Arthroplasty Today最新文献_第2页

Determinants of Salary Variation and the Gender Pay Gap: A Survey of the American Association of Hip and Knee Surgeons (AAHKS) Surgeon Member Workforce 薪酬差异和性别薪酬差距的决定因素：对美国髋关节和膝关节外科医生协会（AAHKS）外科医生成员队伍的调查

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-07 DOI: 10.1016/j.artd.2024.101554

Prem N. Ramkumar MD, MBA , Jenna A. Bernstein MD , David C. Landy MD, PhD , David E. DeMik MD , Justin T. Deen MD , Reena J. Olsen MS , Anna Cohen-Rosenblum MD

Background

The increased emphasis on reimbursement, diversity, and burnout in hip and knee arthroplasty necessitates a foundational understanding of the surgeon workforce. The purpose of the study was to cross sectionally survey a representative sample of the AAHKS surgeon membership on the subject of salary, practice patterns, and demographic factors to establish a baseline framework for future advocacy efforts and initiatives.

Methods

An online survey was sent to AAHKS members between December 20, 2022 and January 19, 2023. Surgeon demographic data, experience, practice geography and type, and annual case volume were solicited. Univariate and multivariate analyses were performed to describe the association of respondent characteristics with reported salary directly from patient care, as well as indirect revenue streams.

Results

A total of 730 AAHKS members responded to the survey. The largest proportion of surgeons performed 251-400 cases annually (36%); 81% (n = 592) and 93% (n = 679) of respondents identified as white and male, respectively. Case volume was the primary determinant for surgeon salary, followed by practice type, years in practice, and gender. After controlling for confounding variables, multivariate analyses revealed the direct salary of women surgeons was 14.4% less than men [95% confidence interval, 0.4%-28.3%]. When considering indirect revenue, the gender pay gap widened. Salary was not associated with reported hours worked per week, geographic location, or ethnicity.

Conclusions

Salary is an important but underdiscussed subject that reflects the realities of our culture and value system in medicine. A direct relationship between salary and modifiable variables like case volume is clear. However, after controlling for confounders, women arthroplasty surgeons still earn 86 cents on the dollar compared to their male colleagues from direct surgical revenue.

背景髋关节和膝关节置换术中的报销、多样性和职业倦怠问题日益受到重视，因此有必要对外科医生队伍进行基本了解。本研究的目的是对AAHKS外科医生成员中具有代表性的样本进行横截面调查，内容涉及薪资、执业模式和人口统计因素，以便为未来的宣传工作和倡议建立基线框架。方法在2022年12月20日至2023年1月19日期间向AAHKS成员发送在线调查。调查内容包括外科医生的人口统计学数据、经验、执业地域和类型以及年病例量。我们进行了单变量和多变量分析，以描述受访者特征与所报告的直接来自患者护理的薪酬以及间接收入流之间的关联。最大比例的外科医生年手术量为 251-400 例（36%）；分别有 81% （n = 592）和 93% （n = 679）的受访者认为自己是白人和男性。病例量是决定外科医生薪酬的主要因素，其次是执业类型、执业年限和性别。在控制了混杂变量后，多变量分析显示女外科医生的直接薪酬比男外科医生低 14.4% [95%置信区间，0.4%-28.3%]。当考虑到间接收入时，性别薪酬差距扩大了。薪资与报告的每周工作时间、地理位置或种族无关。结论薪资是一个重要但讨论不足的话题，它反映了我们的医学文化和价值体系的现实。薪酬与病例量等可修改变量之间的直接关系显而易见。然而，在控制了混杂因素后，女性关节置换外科医生的直接手术收入仍比男性同事少 86 美分。

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引用次数: 0

Perioperative Tranexamic Acid Should Be Considered for Total Joint Arthroplasty Patients Receiving Apixaban for Thromboprophylaxis 接受阿哌沙班预防血栓形成治疗的全关节置换术患者围手术期应考虑使用氨甲环酸

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-06 DOI: 10.1016/j.artd.2024.101548

Sagar Telang BS, Ryan Palmer BS, Andrew Dobitsch MD, Jacob R. Ball MD, Nathanael D. Heckmann MD, Jay R. Lieberman MD

Background

This study aims to investigate if the perioperative administration of tranexamic acid (TXA) for total joint arthroplasty (TJA) patients receiving apixaban for thromboprophylaxis can reduce the risk of postoperative bleeding without increasing the rate of thromboembolic events.

Methods

The Premier Healthcare Database was utilized to identify all primary elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients. Patients receiving apixaban during their in-hospital admission who received TXA on the day of surgery were compared to those who did not receive TXA. Differences in demographics, hospital characteristics, and comorbidities were assessed between groups. Univariate and multivariable regressions were utilized to assess differences in 90-day bleeding, thromboembolic, and medical postoperative outcomes between cohorts.

Results

In total, 118,219 TJA patients were identified (TKA: 65.3%; THA: 34.7%), of which 30,592 (25.9%) received apixaban alone, and 87,627 (74.1%) received apixaban and TXA. Multivariable analyses found that patients who received apixaban and TXA had a reduced risk of aggregate bleeding complications (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI]: 0.81-0.86, P < .001), transfusion (aOR 0.47, 95% CI: 0.43-0.52, P < .001), acute anemia (aOR 0.84, 95% CI: 0.81-0.87, P < .001), deep vein thrombosis (aOR 0.74, 95% CI: 0.66-0.83, P < .001), and pulmonary embolism (aOR 0.84, 95% CI: 0.72-0.96, P = .012). No differences between cohorts were observed for risk of stroke (aOR 1.09, 95% CI: 0.82-1.46, P = .372) and myocardial infarction (aOR 0.94, 95% CI: 0.76-1.16, P = .564).

Conclusions

Perioperative administration of TXA to TJA patients receiving apixaban reduces the risk of bleeding complications without increasing thromboembolic risk. Arthroplasty surgeons should strongly consider providing TXA to TJA patients receiving apixaban.

背景本研究旨在探讨接受阿哌沙班血栓预防治疗的全关节置换术（TJA）患者围手术期服用氨甲环酸（TXA）能否降低术后出血风险，同时不增加血栓栓塞事件的发生率。方法利用Premier医疗保健数据库识别所有初级择期全膝关节置换术（TKA）和全髋关节置换术（THA）患者。将在住院期间接受阿哌沙班治疗并在手术当天接受TXA治疗的患者与未接受TXA治疗的患者进行比较。评估了各组之间在人口统计学、医院特征和合并症方面的差异。结果共确定了118219例TJA患者（TKA：65.3%；THA：34.7%），其中30592例（25.9%）仅接受了阿哌沙班，87627例（74.1%）接受了阿哌沙班和TXA。多变量分析发现，接受阿哌沙班和TXA治疗的患者发生出血并发症的风险降低（调整赔率[aOR]0.83，95%置信区间[CI]：0.81-0.86，P＜0.05）：0.81-0.86, P < .001）、输血（aOR 0.47, 95% CI: 0.43-0.52, P < .001）、急性贫血（aOR 0.84, 95% CI: 0.81-0.87, P < .001）、深静脉血栓（aOR 0.74，95% CI：0.66-0.83，P < .001）和肺栓塞（aOR 0.84，95% CI：0.72-0.96，P = .012）。结论接受阿哌沙班治疗的 TJA 患者围手术期使用 TXA 可降低出血并发症的风险，而不会增加血栓栓塞风险。关节置换外科医生应积极考虑为接受阿哌沙班治疗的 TJA 患者提供 TXA。

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引用次数: 0

Planned Realignment Osteotomies Ahead of Knee Arthroplasty for Pronounced Joint Malalignment: A Case Report in Hereditary Multiple Exostoses Disease 膝关节置换术前的计划性对位截骨术治疗明显的关节错位：遗传性多发性骨质疏松症病例报告

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-06 DOI: 10.1016/j.artd.2024.101519

Tim Schmid MD , Marietta Schmid MD , Pascal A. Schai MD

Various approaches have been reported to achieve correctly aligned total knee arthroplasty in cases of knee arthritis with pronounced extra-articular bone malalignment. Revision instrumentation and implants have enabled bone correction coincident with knee arthroplasty in notable tibial and/or femoral deviation, however increasing operative complexity and inherent risks. In the presented patient with hereditary multiple exostoses disease and progressing knee arthritis for extra-articular malalignment, elected treatment strategy was to primarily correct joint plane deformity through femoral and tibial osteotomies, ahead of and preparing for later knee arthroplasty. Staged osteotomies prior to total knee arthroplasty are effective for managing severe extra-articular malalignment, improving surgical outcome and prosthetic longevity.

对于关节外骨错位明显的膝关节炎病例，有多种方法可实现正确对齐的全膝关节置换术。翻修器械和植入物可以在进行膝关节置换术的同时对明显的胫骨和/或股骨偏移进行骨矫正，但增加了手术的复杂性和固有风险。这位患者患有遗传性多发性外生骨病，膝关节炎因关节外错位而不断进展，因此选择的治疗策略主要是通过股骨和胫骨截骨术矫正关节面畸形，为日后的膝关节置换术做好准备。在全膝关节置换术前进行分阶段截骨，可有效控制严重的关节外错位，提高手术效果和假体寿命。

引用次数: 0

Letter to Editor: Intraarticular Vancomycin Reduces Prosthetic Infection in Primary Hip and Knee Arthroplasty 致编辑的信：关节腔内万古霉素可减少初次髋关节和膝关节置换术中的假体感染

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-06 DOI: 10.1016/j.artd.2024.101546

Praharsha Mulpur MBBS, DNB (Ortho), Tarun Jayakumar MBBS, MS (Ortho), A.V. Gurava Reddy MBBS, D (Ortho), DNB (Ortho), FRCS (Edinburgh), FRCS (Glasgow), FRCS (London), MCh Ortho (Liverpool)

引用次数: 0

Impact of Benign Prostatic Hyperplasia on Postoperative Complications and Periprosthetic Joint Infections After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis 良性前列腺增生对全关节成形术后并发症和假体周围感染的影响：系统回顾与元分析

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-05 DOI: 10.1016/j.artd.2024.101552

Sina Esmaeili MD, Hannaneh Razaghi MD, Mahda Malekshahi MD, Mohammad Soleimani MD, Seyyed Hossein Shafiei MD, Mohammadreza Golbakhsh MD

Background

Total joint arthroplasty (TJA) is one of the most frequently performed surgical procedures each year, offering considerable cost-effectiveness and numerous benefits. However, certain postoperative complications can be observed following TJA. While the relationship between various comorbidities and these complications has been well-documented, this study aims to specifically investigate the impact of benign prostatic hyperplasia (BPH) on postoperative outcomes.

Methods

For this systematic review, we searched PubMed, Scopus, and Web of Science using terms like "total hip arthroplasty," "total knee arthroplasty," "BPH," and "benign prostatic hypertrophy." Screening of retrieved articles was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies comparing complications in TJA between patients with and without preexisting BPH were eligible for inclusion. Data extraction was performed on the included articles, and their quality was assessed using the Newcastle-Ottawa scale. A meta-analysis was conducted using the Mantel-Haenszel method.

Results

This systematic review encompassed 4 articles evaluating TJA outcomes in men with a history of BPH, involving a total of 75,222 male cases. Among these, 17,183 cases (23%) presented with symptomatic BPH. The meta-analysis revealed that the incidence rate of periprosthetic joint infection did not significantly differ between BPH and non-BPH groups across both total hip and knee arthroplasty cases (odds ratio [OR] (95% confidence interval [CI]) = 1.28 [0.92-1.79]). However, postoperative urinary retention was significantly higher among patients with BPH (OR [95% CI] = 3.43 [2.04-5.78]). Additionally, patients with BPH exhibited a notably elevated incidence of postoperative urinary tract infection (OR [95% CI] = 2.55 [2.33-2.79]), as well as sepsis (OR [95% CI] = 1.31 [1.09-1.58]).

Conclusions

It is noteworthy that while patients with BPH are prone to certain complications, meta-analysis indicate that BPH cannot be considered a comorbidity that increases the risk of periprosthetic joint infection.

背景全关节置换术（TJA）是每年最常见的外科手术之一，具有相当高的成本效益和众多优点。然而，TJA 术后可能会出现某些并发症。虽然各种合并症与这些并发症之间的关系已得到充分证实，但本研究旨在专门调查良性前列腺增生症（BPH）对术后结果的影响。方法在这篇系统性综述中，我们使用 "全髋关节置换术"、"全膝关节置换术"、"BPH "和 "良性前列腺肥大 "等术语检索了 PubMed、Scopus 和 Web of Science。根据《系统综述和元分析首选报告项目》指南对检索到的文章进行筛选。对患有和未患有良性前列腺增生症的患者进行TJA并发症比较的研究符合纳入条件。对纳入的文章进行数据提取，并使用纽卡斯尔-渥太华量表对其质量进行评估。结果该系统性综述包括4篇评估有良性前列腺增生病史的男性TJA结果的文章，共涉及75222例男性病例。其中，17183 例（23%）有症状的良性前列腺增生。荟萃分析显示，在全髋关节和膝关节置换术病例中，BPH 组和非 BPH 组的假体周围关节感染发生率没有显著差异（几率比 [OR] (95% 置信区间 [CI]) = 1.28 [0.92-1.79]）。然而，良性前列腺增生患者的术后尿潴留率明显更高（OR [95% CI] = 3.43 [2.04-5.78]）。此外，良性前列腺增生患者术后尿路感染（OR [95% CI] = 2.55 [2.33-2.79]）和败血症（OR [95% CI] = 1.31 [1.09-1.58]）的发生率明显升高。

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引用次数: 0

A Mathematical Evaluation of the Effects of the Head and Neck Diameter on the Arc of Motion and the Implications in Total Hip Arthroplasty 头颈直径对运动弧度的影响及其在全髋关节置换术中的意义的数学评估

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-05 DOI: 10.1016/j.artd.2024.101556

Stanley E. Asnis MD , Jamie C. Heimroth MD , Todd Goldstein PhD

Background

Instability following total hip arthroplasty (THA) is a leading cause of revisions. Our objective was to evaluate the options that the surgeon has, to gain inherent stability with the use of conventional large femoral and dual mobility systems, and how the arc of motion (AOM) and jump distances (JDs) vary between them.

Methods

The head sizes examined spanned from 22 mm-54 mm, and neck sizes spanned from 10 mm-14 mm. Autodesk Fusion 360 is full-scale computer-aided designsoftware that can run simulations to validate a design. It was employed to calculate the AOM for each model. The JD was calculated with varying head sizes and 10- and 20-degree highwall liners.

Results

Increasing head sizes from 22, 28, 32-36 mm showed a considerable increase in the AOM for every neck size; however, there was substantially less of an increase with head sizes larger than 36 mm. As neck sizes increased from 10-14 mm, the AOM decreased. The JD increased substantially with the addition of 10- and 20-degree highwall liners.

Conclusions

Both classical THA and the dual mobility systems achieve greater AOM than an anatomical normal hip. As the head diameter increases, the AOM and the JD increases. Increases in head size improve range of motion; however, head sizes over 36-40 mm gain little regarding component stability. The more durable and thinner modern polyethylene liners allow for larger conventional femoral heads. When considering between a classical THA or a dual mobility system, the minimal gains with increasing the head size in using a dual mobility system may be far outweighed by the increase in directional stability offered by the large head THA with highwall liners.

背景全髋关节置换术（THA）后的不稳定性是造成翻修的主要原因。我们的目的是评估外科医生在使用传统的大股骨和双活动度系统获得固有稳定性方面有哪些选择，以及它们之间的活动弧度（AOM）和跳跃距离（JDs）是如何变化的。Autodesk Fusion 360 是一款全尺寸计算机辅助设计软件，可以运行模拟来验证设计。它被用来计算每个模型的 AOM。结果头部尺寸从 22 毫米、28 毫米、32 毫米到 36 毫米的增加表明，每种颈部尺寸的 AOM 都有相当大的增加；但是，头部尺寸大于 36 毫米时，增加的幅度要小得多。随着颈围从 10 毫米增加到 14 毫米，AOM 有所下降。结论传统的全髋关节置换和双活动度系统都能获得比解剖正常髋关节更大的AOM。随着髋臼头直径的增加，AOM和JD也随之增加。髋臼头直径增大可改善活动范围；但髋臼头直径超过36-40毫米时，组件的稳定性几乎没有提高。现代聚乙烯内衬更耐用、更薄，因此可以使用更大的传统股骨头。在考虑传统的 THA 还是双活动度系统时，使用双活动度系统增加头部尺寸所带来的微小收益可能远远超过使用高壁内衬的大头部 THA 所带来的方向稳定性的增加。

{"title":"A Mathematical Evaluation of the Effects of the Head and Neck Diameter on the Arc of Motion and the Implications in Total Hip Arthroplasty","authors":"Stanley E. Asnis MD , Jamie C. Heimroth MD , Todd Goldstein PhD","doi":"10.1016/j.artd.2024.101556","DOIUrl":"10.1016/j.artd.2024.101556","url":null,"abstract":"<div><h3>Background</h3><div>Instability following total hip arthroplasty (THA) is a leading cause of revisions. Our objective was to evaluate the options that the surgeon has, to gain inherent stability with the use of conventional large femoral and dual mobility systems, and how the arc of motion (AOM) and jump distances (JDs) vary between them.</div></div><div><h3>Methods</h3><div>The head sizes examined spanned from 22 mm-54 mm, and neck sizes spanned from 10 mm-14 mm. Autodesk Fusion 360 is full-scale computer-aided designsoftware that can run simulations to validate a design. It was employed to calculate the AOM for each model. The JD was calculated with varying head sizes and 10- and 20-degree highwall liners.</div></div><div><h3>Results</h3><div>Increasing head sizes from 22, 28, 32-36 mm showed a considerable increase in the AOM for every neck size; however, there was substantially less of an increase with head sizes larger than 36 mm. As neck sizes increased from 10-14 mm, the AOM decreased. The JD increased substantially with the addition of 10- and 20-degree highwall liners.</div></div><div><h3>Conclusions</h3><div>Both classical THA and the dual mobility systems achieve greater AOM than an anatomical normal hip. As the head diameter increases, the AOM and the JD increases. Increases in head size improve range of motion; however, head sizes over 36-40 mm gain little regarding component stability. The more durable and thinner modern polyethylene liners allow for larger conventional femoral heads. When considering between a classical THA or a dual mobility system, the minimal gains with increasing the head size in using a dual mobility system may be far outweighed by the increase in directional stability offered by the large head THA with highwall liners.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101556"},"PeriodicalIF":1.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586061","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}

引用次数: 0

What Are the Research Highlights of Periprosthetic Joint Infections From the 100 Most Cited Studies? 被引用次数最多的 100 项研究中有哪些关于假体周围关节感染的研究亮点？

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-05 DOI: 10.1016/j.artd.2024.101564

Marcos R. Gonzalez MD , Jose I. Acosta BS , Joshua Davis BS , Felipe Larios MD , Adam S. Olsen MD , Antonia F. Chen MD, MBA

Background

Periprosthetic joint infections (PJIs) are a serious complication after total joint arthroplasty. Our study aimed to analyze the characteristics and research highlights of the top 100 most cited studies on PJI from an orthopaedic standpoint. Moreover, we sought to assess whether there has been a change in the level of evidence (LOE) throughout time.

Methods

We conducted a search of the PubMed, Embase, and Web of Science databases to identify the top 100 studies primarily focusing on PJI. Study characteristics assessed included publication year, LOE, journal of publication, and type of study. Research highlights of the included studies were classified into 6 sections. Linear regression was employed to assess correlation between LOE and publication year.

Results

The aggregated citation count of all studies was 19,558 and the median citation number was 129.5. While cohort studies were the most prevalent, articles focusing on analysis of costs associated with PJI care or PJI definition garnered the highest yearly citation counts. The bulk of included studies were concentrated in 3 orthopaedic journals and published in the 2010s. The majority of studies had a LOE II (30%) or III (34%). On regression analysis, LOE was not correlated with publication year (Pearson’s r = 0.013, P = .61).

Conclusions

The most cited PJI articles assessed the definition of PJI and PJI cost. Despite growing interest in PJI, the majority of studies had LOE II or III, highlighting the difficulty of conducting prospective randomized controlled trials in PJI patients.

Level of evidence

IV.

背景人工关节感染（PJI）是全关节成形术后的一种严重并发症。我们的研究旨在从骨科角度分析被引用次数最多的前 100 篇有关 PJI 的研究的特点和研究亮点。方法我们对PubMed、Embase和Web of Science数据库进行了检索，以确定主要关注PJI的前100项研究。评估的研究特征包括发表年份、LOE、发表期刊和研究类型。纳入研究的研究重点分为 6 个部分。结果所有研究的总引用次数为 19,558 次，中位引用次数为 129.5 次。虽然队列研究最为普遍，但侧重于分析与 PJI 护理相关的成本或 PJI 定义的文章每年获得的引用次数最高。大部分纳入的研究集中在 3 种骨科期刊上，发表于 2010 年代。大多数研究的LOE为II（30%）或III（34%）。在回归分析中，LOE与发表年份无关（Pearson's r = 0.013，P = .61）。结论被引用最多的PJI文章评估了PJI的定义和PJI成本。尽管人们对PJI的兴趣与日俱增，但大多数研究的LOE为II或III，这凸显了对PJI患者进行前瞻性随机对照试验的难度。

{"title":"What Are the Research Highlights of Periprosthetic Joint Infections From the 100 Most Cited Studies?","authors":"Marcos R. Gonzalez MD , Jose I. Acosta BS , Joshua Davis BS , Felipe Larios MD , Adam S. Olsen MD , Antonia F. Chen MD, MBA","doi":"10.1016/j.artd.2024.101564","DOIUrl":"10.1016/j.artd.2024.101564","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infections (PJIs) are a serious complication after total joint arthroplasty. Our study aimed to analyze the characteristics and research highlights of the top 100 most cited studies on PJI from an orthopaedic standpoint. Moreover, we sought to assess whether there has been a change in the level of evidence (LOE) throughout time.</div></div><div><h3>Methods</h3><div>We conducted a search of the PubMed, Embase, and Web of Science databases to identify the top 100 studies primarily focusing on PJI. Study characteristics assessed included publication year, LOE, journal of publication, and type of study. Research highlights of the included studies were classified into 6 sections. Linear regression was employed to assess correlation between LOE and publication year.</div></div><div><h3>Results</h3><div>The aggregated citation count of all studies was 19,558 and the median citation number was 129.5. While cohort studies were the most prevalent, articles focusing on analysis of costs associated with PJI care or PJI definition garnered the highest yearly citation counts. The bulk of included studies were concentrated in 3 orthopaedic journals and published in the 2010s. The majority of studies had a LOE II (30%) or III (34%). On regression analysis, LOE was not correlated with publication year (Pearson’s <em>r</em> = 0.013, <em>P</em> = .61).</div></div><div><h3>Conclusions</h3><div>The most cited PJI articles assessed the definition of PJI and PJI cost. Despite growing interest in PJI, the majority of studies had LOE II or III, highlighting the difficulty of conducting prospective randomized controlled trials in PJI patients.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101564"},"PeriodicalIF":1.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586060","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}

引用次数: 0

Blood Metal Ion Levels After Hip Resurfacing: A Comparison of 2 Different Implants 髋关节置换术后血液中的金属离子水平：两种不同植入物的比较

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-30 DOI: 10.1016/j.artd.2024.101555

Renee Ren BA, Ryan Cheng BA, Andrew Jordan MS, Jonathan Spaan MS, Rachelle Hornick MPH, Walter L. Taylor IV MPhil, Edwin P. Su MD

Background

While hip resurfacing arthroplasty has been shown to be an effective prosthetic solution for end-stage osteoarthritis, prior studies have also reported an increasing concern regarding blood metal ion levels following the use of metal-on-metal articulations. The purpose of this study was to compare early and midterm blood metal ion levels to functional outcomes and implant survivorship for patients treated with the Birmingham Hip Resurfacing (BHR) implant system and the ReCap Magnum.

Methods

A retrospective review identified 104 patients who underwent 134 hip resurfacing arthroplasties using BHR (n = 67) and ReCap (n = 67) at a single institution between 2006 and 2018. ReCap and BHR patients were matched 1:1 by sex, femoral head and acetabular cup sizes, age, and year of surgery. The primary outcome of interest was cobalt (Co) and chromium (Cr) ion levels.

Results

The ReCap cohort had lower median metal ion levels compared to the BHR cohort at 1-2 y (Co: 1.5 vs 1.9 parts per billion [ppb], P = .018; Cr: 1.3 vs 2.8 ppb, P = .008) and 3-5 y (Co: 1.1 vs 1.9 ppb, P = .001; Cr: 1.2 vs 2.2 ppb, P = .003) after surgery. Correlation analysis showed no significant associations between Co and Cr ion levels and pre- and postoperative patient-reported outcomes. Indications for revision differed between groups. Three BHR hips were revised due to adverse reactions to metal debris, whereas 2 ReCap hips required revisions: one for instability and another for periprosthetic fracture.

Conclusions

BHR patients had higher metal ion levels than ReCap patients at 1-2 and 3-5 y after surgery, though these metal levels are still low and in line with prior studies. Indications for revision differed between patients treated with BHR and ReCap. Surgeons should be aware of these outcomes when counseling patients regarding these metal-on-metal articulations.

背景虽然髋关节置换术已被证明是治疗终末期骨关节炎的有效假体解决方案，但之前的研究也报告称，使用金属关节后，血液中的金属离子水平越来越令人担忧。本研究的目的是比较使用伯明翰髋关节置换术（BHR）植入系统和 ReCap Magnum 治疗的患者的早期和中期血液金属离子水平、功能预后和植入物存活率。方法回顾性研究确定了 2006 年至 2018 年期间在一家机构使用 BHR（n = 67）和 ReCap（n = 67）进行了 134 例髋关节置换关节置换术的 104 名患者。ReCap和BHR患者按性别、股骨头和髋臼杯尺寸、年龄和手术年份1:1配对。研究的主要结果是钴离子（Co）和铬离子（Cr）水平。结果ReCap队列与BHR队列相比，1-2岁时的金属离子水平中位数较低（Co：1.5 vs 1.9 parts per billion [ppb]，P = .018；Cr：1.3 vs 2.8 ppb，P = .018）：手术后 1-2 年（Co：1.5 vs 1.9 十亿分之一 [ppb]；Cr：1.3 vs 2.8 十亿分之一，P = .008）和 3-5 年（Co：1.1 vs 1.9 十亿分之一，P = .001；Cr：1.2 vs 2.2 十亿分之一，P = .003），与 BHR 队列相比，中位金属离子水平较低。相关性分析表明，Co 和 Cr 离子水平与术前和术后患者报告的结果之间没有明显关联。各组的翻修指征不同。结论BHR患者在术后1-2年和3-5年的金属离子水平高于ReCap患者，但这些金属离子水平仍然较低，与之前的研究结果一致。BHR和ReCap患者的翻修指征不同。外科医生在向患者提供有关这些金属对金属关节的咨询时应注意这些结果。

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引用次数: 0

Is Wear Still a Concern in Total Knee Arthroplasty With Contemporary Conventional and Highly Crosslinked Polyethylene Tibial Inserts in the mid- to Long-Term? 使用当代传统和高交联聚乙烯胫骨假体进行全膝关节置换术的中长期磨损问题仍然存在吗？

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-30 DOI: 10.1016/j.artd.2024.101550

Devin P. Asher BS , Jennifer L. Wright MS , Deborah J. Hall BS , Hannah J. Lundberg PhD , Douglas W. Van Citters PhD , Joshua J. Jacobs MD , Brett R. Levine MD, MS , Robin Pourzal PhD

Background

Modern literature has brought into question if wear of tibial inserts made from conventional or highly crosslinked polyethylene (HXL PE) is still a factor limiting longevity of total knee arthroplasty (TKA) in the mid- to long-term. It is the objective of this study to determine: 1) most common causes of mid- to long-term TKA failure, 2) the prevalence of delamination, and 3) the medial/lateral linear wear rates of conventional and HXL PE tibial inserts retrieved in the mid- to long-term.

Methods

A tibial insert retrieval cohort of 107 inserts (79 conventional, 28 HXL PE) with a minimum time in situ of 6.5 years (mean 11.7 ± 4) was studied. Failure causes were determined from chart-review, delamination presence was assessed microscopically, and medial/lateral linear wear was determined by minimal thickness changes measured with a dial-indicator.

Results

The most common mid-to long-term etiologies for failure were instability (44.9%), PE wear 15%), aseptic loosening (14%), and infection (13.1%). Delamination occurred in 70% of inserts (72.1% conventional, 64.3% HXLPE). Gross material loss due to delamination appeared to be the underlying reason for at least 33.3% of cases exhibiting instability. Of the cases removed for infection, 75% exhibited no histopathological hallmarks of acute infection. The medial/lateral wear rates were 0.054/0.051 (conventional) and 0.014/0.011 (HXL) mm/y, respectively.

Conclusions

Polyethylene wear still appears to be a major primary and secondary cause for TKA revision in the mid- to long-term. Wear may manifest as destabilizing delamination or as continuous release of fine wear particles potentially resulting in inflammatory responses and subsequent failure.

背景现代文献对传统或高交联聚乙烯（HXL PE）制成的胫骨假体的磨损是否仍然是限制全膝关节置换术（TKA）中长期使用寿命的一个因素提出了质疑。本研究的目的在于确定1) 中长期 TKA 失败的最常见原因；2) 分层的发生率；3) 中长期取回的传统和 HXL PE 胫骨假体的内侧/外侧线性磨损率。方法研究了一组取回的胫骨假体，共 107 个假体（79 个传统假体，28 个 HXL PE 假体），假体在原位的时间最短为 6.5 年（平均为 11.7 ± 4）。研究结果最常见的中长期失效原因是不稳定性（44.9%）、PE 磨损（15%）、无菌性松动（14%）和感染（13.1%）。70%的插入物出现分层（72.1%为传统插入物，64.3%为 HXLPE 插入物）。至少有 33.3% 的病例显示出不稳定性，其根本原因似乎是分层导致的材料大面积流失。在因感染而被移除的病例中，75%的病例没有表现出急性感染的组织病理学特征。内侧/外侧磨损率分别为0.054/0.051（传统）和0.014/0.011（HXL）毫米/年。磨损可能表现为不稳定的分层或细小磨损颗粒的持续释放，可能导致炎症反应和随后的失败。

{"title":"Is Wear Still a Concern in Total Knee Arthroplasty With Contemporary Conventional and Highly Crosslinked Polyethylene Tibial Inserts in the mid- to Long-Term?","authors":"Devin P. Asher BS , Jennifer L. Wright MS , Deborah J. Hall BS , Hannah J. Lundberg PhD , Douglas W. Van Citters PhD , Joshua J. Jacobs MD , Brett R. Levine MD, MS , Robin Pourzal PhD","doi":"10.1016/j.artd.2024.101550","DOIUrl":"10.1016/j.artd.2024.101550","url":null,"abstract":"<div><h3>Background</h3><div>Modern literature has brought into question if wear of tibial inserts made from conventional or highly crosslinked polyethylene (HXL PE) is still a factor limiting longevity of total knee arthroplasty (TKA) in the mid- to long-term. It is the objective of this study to determine: 1) most common causes of mid- to long-term TKA failure, 2) the prevalence of delamination, and 3) the medial/lateral linear wear rates of conventional and HXL PE tibial inserts retrieved in the mid- to long-term.</div></div><div><h3>Methods</h3><div>A tibial insert retrieval cohort of 107 inserts (79 conventional, 28 HXL PE) with a minimum time in situ of 6.5 years (mean 11.7 ± 4) was studied. Failure causes were determined from chart-review, delamination presence was assessed microscopically, and medial/lateral linear wear was determined by minimal thickness changes measured with a dial-indicator.</div></div><div><h3>Results</h3><div>The most common mid-to long-term etiologies for failure were instability (44.9%), PE wear 15%), aseptic loosening (14%), and infection (13.1%). Delamination occurred in 70% of inserts (72.1% conventional, 64.3% HXLPE). Gross material loss due to delamination appeared to be the underlying reason for at least 33.3% of cases exhibiting instability. Of the cases removed for infection, 75% exhibited no histopathological hallmarks of acute infection. The medial/lateral wear rates were 0.054/0.051 (conventional) and 0.014/0.011 (HXL) mm/y, respectively.</div></div><div><h3>Conclusions</h3><div>Polyethylene wear still appears to be a major primary and secondary cause for TKA revision in the mid- to long-term. Wear may manifest as destabilizing delamination or as continuous release of fine wear particles potentially resulting in inflammatory responses and subsequent failure.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101550"},"PeriodicalIF":1.5,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553457","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}

引用次数: 0

Spinal Anesthesia in Total Hip Arthroplasty is Associated With Improved Outcomes in the American Joint Replacement Registry Population 全髋关节置换术中的脊髓麻醉与美国关节置换注册人口的疗效改善有关

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-30 DOI: 10.1016/j.artd.2024.101566

Sagar Telang BS , Nathanael D. Heckmann MD , Adam Olsen MD , Ayushmita De PhD , Jeffrey B. Stambough MD

Background

Despite previous studies showing benefits of spinal anesthesia (SA) for patients undergoing elective total hip arthroplasty (THA), most THA procedures throughout the United States still utilize general anesthesia (GA). Using the American Joint Replacement Registry data, our study explored outcome difference for patients undergoing THA administered SA vs GA.

Methods

All available THAs were identified using American Joint Replacement Registry data from 2017 to 2020. THA patients were categorized into 2 cohorts by anesthesia type. Demographics, hospital characteristics, and comorbidities were documented for each patient. Outcomes included operative time, length of stay, 30- and 90-day readmission, and 90-day all-cause revision. Chi-square analysis was used to assess categorical variables while multivariable regression analyzed the association between anesthesia type and outcomes of interest.

Results

A total of 217,124 THAs were identified, including 119,425 (55.0%) patients who received GA and 97,699 (45.0%) patients who received SA. Multivariable regression showed that SA was associated with a decreased risk of hospital length of stay >3 days (adjusted odds ratio [aOR] 0.4, 95% confidence interval [CI]: 0.34-0.36, P < .0001) and a lower likelihood of prolonged operative time (aOR 0.8, 95% CI: 0.79-0.82, P < .0001). Additionally, patients who received SA had lower rates of 90-day readmission (aOR 0.7, 95% CI: 0.67-0.78, P < .0001) and a decreased risk of 90-day all-cause revision (aOR 0.5, 95% CI: 0.47-0.54, P < .0001).

Conclusions

Patients receiving SA during THA had shorter operative time, reduced length of stay, and decreased rates of readmission and revision compared to patients who received GA. These findings add to the growing body of literature supporting the benefits of SA over GA for THA patients.

背景尽管之前的研究显示脊髓麻醉（SA）对接受择期全髋关节置换术（THA）的患者有好处，但美国的大多数 THA 手术仍采用全身麻醉（GA）。我们的研究利用美国关节置换登记处的数据，探讨了接受椎管内麻醉与全身麻醉的全髋关节置换术患者的预后差异。方法利用美国关节置换登记处 2017 年至 2020 年的数据确定了所有可用的全髋关节置换术。根据麻醉类型将 THA 患者分为 2 个队列。记录了每位患者的人口统计学特征、医院特征和合并症。研究结果包括手术时间、住院时间、30 天和 90 天再入院率以及 90 天全因翻修率。采用卡方分析法评估分类变量，同时采用多变量回归法分析麻醉类型与相关结果之间的关系。结果共确定了217124例 THAs，其中119425例（55.0%）患者接受了GA，97699例（45.0%）患者接受了SA。多变量回归显示，SA 与住院时间减少 3 天的风险相关（调整后的几率比 [aOR] 0.4，95% 置信区间 [CI]：0.34-0.36，P＜0.05）：0.34-0.36，P <.0001）和手术时间延长的可能性降低（aOR 0.8，95% 置信区间：0.79-0.82，P <.0001）。此外，接受 SA 治疗的患者 90 天再入院率较低（aOR 0.7，95% CI：0.67-0.78，P < .0001），90 天全因翻修风险较低（aOR 0.5，95% CI：0.47-0.54，P < .0001）。结论与接受 GA 治疗的患者相比，在 THA 期间接受 SA 治疗的患者手术时间更短、住院时间更短、再入院率和翻修率更低。越来越多的文献支持在 THA 患者中使用 SA 术比使用 GA 术更有益处，这些研究结果是对这一观点的进一步补充。

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