Arthroplasty Today最新文献_第2页

A Single Surgeon Experience of Selective Patellar Resurfacing During Primary Total Knee Arthroplasty 单个外科医生在初级全膝关节置换术中选择性髌骨复位的经验

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-18 DOI: 10.1016/j.artd.2024.101563

Catelyn A. Woelfle BA, H. John Cooper MD

Background

Routine patellar resurfacing remains controversial in primary total knee arthroplasty (TKA). This study reports the experience of a high-volume arthroplasty surgeon who stopped routinely resurfacing patellae for a 3-year period.

Methods

All primary TKAs performed by a single surgeon between January 2018 and September 2022 with minimum 1-year follow-up were retrospectively reviewed. Data were analyzed between cohorts—nonresurfaced and resurfaced patellae—and between phases—universal and selective resurfacing. Outcomes included reoperation, patellar complications, and patient-related outcome measure scores.

Results

Five hundred four primary TKAs, with mean 24-month follow-up, were included. Patellar resurfacing was performed in 77% of the overall cohort, including 58% in the selective and 100% in the universal phases. Reoperation (7.6% vs 0.3%; P < .001) and patellar complications (8.4% vs 1.3%; P < .001) were higher in the nonresurfaced vs resurfaced cohort. Eight of the 9 reoperations in the nonresurfaced group were for secondary resurfacing, and all were female (P = .017). Mean 12-Item Short Form Health Survey Physical Health (P = .037) and Western Ontario and McMaster Universities Arthritis Index Pain scores (P = .002) were better in the resurfaced cohort. Selective resurfacing demonstrated a higher reoperation rate (3.3% vs 0.4%; P = .022) and worse Western Ontario and McMaster Universities Arthritis Index Pain (P = .026) and Knee Society Knee Functional scores (P = .042).

Conclusions

Cessation of routine patellar resurfacing led to inferior clinical results and an unacceptably high early reoperation rate, specifically among women. The generalizability of these findings may be limited due to surgeon-specific factors; however, we urge caution in surgeons who consider similar changes in practice.

Level of Evidence

Level III.

背景在初级全膝关节置换术（TKA）中，常规髌骨再植仍存在争议。本研究报告了一位高产量关节置换术外科医生在 3 年内停止常规髌骨重铺的经验。方法回顾性审查了 2018 年 1 月至 2022 年 9 月期间由一位外科医生实施的所有初级 TKA，随访至少 1 年。对不同队列--未再表面化和再表面化髌骨--以及不同阶段--普遍再表面化和选择性再表面化之间的数据进行了分析。结果包括再手术、髌骨并发症和患者相关结果测量评分。77%的患者进行了髌骨重置，其中58%的患者进行了选择性髌骨重置，100%的患者进行了普遍性髌骨重置。再手术率（7.6% vs 0.3%; P <.001）和髌骨并发症（8.4% vs 1.3%; P <.001）在非髌骨表面移植组和髌骨表面移植组中都较高。非磨面组的 9 例再手术中有 8 例是二次磨面，且均为女性（P = .017）。再植骨面组的平均 12 项简表健康调查身体健康评分（P = .037）和西安大略与麦克马斯特大学关节炎指数疼痛评分（P = .002）均优于再植骨面组。结论常规髌骨再植术的停止导致了较差的临床效果和不可接受的高早期再手术率，尤其是在女性患者中。由于外科医生的特异性因素，这些研究结果的推广性可能有限；但是，我们建议外科医生在考虑改变类似做法时要谨慎。

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引用次数: 0

Early Results of a Patient-Specific Total Knee Arthroplasty Implant Cast From a 3D-Printed Mold 根据 3D 打印模具铸造患者专用全膝关节置换术假体的早期结果

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-16 DOI: 10.1016/j.artd.2024.101558

Adam E. Roy MD , Alexandre Barbieri Mestriner MD , Brielle Antonelli BS, PA-S , Jakob Ackermann MD , Antonia F. Chen MD, MBA , Jeffrey K. Lange MD

Background

The second generation of a custom total knee arthroplasty (TKA) implant cast from a 3D-printed mold was introduced into the market in 2012. The purpose of this retrospective study was to investigate short- to mid-term survivorship and complication rates of this novel implant.

Methods

This study is a retrospective analysis of 314 TKA procedures (264 patients) performed by a single surgeon using a customized TKA from September 2012 to November 2015. Patient demographics, rate of implant revision, rate of reoperation for any reason, and rate of postoperative complications were recorded.

Results

At the time of index surgery, the mean patient age was 64.7 years, and the mean follow-up duration was 3 years. At the final follow-up, implant survivorship free from revision was 98.1%, and survivorship free from reoperation for any reason was 92.4%.

Conclusions

Our analysis revealed favorable short- to mid-term survivorship for a customized TKA implant. While the short- to mid-term outcomes for this implant are promising, future studies are required to assess long-term outcomes and durability.

背景第二代定制全膝关节置换术（TKA）植入体由 3D 打印模具铸造而成，于 2012 年投放市场。本回顾性研究旨在调查这种新型植入体的中短期存活率和并发症发生率。方法本研究是对 2012 年 9 月至 2015 年 11 月期间由一名外科医生使用定制 TKA 进行的 314 例 TKA 手术（264 名患者）的回顾性分析。研究记录了患者的人口统计学特征、植入物翻修率、因任何原因再次手术率以及术后并发症发生率。结果在进行指数手术时，患者的平均年龄为 64.7 岁，平均随访时间为 3 年。结论我们的分析显示，定制 TKA 植入体的中短期存活率良好。虽然这种假体的中短期疗效很好，但还需要未来的研究来评估其长期疗效和耐久性。

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引用次数: 0

Erratum to 'Long-Term Outcomes of the Knee and Hip Arthroplasties in Patients with Alkaptonuria' [Arthroplasty Today. Volume 6, Issue 4, December 2020, Pages 689-693].

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-16 eCollection Date: 2024-12-01 DOI: 10.1016/j.artd.2024.101579

Jihad M Al-Ajlouni, Mohammed S Alisi, Mohamad S Yasin, Aws Khanfar, Mohammad Hamdan, Ahmad Abu Halaweh, Hashem Al Hawamdeh, Mohammed Tayyem, Mohammad S Alsbou

[This corrects the article DOI: 10.1016/j.artd.2020.07.037.].

引用次数: 0

Evaluation of a Mobile App to Assist Patient Education and Research in Arthroplasty 评估辅助关节置换术患者教育和研究的移动应用程序

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-16 DOI: 10.1016/j.artd.2024.101549

Leina Suzuki BE(Hons) , Francis Connon MBBS, FRACS , Selin Munir PhD , Sarah Piplica BHlthSci, MPH , Hemant Pandit FRCS (Orth), D Phil (Oxon) , Daevyd Rodda MBBS, FRACS

Background

Paper-based patient-reported outcome measures (PROMs) and patient education can assist in improving outcomes but is administratively burdensome. Mobile phone applications (‘apps’) can distribute extensive information and PROMs at relevant time points. This study aimed to assess the suitability of an app to guide postoperative management and record PROMs based on satisfaction and compliance.

Methods

Thirty-four patients who were scheduled for a total hip/knee arthroplasty were enrolled into the study. Automatic notifications were sent by the app to complete PROMs at the appropriate time points. Patients were reminded via phone call if PROMs were not completed. An app satisfaction questionnaire was also completed, where a high score represented satisfaction with the app.

Results

Patients remained satisfied with the app throughout the study with a mean score of 19.0 out of 25. 57% found the app to be helpful with completing surveys, with 63% preferring the app over paper handouts. Majority of the participants (68%) stated that they would use the app again. There was an overall mean compliance of 78% at all time points. Most patients (82%) required at least one phone call reminder, with 18% of patients completing their PROMs prompted by the app notification alone.

Conclusions

A mobile phone app can be useful for both distributing patient education and collecting PROMs. PROMs collected using a mobile phone app still caused some administrative burden with many participants requiring multiple reminders to complete their questionnaires. While paper-forms will still be required for some patients, most found the app preferable to paper-form.

背景基于纸张的患者报告结果测量（PROMs）和患者教育有助于改善疗效，但行政负担较重。手机应用程序（"App"）可以在相关时间点发布大量信息和 PROMs。本研究旨在评估一款应用程序是否适合指导术后管理，并根据满意度和依从性记录PROMs。应用程序自动发送通知，要求患者在适当的时间点完成 PROMs。如果患者未完成 PROM，则会通过电话提醒患者。患者还填写了一份应用程序满意度问卷，高分代表对应用程序的满意度。57%的人认为该应用程序有助于完成调查，63%的人认为该应用程序优于纸质问卷。大多数参与者（68%）表示他们会再次使用该应用程序。所有时间点的总体平均依从性为 78%。大多数患者（82%）至少需要一次电话提醒，其中 18% 的患者仅在应用程序通知的提示下就完成了 PROM。使用手机应用收集 PROMs 仍会造成一定的管理负担，许多参与者需要多次提醒才能完成问卷。虽然有些患者仍需要纸质表格，但大多数人认为手机应用比纸质表格更可取。

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引用次数: 0

Corrigendum to 'Machine Learning-Based Predictive Models for 90-Day Readmission of Total Joint Arthroplasty Using Comprehensive Electronic Health Records and Patient-Reported Outcome Measures'. [Arthroplasty Today Volume 25, February 2024, 101308].

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-16 eCollection Date: 2024-12-01 DOI: 10.1016/j.artd.2024.101567

Jaeyoung Park, Xiang Zhong, Emilie N Miley, Rachel S Rutledge, Jaquelyn Kakalecik, Matthew C Johnson, Chancellor F Gray

[This corrects the article DOI: 10.1016/j.artd.2023.101308.].

引用次数: 0

Vancomycin Is Not an Effective Prophylactic Agent Alone and Should Be Combined With Another Agent 万古霉素不是一种有效的预防性药物，应与另一种药物联合使用

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-14 DOI: 10.1016/j.artd.2024.101578

Stephen Duncan MD, Ryland Kagan MD

引用次数: 0

Operatively Managed Transverse or Short Oblique B1 Periprosthetic Fractures Around a Polished Taper-Slip Femoral Stem Are Associated With Reoperation in One Third of Cases: A Retrospective Cohort Study 手术治疗的抛光锥形滑移股骨柄周围横向或短斜向 B1 假体周围骨折有三分之一的病例需要再次手术：一项回顾性队列研究

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-13 DOI: 10.1016/j.artd.2024.101551

Matilda F.R. Powell-Bowns BSc, MMed, FRCSEd , Damien Martin MBChB, MRCSEd , Abbey Bowley BSc , Matthew Moran MSc, FRCSEd , Nick D. Clement MD, PhD, FRCS , Chloe E.H. Scott MD, MSc, BSc, FRCSEd (Tr&Orth), MFSTEd

Background

Transverse or short oblique periprosthetic femoral fractures around total hip arthroplasty (THA) stems are typically classified as B1 fractures (stem well-fixed) and usually managed with fixation. These fractures have high non-union rates. This study aimed to identify reoperation rates in patients with operatively managed transverse or short oblique fractures around a cemented polished taper-slip stem and determine any associations with treatment failure.

Methods

This retrospective cohort study included 31 patients with Arbeitsgemeinschaft für Osteosynthesefragen transverse or short oblique Vancouver B1 periprosthetic femoral fractures around THA with a cemented taper slip stem: 12 males (39%); mean age 74 ± 11.9 years (range 44-91); mean BMI 28.5 ± 1.4 (range 16-48); median American Society of Anesthesiologists score 3. Patient journeys were assessed and re-interventions recorded. The primary outcome was reoperation.

Results

The mean time from primary THA to fracture was 11.3 ± 7.8 years (0.5-26 years). Surgical management involved fixation in 27/31 cases and revision-THA (r-THA) in 4/31. Ten patients (32%) required reoperation (8 following ORIF and 2 following r-THA, P = .584), most commonly within 2 years of injury (9/10) due to non-union (6/10). No significant associations with reoperation requirement were identified. Kaplan-Meier survival free from reoperation was 67.4% (95% CI 49.8-85.0) at 2 years, unaffected by initial management with fixation or revision (Log rank 0.898). Of those reoperated, 60% (6/10) required multiple reoperations to achieve bony union or a stable revision construct.

Conclusions

These fractures are challenging to manage with either fixation or revision. Patients should be counseled about a one in 3 risk of reoperation and a one in 5 risk of requiring multiple reoperations.

背景全髋关节置换术（THA）骨干周围的横向或短斜股骨假体周围骨折通常被归类为B1骨折（骨干固定良好），通常采用固定治疗。这些骨折的不愈合率很高。本研究旨在确定经手术治疗的骨水泥抛光锥形滑动柄周围横向或短斜向骨折患者的再手术率，并确定与治疗失败的任何关联。方法这项回顾性队列研究纳入了31例Arbeitsgemeinschaft für Osteosynthesefragen横向或短斜Vancouver B1股骨假体周围骨折患者，这些患者均为使用骨水泥锥形滑移骨干的THA患者：12例男性（39%）；平均年龄为74±11.9岁（范围44-91岁）；平均体重指数为28.5±1.4（范围16-48岁）；美国麻醉医师协会评分中位数为3分。对患者的行程进行了评估，并记录了再次干预的情况。结果从初次THA到骨折的平均时间为11.3 ± 7.8年（0.5-26年）。27/31例患者接受了固定手术，4/31例患者接受了翻修型THA（r-THA）手术。10例患者（32%）需要再次手术（8例在ORIF术后，2例在翻修-THA术后，P = .584），最常见的是在受伤后2年内（9/10），原因是不愈合（6/10）。未发现与再次手术要求有明显关联的情况。2 年后免再次手术的 Kaplan-Meier 生存率为 67.4% (95% CI 49.8-85.0)，不受最初固定或翻修处理的影响（对数秩 0.898）。在再次手术的患者中，60%（6/10）需要多次再次手术才能达到骨性结合或稳定的翻修结构。应告知患者三分之一的患者有再次手术的风险，五分之一的患者有需要多次再次手术的风险。

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引用次数: 0

Are Activity Restrictions Necessary After Total Hip Arthroplasty: A Systematic Review 全髋关节置换术后是否有必要限制活动？系统回顾

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-13 DOI: 10.1016/j.artd.2024.101576

Sagar Telang BS , Amir Human Hoveidaei MD, MSc , Cory K. Mayfield MD , Jay R. Lieberman MD , Michael A. Mont MD , Nathanael D. Heckmann MD

Background

There remains a lack of universal guidelines regarding the appropriate level of postoperative activity restrictions following total hip arthroplasty (THA). This systematic review aims to assess whether the liberalization of postoperative activity restrictions following THA impacts implant survivorship, return to sport, patient satisfaction, and functional health outcomes.

Methods

A comprehensive search strategy was completed across PubMed, Scopus, and Web of Science databases using targeted keywords from January 1, 2010, to November 22, 2023. Inclusion criteria included randomized clinical trials, case-control, and cohort studies written in English. Data extraction focused on activity levels, rehabilitation protocols, implant survivorship, and physical and psychological outcomes. The primary search yielded 7420 articles, with 28 studies included after screening.

Results

Return to sports outcomes demonstrated notable variability (20%-98.5%). Most studies reported improved survivorship in high-activity patients. High-activity participants had all-cause revision rates of 0.9%-8.57% and aseptic revision rates of 0.4%-5.7%. Low-activity participants had all-cause revision rates of 0.7%-3.4% and aseptic revision rates of 0.0%-2.1%. There was no clear association between activity level and dislocation rates. Positive associations between post-THA activities and improved mental health and patient satisfaction were observed.

Conclusions

The current arthroplasty literature demonstrates that patients engaging in high-activity levels after THA exhibit similar or improved implant survivorship rates compared to patients participating in low-activity levels. However, high-quality prospective studies are needed to provide evidence-based guidelines. Patients should be encouraged to partake in activities at their own comfort levels with an understanding of their own limitations and risks.

背景关于全髋关节置换术（THA）术后活动限制的适当程度仍缺乏通用指南。本系统性综述旨在评估放宽全髋关节置换术后活动限制是否会影响植入物存活率、运动恢复、患者满意度和功能性健康结果。方法从 2010 年 1 月 1 日至 2023 年 11 月 22 日，使用目标关键词在 PubMed、Scopus 和 Web of Science 数据库中完成了全面的检索策略。纳入标准包括用英语撰写的随机临床试验、病例对照和队列研究。数据提取的重点是活动水平、康复方案、植入物存活率以及生理和心理结果。初选检索共获得 7420 篇文章，经筛选后纳入 28 项研究。结果重返运动场的结果显示出显著的差异性（20%-98.5%）。大多数研究报告称，高运动量患者的存活率有所提高。高运动量患者的全因翻修率为 0.9%-8.57%，无菌性翻修率为 0.4%-5.7%。低活动量参与者的全因翻修率为 0.7%-3.4%，无菌性翻修率为 0.0%-2.1%。活动量与脱位率之间没有明显的关联。结论目前的关节置换术文献表明，THA术后参与高活动水平的患者与参与低活动水平的患者相比，植入物存活率相似或有所提高。然而，还需要高质量的前瞻性研究来提供循证指南。应鼓励患者在了解自身局限性和风险的情况下，参加自己舒适程度的活动。

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引用次数: 0

The Addition of Navigation Technology to the Femur-First Approach in Anterior Total Hip Arthroplasty Improves Leg Length Restoration 在前路全髋关节置换术的股骨先入路中加入导航技术可改善腿长恢复效果

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-13 DOI: 10.1016/j.artd.2024.101577

Stephanie V. Kaszuba MD , Noah Gordon BS , Alex C. Gordon MD

Background

The addition of computer navigation (CN) technology in direct anterior approach (DAA) total hip arthroplasty (THA) has the potential to improve restoration of hip offset and leg length. In this investigation, we examine the effect of one fluoroscopic-based CN system on biomechanical parameters in DAA THA with femur-first (FF) workflow.

Methods

A retrospective review was performed on 235 primary DAA FF THA cases, with 100 CN cases and 135 in the conventional fluoroscopic overlay (FO) group. Radiographic examination was performed. Radiographic outcome measures included differences in hip center position, femoral offset, global offset, and leg length between the THA and native hips. Intraoperative and postoperative complications were also documented. Statistical analysis was performed using a t test for continuous data and a ꭓ² test for categorical data.

Results

While there were differences in individual components of femoral offset and the horizontal hip center, mean difference in global offset was not statistically different between the CN (mean: 2.15 mm) and FO (mean: 1.85 mm) groups (P = .898). The number of outliers was also statistically insignificant. The CN group demonstrated significant improvement in mean leg length discrepancy (mean: 1.52 mm) in comparison to the FO group (mean: 2.26 mm) (P = .001), with 1.09% and 8.89% of outliers, respectively (P = .013).

Conclusions

The addition of CN technology to DAA FF THA improved the accuracy and precision of restoring leg length. CN did not significantly affect global offset. There was no significant difference in complications between the CN and FO groups.

背景在直接前路（DAA）全髋关节置换术（THA）中增加计算机导航（CN）技术有可能改善髋关节偏移和腿长的恢复。在这项调查中，我们研究了一种基于透视的 CN 系统对股骨先露（FF）工作流程下 DAA THA 生物力学参数的影响。方法对 235 例初级 DAA FF THA 进行了回顾性审查，其中 CN 组 100 例，传统透视覆盖（FO）组 135 例。进行了放射学检查。影像学结果测量包括THA和原髋之间髋关节中心位置、股骨偏移、整体偏移和腿长的差异。术中和术后并发症也被记录在案。对连续数据采用t检验，对分类数据采用ꭓ2检验进行统计分析。结果虽然股骨偏移量和水平髋关节中心的各个部分存在差异，但CN组（平均：2.15毫米）和FO组（平均：1.85毫米）之间的总体偏移量平均差异没有统计学差异（P = .898）。异常值的数量在统计学上也不显著。与 FO 组（平均：2.26 毫米）相比，CN 组的平均腿长差异（平均：1.52 毫米）明显改善（P = .001），异常值分别为 1.09% 和 8.89%（P = .013）。CN技术对整体偏移无明显影响。CN组和FO组在并发症方面无明显差异。

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引用次数: 0

A Video-Based Intervention for Increasing Health Literacy in Total Joint Arthroplasty Patients at a Safety-Net Hospital: A Prospective Single-Blind Cohort Study 一项基于视频的干预措施，旨在提高一家安全网医院全关节置换术患者的健康素养：前瞻性单盲队列研究

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-12 DOI: 10.1016/j.artd.2024.101575

Sung Jun Son MD, MS , Justin Sedgewick MD , Geordie Lonza MD , Jose George MD , Julissa Li BS , John Andrawis MD

Background

Health literacy is a major determinant of health outcomes, with low literacy correlated with increased risk of postoperative complications and lower patient-reported outcomes. This study sought to increase health literacy in a subset of Los Angeles County patients who would be undergoing total joint arthroplasty (TJA) using a video-based intervention.

Methods

We enrolled 51 patients scheduled to undergo TJA. The first 26 patients were allocated into the prevideo group who underwent the typical preoperative visit, and the next 25 patients were enrolled into the video-intervention (postvideo) group.

Results

No differences in baseline health literacy based on the Newest Vital Sign survey were noted between the groups (1.88 ± 1.90 vs 1.28 ± 1.24; P = .94). Higher knowledge scores regarding arthritis and TJA were seen in the postvideo group (71.52 ± 24.50 vs 54.92 ± 26.93; P = .01). This finding was consistent in primary Spanish speakers (66.40 ± 24.51 vs 49.60 ± 24.93; P = .04). There were no differences in preoperative anxiety and information requirement between the groups (16.00 ± 6.21 vs 16.88 ± 6.27; P = .31). The total low literacy version of the Decisional Conflict Scale score utilized to quantify patients’ decisional conflict in the setting of TJA were not different between the groups (11.44 ± 14.32 vs 10.40 ± 15.41; P = .40).

Conclusions

Patient knowledge about arthritis and TJA significantly improved as measured by the modified arthritis knowledge survey in the postvideo group compared to a discussion with their surgeon.

背景健康素养是影响健康结果的一个主要决定因素，低健康素养与术后并发症风险增加和患者报告的结果降低相关。本研究试图通过视频干预提高洛杉矶县即将接受全关节成形术（TJA）的部分患者的健康素养。结果根据最新生命体征调查，两组患者的基线健康素养无差异（1.88 ± 1.90 vs 1.28 ± 1.24；P = .94）。观看视频后组对关节炎和 TJA 的了解程度较高（71.52 ± 24.50 vs 54.92 ± 26.93；P = .01）。这一结果在主要讲西班牙语的人中是一致的（66.40 ± 24.51 vs 49.60 ± 24.93；P = .04）。两组患者在术前焦虑和信息需求方面没有差异（16.00 ± 6.21 vs 16.88 ± 6.27；P = .31）。结论与与外科医生讨论相比，通过改良的关节炎知识调查，视频后组患者对关节炎和 TJA 的了解显著提高。

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引用次数: 0