), POD 1 (14.4, 95% CI: 10.1-18.8), POD 2 (12.4, 95% CI: 7.5-17.2) when comparing patients who did or did not receive DEX. Additionally, patients receiving DEX, compared to patients who did not receive DEX, had increased odds of experiencing hyperglycemia on POD 0 (odds ratio: 4.0, 95% CI: 3.1-5.2). DEX was not associated with a significant difference in insulin administration, surgical site infections, hospital readmission, or mortality.</p></div><div><h3>Conclusions</h3><p>In our review of 1372 patients with propensity-matched type 2 diabetes mellitus undergoing elective, primary TJA, we found that DEX administration was associated with an increased risk of elevated mean glucose on POD 0-2, hyperglycemia on POD 0, but was not associated with an increase in total insulin dose administered nor occurrence of surgical site infections, hospital readmission, or mortality within 30 days of surgery in patients who received DEX compared to patients who did not receive DEX.</p></div><div><h3>Level of Evidence</h3><p>IV.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124000761/pdfft?md5=0c1c54ba06e8624a7078ccd92e8b3746&pid=1-s2.0-S2352344124000761-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140948782","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 : 2024-05-14DOI: 10.1016/j.artd.2024.101388
Kurtis D. Carlock MD, Jacob B. Wilkerson MD, Jonathan T. Yamaguchi MD, Navin D. Fernando MD
Background
Some studies have suggested the risk of wound complications may be higher using the direct anterior (DA) approach to total hip arthroplasty (THA). This study aimed to compare the risk of early postoperative wound complications between the DA and direct lateral (DL) approaches to THA and to determine patient risk factors that may contribute to this problem.
Methods
All patients who underwent primary THA with a single surgeon over a 5-year period were retrospectively reviewed. All patients were treated with either the DA or DL approach. Data collected included patient demographics, surgical approach, and wound status. There was a minimum follow-up of 6 weeks to allow for an adequate assessment of surgical wound healing. Univariate and multivariate analyses were used to compare the 2 approaches.
Results
Five hundred seventy-nine patients (77.6%) who underwent DA approach and 167 patients (22.4%) who underwent DL approach were included. Patients who underwent DL approach had a higher body mass index and a higher rate of diabetes than those treated with the DA approach. Forty patients (6.9%) in the DA cohort and 14 (8.4%) in the DL cohort experienced early wound complications, P = .523. After controlling for potential confounding variables, the surgical approach was not an independent risk factor for early postoperative wound complications.
Conclusions
While there have been concerns regarding use of the DA approach in patients with higher body mass index and certain medical comorbidities, the results of this study suggest the choice of surgical approach may have minimal effect on the rate of early postoperative wound complications.
背景一些研究表明,采用直接前路(DA)方法进行全髋关节置换术(THA)的伤口并发症风险可能更高。本研究旨在比较DA和直接外侧(DL)入路进行全髋关节置换术的术后早期伤口并发症风险,并确定可能导致这一问题的患者风险因素。所有患者均接受了DA或DL方法治疗。收集的数据包括患者的人口统计学特征、手术方式和伤口状况。随访时间至少为 6 周,以便对手术伤口愈合情况进行充分评估。采用单变量和多变量分析对两种方法进行比较。结果有 579 名患者(77.6%)接受了 DA 方法,167 名患者(22.4%)接受了 DL 方法。接受 DL 方法治疗的患者与接受 DA 方法治疗的患者相比,体重指数更高,糖尿病发病率更高。DA队列中有40名患者(6.9%)和DL队列中有14名患者(8.4%)出现了早期伤口并发症,P = .523。结论虽然有人担心体质指数较高和患有某些并发症的患者会使用DA方法,但本研究结果表明,手术方法的选择对术后早期伤口并发症的发生率影响很小。
{"title":"A Comparison of Wound Complications Following Total Hip Arthroplasty Performed Through the Direct Anterior Versus Direct Lateral Approach","authors":"Kurtis D. Carlock MD, Jacob B. Wilkerson MD, Jonathan T. Yamaguchi MD, Navin D. Fernando MD","doi":"10.1016/j.artd.2024.101388","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101388","url":null,"abstract":"<div><h3>Background</h3><p>Some studies have suggested the risk of wound complications may be higher using the direct anterior (DA) approach to total hip arthroplasty (THA). This study aimed to compare the risk of early postoperative wound complications between the DA and direct lateral (DL) approaches to THA and to determine patient risk factors that may contribute to this problem.</p></div><div><h3>Methods</h3><p>All patients who underwent primary THA with a single surgeon over a 5-year period were retrospectively reviewed. All patients were treated with either the DA or DL approach. Data collected included patient demographics, surgical approach, and wound status. There was a minimum follow-up of 6 weeks to allow for an adequate assessment of surgical wound healing. Univariate and multivariate analyses were used to compare the 2 approaches.</p></div><div><h3>Results</h3><p>Five hundred seventy-nine patients (77.6%) who underwent DA approach and 167 patients (22.4%) who underwent DL approach were included. Patients who underwent DL approach had a higher body mass index and a higher rate of diabetes than those treated with the DA approach. Forty patients (6.9%) in the DA cohort and 14 (8.4%) in the DL cohort experienced early wound complications, <em>P</em> = .523. After controlling for potential confounding variables, the surgical approach was not an independent risk factor for early postoperative wound complications.</p></div><div><h3>Conclusions</h3><p>While there have been concerns regarding use of the DA approach in patients with higher body mass index and certain medical comorbidities, the results of this study suggest the choice of surgical approach may have minimal effect on the rate of early postoperative wound complications.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124000736/pdfft?md5=54f14d3a704aa390851b64e647b3931f&pid=1-s2.0-S2352344124000736-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140918801","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 : 2024-05-09DOI: 10.1016/j.artd.2024.101392
Jacob Shermetaro DO, Lawrence Jajou DO, Aaron Seidman DO, Daniel McCall DO
Aneurysmal bone cysts (ABCs) are rare benign bone lesions with a predilection for the metaphysis of long bones. They are often cystic, expansive, and osteolytic and may result in bony deformity. In general, there remains debate about optimal treatment for ABCs; however, the mainstay typically consists of a combination of curettage, bone grafting, and considering the need for internal fixation and osteotomies. The goals of treatment include preserving bony anatomy while eliminating the lesion. There is sparse literature regarding the treatment of osteoarthritis adjacent to benign bony tumors. If total hip arthroplasty is chosen as a treatment option, diligent preoperative planning is required, and the surgeon must assess the patient’s bone stock, account for bony deformity, and utilize specific implants and techniques based on the patient’s characteristics. We present a case of an adult patient with proximal femur ABC and symptomatic adjacent hip osteoarthritis who underwent treatment with total hip arthroplasty.
{"title":"Total Hip Arthroplasty in a Patient With a Large Proximal Femur Aneurysmal Bone Cyst: A Case Report and Literature Review","authors":"Jacob Shermetaro DO, Lawrence Jajou DO, Aaron Seidman DO, Daniel McCall DO","doi":"10.1016/j.artd.2024.101392","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101392","url":null,"abstract":"<div><p>Aneurysmal bone cysts (ABCs) are rare benign bone lesions with a predilection for the metaphysis of long bones. They are often cystic, expansive, and osteolytic and may result in bony deformity. In general, there remains debate about optimal treatment for ABCs; however, the mainstay typically consists of a combination of curettage, bone grafting, and considering the need for internal fixation and osteotomies. The goals of treatment include preserving bony anatomy while eliminating the lesion. There is sparse literature regarding the treatment of osteoarthritis adjacent to benign bony tumors. If total hip arthroplasty is chosen as a treatment option, diligent preoperative planning is required, and the surgeon must assess the patient’s bone stock, account for bony deformity, and utilize specific implants and techniques based on the patient’s characteristics. We present a case of an adult patient with proximal femur ABC and symptomatic adjacent hip osteoarthritis who underwent treatment with total hip arthroplasty.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124000773/pdfft?md5=3b2c4be8828a4d38d885d8c0ba310a56&pid=1-s2.0-S2352344124000773-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140901297","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}