Arthroplasty Today最新文献_第2页

Mid-Term Outcomes of Cement-In-Cement Revision for Aseptic Loosening Versus Infection: A Comparative Study in a Small Retrospective Cohort 在一项小型回顾性队列研究中，对无菌性松动和感染进行骨水泥内翻修的中期结果进行比较研究

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-01-12 DOI: 10.1016/j.artd.2025.101934

Junyan Li MD , Shengqun Zhang MD , Weiliang Cai MD , Xianzhe Huang MD , Shuo Jie MD , Hui Li MD , Hongxing Li MD , Xinzhan Mao MD

Background

The cement-in-cement technique, which preserves the original cement mantle, has become a widely used surgical method in hip revision surgeries due to its ability to significantly simplify the procedure. Currently, no studies have directly compared the mid-term outcomes of using the cement-in-cement technique in patients with aseptic loosening vs those undergoing 1-stage revisions due to infection. We report the clinical and radiological outcomes of cement-in-cement femoral revisions performed for aseptic loosening and infection of hip.

Methods

We identified all patients undergoing cement-in-cement revision from January 2014 to October 2025. All cases were performed by the senior author using the Exeter Stem (Stryker Orthopaedics, Mahwah, New Jersey). Patients were followed-up annually with clinical and radiological assessment including survival rate, Oxford Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index scores, quality of cementation and component subsidence.

Results

A total of 13 patients matched the inclusion criteria (8 aseptic loosening and 5 infection). Mean follow-up was 3.5 years. A significant improvement in Oxford Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index scores was observed in both groups ((P < .001). No difference was found between the 2 groups in functional and radiological assessment. One patient in the aseptic loosening group underwent further operation for infection. No femoral components were revised for aseptic loosening in both groups.

Conclusions

The cement-in-cement technique may be a reasonable option for single-stage revision for infection when the existing cement mantle is intact, providing bone preservation and outcomes comparable to aseptic revisions.

水泥中水泥技术保留了原有的水泥套，由于其能够显著简化手术过程，已成为髋关节翻修手术中广泛使用的手术方法。目前，没有研究直接比较在无菌性松动患者中使用骨水泥-骨水泥技术与因感染而进行一期翻修的患者的中期结果。我们报告对无菌性松动和髋关节感染进行骨水泥-骨水泥股骨翻修的临床和放射学结果。方法选取2014年1月至2025年10月期间接受骨水泥内翻修术的所有患者。所有病例均由资深作者使用Exeter Stem （Stryker Orthopaedics, Mahwah, New Jersey）进行手术。每年随访患者的临床和放射学评估，包括生存率、牛津髋关节评分、西部安大略省和麦克马斯特大学骨关节炎指数评分、骨水泥质量和部件下沉。结果13例患者符合纳入标准（无菌性松动8例，感染5例）。平均随访时间为3.5年。两组患者的牛津髋关节评分、西安大略大学和麦克马斯特大学骨关节炎指数评分均有显著改善（P < .001）。两组在功能和放射学评价方面无差异。无菌松动组1例患者因感染进一步手术治疗。两组均未对无菌性松动股骨假体进行修改。结论在现有骨水泥套完整的情况下，骨水泥-骨水泥技术可能是治疗感染的单阶段翻修的合理选择，可提供骨保存和与无菌翻修相当的结果。

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引用次数: 0

Robotic-Assisted Medial Epicondylar Osteotomy and Dual Fixation Technique During Total Knee Arthroplasty for Severe Varus Deformity 机器人辅助内上髁截骨和双固定技术在全膝关节置换术中治疗严重内翻畸形

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-01-08 DOI: 10.1016/j.artd.2025.101946

Narayan Hulse FRCS (Tr&Orth), MCh, MRCS, MS, DNB

We report a robotic-assisted sliding medial epicondylar osteotomy along with a transosseous dual-fixation technique to balance severe varus deformities that are not amenable to medial release during total knee arthroplasty. A 60-year-old woman with bilateral knee osteoarthritis and a varus deformity of about 50° (hip–knee–ankle angle: Right 133°, left 127°) underwent staggered, bilateral robotic-assisted total knee arthroplasty. Despite excising osteophytes, performing a complete medial release, a reduction osteotomy, and reconstructing the medial tibial defect with a 10 mm modular metal augment, a significant imbalance with 9.5° of varus deformity remained uncorrected. Therefore, a medial epicondylar osteotomy was performed. The osteotomy fragment was displaced distally and posteriorly under real-time robotic control to achieve equal flexion and extension gaps. Robotic workflow is also used to monitor alignment and gaps during component cementation and osteotomy fixation. A dual-fixation technique is described using 2 interfragmentary cannulated screws and 2 transosseous nonabsorbable sutures to counter the deforming forces. The osteotomies healed bilaterally at 8 weeks. After 9 months of follow-up, the patient reports no pain, walks independently, has a range of motion of 0° to 115° bilaterally, and has a hip–knee–ankle angle of 178° on the right and 179° on the left.

我们报道了一种机器人辅助的内上髁滑动截骨术以及经骨双固定技术来平衡在全膝关节置换术中不能内侧松解的严重内翻畸形。一位60岁的双侧膝关节骨性关节炎和约50°内翻畸形（髋关节-膝关节-踝关节角度：右133°，左127°）的女性接受了双侧交错机器人辅助全膝关节置换术。尽管切除了骨赘，进行了完全的内侧松解，复位截骨术，并使用10毫米模块化金属增强物重建胫骨内侧缺损，但9.5°内翻畸形的严重不平衡仍未得到纠正。因此，我们进行了内上髁截骨术。在实时机器人控制下，将截骨碎片向远端和后端移位，以达到相同的屈伸间隙。机器人工作流程也用于监测组件粘合和截骨固定期间的对齐和间隙。采用双固定技术，使用2枚椎间空心螺钉和2枚经骨不可吸收缝合线来对抗变形力。截骨术在8周时双侧愈合。随访9个月后，患者无疼痛，独立行走，双侧活动范围为0°至115°，髋关节-膝关节-踝关节右角度为178°，左角度为179°。

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引用次数: 0

Tendency of Tibial Component Placement and Short-Term Outcomes in ROSA-Assisted Unicompartmental Knee Arthroplasty Using the Persona Partial Knee System 使用局部膝关节系统的rosa辅助单室膝关节置换术中胫骨假体放置的趋势和短期结果

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-01-08 DOI: 10.1016/j.artd.2025.101938

Daichi Ishimaru MD, PhD, Kazuki Sohmiya MD, Nobuo Terabayashi MD, PhD, Kazu Matsumoto MD, PhD

Background

Robot-assisted unicompartmental knee arthroplasty (UKA) has been introduced to improve component positioning. The ROSA Knee System and Persona Partial Knee (Zimmer Biomet, Warsaw, IN, USA) constitute a relatively new robotic platform with limited data. We aimed to quantify tibial and femoral component alignment and evaluate short-term clinical outcomes.

Methods

We reviewed 64 consecutive medial UKAs performed with this system. Preoperative planning used computed tomography (CT)-based three-dimensional models. Postoperative component alignment was measured on radiographs and CT. Clinical outcomes were assessed with the 2011 Knee Society Score (KSS) preoperatively and at 1 year; paired analyses were performed in 34 knees with complete preoperative and postoperative KSS data.

Results

Tibial components were implanted in greater varus and with less posterior slope than planned. The planned tibial coronal angle was 0.0° ± 0.1°, whereas the postoperative CT-based angle was −2.7° ± 2.3°; posterior slope decreased from 7.8° ± 1.4° to 4.5° ± 2.4°. Femoral alignment showed minimal deviation. In the 34 knees with complete KSS data, mean symptom, satisfaction, and functional activity subscores improved from 7.4 ± 4.9, 16.1 ± 6.4, and 47.7 ± 17.2 to 19.4 ± 5.3, 29.8 ± 6.4, and 75.7 ± 14.5, respectively (all P < .0001).

Conclusions

Medial robot-assisted UKA with this system showed generally accurate component positioning but a consistent tendency toward approximately 2° greater tibial varus and reduced posterior slope relative to the plan. Awareness of this systematic deviation may help optimize tibial placement, and short-term clinical outcomes were favorable.

机器人辅助的单室膝关节置换术（UKA）已被引入以改善部件定位。ROSA膝关节系统和Persona Partial Knee （Zimmer Biomet, Warsaw， IN， USA）构成了一个相对较新的机器人平台，数据有限。我们的目的是量化胫骨和股骨组成部分对齐并评估短期临床结果。方法对使用该系统进行的64例连续医学uka进行回顾性分析。术前规划采用基于计算机断层扫描（CT）的三维模型。在x线片和CT上测量术后部件对齐。采用2011膝关节社会评分（KSS）评估术前和术后1年的临床结果；对34个膝关节进行配对分析，获得完整的术前和术后KSS数据。结果胫骨假体植入时内翻较大，后倾角小于原计划。计划胫骨冠状角为0.0°±0.1°，而术后ct角度为- 2.7°±2.3°；后坡度由7.8°±1.4°降至4.5°±2.4°。股骨对准显示最小偏差。在34个具有完整KSS数据的膝关节中，平均症状、满意度和功能活动评分分别从7.4±4.9、16.1±6.4和47.7±17.2改善到19.4±5.3、29.8±6.4和75.7±14.5（均P <； .0001）。结论使用该系统的内侧机器人辅助UKA具有大致准确的部件定位，但相对于计划，始终倾向于胫骨内翻约2°，后倾角减小。意识到这种系统性偏差可能有助于优化胫骨放置，短期临床结果是有利的。

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引用次数: 0

Primary Versus Salvage Distal Femoral Endoprosthetic Replacement Following Native Distal Femur Fracture: A Systematic Review and Meta-Analysis 原发性股骨远端骨折后行股骨远端假体置换术与补救性股骨远端假体置换术：系统回顾和荟萃分析

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-01-07 DOI: 10.1016/j.artd.2025.101939

Lucas Ho MBChB (Hons) , Navnit S. Makaram MSc, MRCS (Ed) , Catherine James MBBCh, MRCS , Chryssa Neo MBChB, MSc, MRCS , Nick D. Clement MBBS, MD, PhD, FRCS Ed (Tr & Orth) , Chloe E.H. Scott MD, FRCSEd (Tr & Orth)

Background

Surgical management of native distal femoral fractures (DFFs) in elderly patients includes open reduction and internal fixation (ORIF) or distal femoral endoprosthetic replacement (DFR). When ORIF is complicated by nonunion or fixation failure, salvage DFR (sDFR) may be required. The comparative outcomes of primary DFR (pDFR) vs sDFR remain unclear. This systematic review and meta-analysis aimed to assess the quality of published literature and compared clinical and functional outcomes between pDFR and sDFR for native DFFs.

Methods

MEDLINE, Embase, and Cochrane databases were searched from inception to April 2024. Studies investigating outcomes of pDFR or sDFR following native DFFs were included. Studies evaluating periprosthetic fractures, oncologic indications, or primary arthritis were excluded. Twelve studies comprising 281 patients (230 pDFR, 51 sDFR) were included.

Results

Patients undergoing pDFR were significantly older (mean 79.3 vs 64.9 years; P < .001) and more comorbid (American Society of Anesthesiologists score: mean 2.99 vs 2.34; P < .001). Despite this, pDFR was associated with significantly lower reoperation (12.2% vs 23.5%; P = .04) and complication rates (15.7% vs 43.1%; P < .001) compared to sDFR. 1-year mortality rate was higher in the pDFR cohort (10.4% vs 2.0%). Functional outcomes were marginally lower in pDFR, although this was not statistically significant (76.3 vs 80.7%; P = .09).

Conclusions

sDFR following failed fixation of native DFFs was associated with nearly twice the risk of reoperation and postoperative complications compared to pDFR, despite being performed in a younger and less comorbid cohort. Elderly patients at risk of fixation failure may therefore benefit from pDFR.

背景：老年患者先天性股骨远端骨折（dff）的手术治疗包括切开复位内固定（ORIF）或股骨远端假体置换术（DFR）。当ORIF并发骨不连或固定失败时，可能需要补救性DFR （sDFR）。原发性DFR （pDFR）与sDFR的比较结果尚不清楚。本系统综述和荟萃分析旨在评估已发表文献的质量，并比较pDFR和sDFR治疗本地dff的临床和功能结果。方法检索medline、Embase和Cochrane数据库，检索时间为建库至2024年4月。纳入了调查本地dff后pDFR或sDFR结果的研究。评估假体周围骨折、肿瘤适应症或原发性关节炎的研究被排除在外。纳入了12项研究，共281例患者（230例pDFR， 51例sDFR）。结果接受pDFR的患者年龄明显增大（平均79.3岁vs 64.9岁；P < 0.001），合合症较多（美国麻醉医师学会评分：平均2.99岁vs 2.34岁；P < 0.001）。尽管如此，与sDFR相比，pDFR的再手术率（12.2% vs 23.5%, P = 0.04）和并发症发生率（15.7% vs 43.1%, P < 0.001）显著降低。pDFR组的1年死亡率更高（10.4% vs 2.0%）。功能结局在pDFR中略低，尽管这没有统计学意义（76.3 vs 80.7%; P = 0.09）。结论：与pDFR相比，原位dff固定失败后的dfr与再手术和术后并发症的风险接近两倍，尽管在更年轻且合并症较少的队列中进行。因此，有固定失败风险的老年患者可能受益于pDFR。

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引用次数: 0

Complications and Reoperation Rates of Total Knee Arthroplasty After High Tibial Osteotomy: A Matched Cohort Analysis From a Nationwide Database 胫骨高位截骨后全膝关节置换术的并发症和再手术率：来自全国数据库的匹配队列分析

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-01-07 DOI: 10.1016/j.artd.2025.101941

Madeleine Orringer MD , Ioanna K. Bolia MD, MS, PhD , Cory K. Mayfield MD , Eric H. Lin BA , Cailan L. Feingold BS , Nathanael D. Heckmann MD , George F.Rick Hatch 3rd MD

Background

Arthritic progression after high tibial osteotomy (HTO) can require total knee arthroplasty (TKA). While primary TKA results are reliably favorable, there remains uncertainty regarding outcomes of TKA after HTO. We aimed to compare perioperative complication and revision rates for patients who converted to TKA after HTO (HTO-TKA) vs patients who underwent primary TKA.

Methods

Retrospective deidentified data were obtained from the PearlDiver Mariner Database from 2010 to 2022. Patients who underwent TKA following HTO were matched in a 1:3 ratio based on age, gender, and Charlson Comorbidity index to patients who underwent primary TKA. The incidence of revision surgery and postoperative complications were compared.

Results

After matching, 786 patients who underwent converted HTO-TKA were compared to 2356 patients who underwent primary TKA. Patients with TKA after HTO had nearly 4-fold increased incidence of postoperative infection (2.9% vs 0.64%, odds ratio (OR) = 4.7, 95% confidence interval [CI] 2.4-9.1, P < .0001) and wound disruption (6.0% vs 1.7%, OR = 3.7, 95% CI 2.4-5.7, P < .0001) compared to primary TKA patients. There was an increased incidence of aseptic loosening (1.8% vs 0.76%, OR = 2.4, 95% CI 1.2-4.8, P = .024). History of prior HTO was also associated with a 3-fold increase in incidence of revision TKA within 2 years (6.2% vs 2.3%, OR = 2.8, 95% CI 1.9-4.2, P < .0001).

Conclusions

Patients who undergo HTO before TKA have a higher incidence of perioperative complications and revision surgery compared to primary TKA patients. These data can be useful when counseling patients; however, further research should investigate whether recent advances in surgical techniques and contemporary changes in infection prophylaxis may enhance outcomes of TKA following HTO.

背景：高位胫骨截骨术（HTO）后关节炎进展可能需要全膝关节置换术（TKA）。虽然TKA的初步结果是可靠的，但HTO后TKA的结果仍然存在不确定性。我们的目的是比较HTO术后转TKA患者（HTO-TKA）与原发TKA患者的围手术期并发症和翻修率。方法从2010 - 2022年PearlDiver Mariner数据库中获得回顾性鉴定数据。根据年龄、性别和Charlson合并症指数，HTO后接受TKA的患者与接受原发性TKA的患者按1:3的比例进行匹配。比较翻修手术及术后并发症的发生率。结果匹配后，786例转行HTO-TKA患者与2356例原发TKA患者进行了比较。与原发TKA患者相比，HTO后TKA患者术后感染（2.9% vs 0.64%，优势比(OR) = 4.7, 95%可信区间[CI] 2.4-9.1, P < 0.0001）和伤口破裂（6.0% vs 1.7%, OR = 3.7, 95% CI 2.4-5.7, P < 0.0001）的发生率增加了近4倍。无菌性松动发生率增加（1.8% vs 0.76%, OR = 2.4, 95% CI 1.2-4.8, P = 0.024）。既往HTO病史也与2年内改版TKA发生率增加3倍相关（6.2% vs 2.3%, OR = 2.8, 95% CI 1.9-4.2, P < 0.0001）。结论TKA术前行HTO的患者围手术期并发症及翻修手术发生率高于原发性TKA患者。这些数据在为患者提供咨询时很有用；然而，进一步的研究应该调查手术技术的最新进展和当代感染预防的变化是否可以提高HTO后TKA的结果。

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引用次数: 0

Patellar Clunk Syndrome: A Systematic Review of Risk Factors and Treatment 髌骨磕碰综合征：危险因素和治疗的系统综述

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-01-05 DOI: 10.1016/j.artd.2025.101936

Margaret Hedeman BA , Jacie Lemos BS , Charles Guerra BS , Hadley Winslow BS , Arnav Sharma BS , William D. Werry MD , Phil Aurigemma MD , Brian Samuelsen MD , Mark J. Lemos MD

Background

Patellar Clunk Syndrome (PCS) is a known complication of total knee arthroplasty (TKA). Prior studies have identified multiple risk factors for PCS, including male sex, patellar size, and implant design. Previous literature suggests surgical intervention as the preferred treatment for PCS. No review to date has systematically assessed risk factors and treatment outcomes of PCS.

Methods

Following PRISMA protocol, 4 online databases were searched for English language studies published during or after the year 2000 that reported PCS as a primary outcome of TKA and identified (1) risk factors for developing PCS and/or (2) outcomes following treatment. The methodological quality of studies was assessed using the Newcastle-Ottawa Scale (NOS). The following outcomes were collected and reported: demographic information, overall PCS complication rate, risk factors, treatment plans, and treatment outcomes.

Results

The initial search yielded 699 articles. A total of 316 articles underwent full-text review; 24 articles were ultimately included and analyzed. Nineteen articles assessed risk factors, 2 assessed treatment outcomes, and 3 assessed both. Of the articles assessing risk factors, 9 (41%) reported specific implants, 3 (16%) reported mobile-bearing design, and 2 (9%) reported posterior stabilized (PS) design. Additional risk factors identified include retained patella, smaller patellar thickness, and higher postoperative knee flexion. Five articles assessed arthroscopic treatment for PCS, and all demonstrated satisfactory outcomes.

Conclusions

Risk factors for developing PCS include implant design, implant type, retained patella, patellar thickness, and higher postoperative flexion. Other risk factors were not supported by multiple studies. Arthroscopic treatment has strong evidence for improving functional outcomes in patients with symptomatic PCS.

背景：髌骨磕碰综合征（PCS）是全膝关节置换术（TKA）的一种已知并发症。先前的研究已经确定了PCS的多种危险因素，包括男性性别、髌骨大小和植入物设计。既往文献建议手术干预是PCS的首选治疗方法。到目前为止，还没有综述系统地评估了PCS的危险因素和治疗结果。方法按照PRISMA协议，检索4个在线数据库，检索2000年前后发表的将PCS作为TKA主要转归的英文研究，并确定：(1)发生PCS的危险因素和/或(2)治疗后的转归。研究的方法学质量采用纽卡斯尔-渥太华量表（NOS）进行评估。收集并报告以下结果：人口统计信息、总体PCS并发症发生率、危险因素、治疗方案和治疗结果。最初的搜索产生了699篇文章。共有316篇文章进行了全文审查；最终纳入并分析了24篇文章。19篇文章评价危险因素，2篇评价治疗结果，3篇评价两者。在评估风险因素的文章中，9篇（41%）报道了特定植入物，3篇（16%）报道了移动轴承设计，2篇（9%）报道了后路稳定（PS）设计。确定的其他危险因素包括保留的髌骨、较小的髌骨厚度和术后较高的膝关节屈曲。五篇文章评估了关节镜下治疗PCS的效果，结果均令人满意。结论发生PCS的危险因素包括假体设计、假体类型、保留髌骨、髌骨厚度和术后高度屈曲。其他危险因素没有得到多项研究的支持。有强有力的证据表明关节镜治疗可以改善症状性PCS患者的功能结局。

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引用次数: 0

Improved Perioperative Outcomes in Robotic-Assisted Revision Total Knee Arthroplasty 机器人辅助翻修全膝关节置换术围手术期疗效的改善

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-01-03 DOI: 10.1016/j.artd.2025.101937

Kevin C. Chang MD , Aleksandra Qilleri BS , Alexandra Echevarria BS , Jonathan R. Danoff MD

Background

This study compares short-term outcomes of robotic-assisted revision total knee arthroplasty (RA-rTKA) to conventional rTKA. We hypothesize that RA-rTKA will accelerate gains in range of motion and time to ambulation postoperatively.

Methods

This is a retrospective case-control study reviewing consecutive rTKA performed by a single surgeon between 2017 and 2024. rTKA cases performed prior to 2022 were compared to RA-rTKA performed from 2022 through present day. Revisions for periprosthetic joint infection or fracture were excluded. The primary outcome was hospital length of stay. Secondary outcomes included physical therapy (PT) metrics, blood loss, surgical time, and complications. Data collected included demographics, surgical and implant data, in-hospital PT progress, and outcomes through a minimum of 1 year.

Results

Sixty-six revision cases (42 rTKA and 24 RA-rTKA) were included with an average age of 67.7 years. Etiologies included loosening (42), second-stage reimplantation (12) after infection eradication, polyethylene wear (6), instability (6), and other etiologies (6). RA-rTKA case time averaged 27 minutes less than conventional; P = .18. The RA-rTKA cohort ambulated further on postoperative day 1 compared to the rTKA group (166.3 vs 87.2 feet; P = .01), was cleared by PT for discharge sooner (2.1 vs 3.1 days; P < .01), and had a shorter hospital length of stay (2.5 vs 3.6 days, P = .01). While all patients in both cohorts achieved at least 110° knee flexion by 6 weeks, RA-rTKA patients demonstrated significantly more knee flexion (119° vs 110°; P = .05). At a minimum of 1-year follow-up, no RA-rTKA patients required rerevisions, compared to 2 rTKA patients.

Conclusions

In this study, RA-rTKA showed improved ambulation in the immediate postoperative period, decreased hospital length of stay, and overall increased knee range of motion. These improvements were realized without increases in complications or operative time.

本研究比较了机器人辅助翻修全膝关节置换术（RA-rTKA）和常规rTKA的短期疗效。我们假设RA-rTKA将加速术后活动范围和活动时间的增加。方法本研究为回顾性病例对照研究，回顾2017年至2024年间同一位外科医生连续实施的rTKA。将2022年之前进行的rTKA病例与2022年至今进行的RA-rTKA进行比较。排除假体周围关节感染或骨折的修正。主要观察指标为住院时间。次要结局包括物理治疗（PT）指标、出血量、手术时间和并发症。收集的数据包括人口统计、手术和植入数据、住院PT进展和至少1年的结果。结果共纳入66例翻修手术，其中rTKA 42例，RA-rTKA 24例，平均年龄67.7岁。病因包括松动（42例）、感染根除后二期再植（12例）、聚乙烯磨损（6例）、不稳定（6例）和其他原因（6例）。RA-rTKA病例平均时间较常规缩短27分钟；P = .18。与rTKA组相比，RA-rTKA组在术后第1天行走更远（166.3对87.2英尺；P = 0.01）， PT清除出院更快（2.1对3.1天；P < 01），住院时间更短（2.5对3.6天，P = 0.01）。虽然两组患者在6周时均达到至少110°膝关节屈曲，但RA-rTKA患者的膝关节屈曲明显更多（119°vs 110°；P = 0.05）。在至少1年的随访中，与2例rTKA患者相比，没有RA-rTKA患者需要复查。结论在本研究中，RA-rTKA在术后立即改善了活动能力，缩短了住院时间，总体上增加了膝关节活动范围。这些改善在没有增加并发症或手术时间的情况下实现。

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引用次数: 0

Stabilizing the Unstable: Cone Hemiarthroplasty in Geriatric Intertrochanteric Fractures 稳定不稳定：锥形半关节置换术治疗老年转子间骨折

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-12-30 DOI: 10.1016/j.artd.2025.101935

Arcot Reddy Vamsi Krishna, Babaji Sitaram thorat, Avtar Singh Kamboj, Abhijit das, Kshitij Srivastav, Arshid H. Wani

Background

Unstable intertrochanteric fractures in the elderly pose a significant treatment challenge due to poor bone quality, comminution, and associated comorbidities. Bipolar hemiarthroplasty offers the advantage of early mobilization and reduced fixation-related complications. This study evaluates short-term outcomes of bipolar hemiarthroplasty using an uncemented titanium fluted, tapered cone femoral prosthesis in such fractures.

Methods

A retrospective analysis was conducted on 43 consecutive elderly patients treated with uncemented bipolar hemiarthroplasty using a tapered, fluted cone stem between June 2023 and July 2024. Radiographic parameters—including stem subsidence, greater trochanter union, and limb-length discrepancy—were assessed at serial follow-ups. Functional outcomes were evaluated using the Harris Hip Score.

Results

Of the 43 patients operated on, 40 completed a minimum of 12 months follow-up. Greater trochanteric union was observed in 97.7% of cases, with one persistent nonunion causing abductor weakness and early dislocation. Mean stem subsidence was 3.5 mm (0.5–20 mm), with all settling occurring within the first 3 postoperative months; 4 patients (9.3%) experienced subsidence of 5 mm or more, including one requiring revision. The mean limb-length discrepancy was 4.7 mm (1–10 mm). At final follow-up, the mean Harris Hip Score among surviving patients was 91.28, with 29 patients (72.5%) achieving excellent outcomes and 11 patients (27.5%) achieving good outcomes.

Conclusions

Bipolar hemiarthroplasty using a tapered, fluted cone stem appears to be a reliable option for carefully selected elderly patients with unstable intertrochanteric fractures, offering predictable fixation, early weight-bearing, and favorable short-term functional results.

背景：老年人不稳定转子间骨折由于骨质量差、粉碎和相关合并症，给治疗带来了重大挑战。双相半关节置换术提供了早期活动和减少固定相关并发症的优势。本研究评估了在双极半关节置换术中使用非骨水泥钛槽锥形股骨假体治疗此类骨折的短期疗效。方法回顾性分析2023年6月至2024年7月连续43例老年患者行非骨水泥双极半关节置换术。在连续随访中评估影像学参数，包括椎体下沉、大转子愈合和肢体长度差异。使用Harris髋关节评分评估功能结果。结果43例手术患者中，40例完成了至少12个月的随访。97.7%的病例出现大转子愈合，其中一例持续不愈合导致外展肌无力和早期脱位。平均茎部下沉3.5 mm (0.5-20 mm)，所有下沉均发生在术后前3个月内；4例患者（9.3%）经历了5毫米或更多的下沉，包括1例需要翻修。平均肢长差异为4.7 mm （1-10 mm）。在最后的随访中，存活患者的Harris髋关节平均评分为91.28，其中29例（72.5%）患者获得了良好的结局，11例（27.5%）患者获得了良好的结局。结论：对于精心挑选的老年不稳定转子间骨折患者，双极半关节置换术采用锥形、槽状锥柄似乎是一种可靠的选择，可提供可预测的固定、早期负重和良好的短期功能效果。

{"title":"Stabilizing the Unstable: Cone Hemiarthroplasty in Geriatric Intertrochanteric Fractures","authors":"Arcot Reddy Vamsi Krishna, Babaji Sitaram thorat, Avtar Singh Kamboj, Abhijit das, Kshitij Srivastav, Arshid H. Wani","doi":"10.1016/j.artd.2025.101935","DOIUrl":"10.1016/j.artd.2025.101935","url":null,"abstract":"<div><h3>Background</h3><div>Unstable intertrochanteric fractures in the elderly pose a significant treatment challenge due to poor bone quality, comminution, and associated comorbidities. Bipolar hemiarthroplasty offers the advantage of early mobilization and reduced fixation-related complications. This study evaluates short-term outcomes of bipolar hemiarthroplasty using an uncemented titanium fluted, tapered cone femoral prosthesis in such fractures.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 43 consecutive elderly patients treated with uncemented bipolar hemiarthroplasty using a tapered, fluted cone stem between June 2023 and July 2024. Radiographic parameters—including stem subsidence, greater trochanter union, and limb-length discrepancy—were assessed at serial follow-ups. Functional outcomes were evaluated using the Harris Hip Score.</div></div><div><h3>Results</h3><div>Of the 43 patients operated on, 40 completed a minimum of 12 months follow-up. Greater trochanteric union was observed in 97.7% of cases, with one persistent nonunion causing abductor weakness and early dislocation. Mean stem subsidence was 3.5 mm (0.5–20 mm), with all settling occurring within the first 3 postoperative months; 4 patients (9.3%) experienced subsidence of 5 mm or more, including one requiring revision. The mean limb-length discrepancy was 4.7 mm (1–10 mm). At final follow-up, the mean Harris Hip Score among surviving patients was 91.28, with 29 patients (72.5%) achieving excellent outcomes and 11 patients (27.5%) achieving good outcomes.</div></div><div><h3>Conclusions</h3><div>Bipolar hemiarthroplasty using a tapered, fluted cone stem appears to be a reliable option for carefully selected elderly patients with unstable intertrochanteric fractures, offering predictable fixation, early weight-bearing, and favorable short-term functional results.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101935"},"PeriodicalIF":2.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effects of Very Early versus Early Mobilization and Walking on Functional and Psychosocial Outcomes in Acute Phase After Total Hip Arthroplasty: A Prospective Observational Study 早期活动和步行对全髋关节置换术后急性期功能和社会心理结局的影响：一项前瞻性观察研究

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-12-27 DOI: 10.1016/j.artd.2025.101933

Davide De Leo PT , Federico Temporiti PT, PhD , Sofia Della Gatta PT , Davide Conti PT , Paola Adamo PT, MSc , Roberto Gatti PT, MSc

Background

Mobilization and walking after total hip arthroplasty (THA) are delivered as early as patients are able, but heterogeneity in administration timing has been reported. The study aimed to investigate the effects of very early (within 8 hours from surgery) vs early (between 12 and 24 hours from surgery) mobilization and walking on functional and psychosocial outcomes after THA.

Methods

In this prospective observational study, 237 patients with THA performed very early (n = 174) or early (n = 63) mobilization and walking. After collecting demographic (age, gender, body mass index) and clinical (osteoarthritis severity, preoperative functional status and comorbidities) characteristics at baseline, participants were assessed for mobility (Timed Up and Go) and pain (Numeric Pain Rating Scale) at baseline, first (T1) and third (T2) postoperative days. Fear of movement (Tampa Scale of Kinesiophobia) and anxiety (Visual Analog Scale for anxiety) were investigated at baseline and T2. Percentage of participants who achieved independent walking at T1, time to meet ambulatory discharge criteria, length of stay, adverse events and satisfaction (Visual Analog Patient Satisfaction Scale) were collected.

Results

No between-group differences were found for Timed Up and Go at T1 (MD -0.8s, CI₉₅ -4.7 to 6.2) and T2 (MD -1.3s, CI₉₅ -1.8 to 4.3). Numeric Pain Rating Scale, Tampa Scale of Kinesiophobia, walking independence at T1, time to meet ambulatory discharge criteria, length of stay, adverse events and Visual Analog Patient Satisfaction Scale showed no between-group differences (P > .05).

Conclusions

Very early mobilization and walking were not superior to early mobilization and walking on functional and psychosocial outcomes after THA.

背景：全髋关节置换术（THA）后的活动和行走应尽早给予患者，但有报道称在给药时间上存在异质性。该研究旨在调查早期（手术后8小时内）和早期（手术后12 - 24小时）活动和行走对THA术后功能和社会心理结局的影响。方法在这项前瞻性观察研究中，237例THA患者进行了非常早期（n = 174）或早期（n = 63）的活动和行走。在基线收集人口统计学（年龄、性别、体重指数）和临床（骨关节炎严重程度、术前功能状态和合并症）特征后，在基线、术后第一天（T1）和第三天（T2）评估参与者的活动能力（Timed Up and Go）和疼痛（数字疼痛评定量表）。运动恐惧（坦帕运动恐惧症量表）和焦虑（焦虑的视觉模拟量表）在基线和T2进行调查。收集T1时实现独立行走的参与者百分比、达到门诊出院标准的时间、住院时间、不良事件和满意度（视觉模拟患者满意度量表）。结果T1 （MD -0.8s, CI95 -4.7 ~ 6.2）和T2 （MD -1.3s, CI95 -1.8 ~ 4.3）时的Timed Up和Go在组间无差异。数值疼痛评定量表、坦帕运动恐惧症量表、T1时的行走独立性、达到流动出院标准的时间、住院时间、不良事件和视觉模拟患者满意度量表在组间无差异（P > 0.05）。结论在THA术后的功能和社会心理结局方面，早期活动和步行并不优于早期活动和步行。

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引用次数: 0

Intraoperative Genicular Nerve Infiltration Offers Comparable Pain Control to Traditional Periarticular Injection After Total Knee Arthroplasty: A Randomized Controlled Trial 术中膝关节神经浸润对全膝关节置换术后疼痛的控制效果与传统关节周注射相当：一项随机对照试验

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-12-26 DOI: 10.1016/j.artd.2025.101927

Jirayu Phaliphot MD , Apisit Aoimoon MD , Chidchanok Ruengorn PhD , Kamolsak Sukhonthamarn MD

Background

Postoperative pain in total knee arthroplasty (TKA) can hinder rehabilitation and impair functional outcomes. Periarticular injection (PAI) is commonly used method to mitigate postoperative pain. However, the optimal injection sites and volumes remain inconclusive. Genicular nerve infiltration (GNI), targeting 3 of the 6 primary genicular nerve branches, has shown promise in nonoperative osteoarthritis treatment. This study aimed to evaluate the efficacy of intraoperative PAI with GNI in reducing postoperative pain following TKA.

Methods

This single-center, double-blinded, 3-arm randomized controlled trial enrolled 78 patients undergoing unilateral TKA (n = 26 per group). Patients were randomized to receive no injection (control), traditional PAI, or PAI with GNI targeting 3 genicular nerves. Bupivacaine was used in both injection groups. Primary outcomes included visual analog scale pain scores at rest and during motion. Secondary outcomes were opioid consumption, range of motion, modified Western Ontario and McMaster Universities Osteoarthritis scores, and adverse events. Outcomes were assessed at 24 and 48 hours and at 2 and 6 weeks postoperatively.

Results

Baseline characteristics were comparable among groups. Both PAI and GNI groups had significantly better outcomes than the control group regarding pain scores at rest and motion, opioid consumption, and active knee extension at 24 and 48 hours (P < .05). Outcomes between the PAI and GNI groups were comparable.

Conclusions

Intraoperative GNI as part of PAI may be effective in reducing postoperative knee pain, opioid use, and improving knee extension following TKA. GNI offers a targeted, consistent, and potentially simplified alternative to conventional PAI techniques.

背景：全膝关节置换术（TKA）术后疼痛会阻碍康复并损害功能预后。关节周注射（PAI）是减轻术后疼痛的常用方法。然而，最佳注射部位和注射量尚无定论。膝神经浸润（GNI），针对6个膝神经分支中的3个，在非手术治疗骨关节炎中显示出希望。本研究旨在评价术中PAI加GNI对TKA术后疼痛的减轻效果。方法本研究为单中心、双盲、3组随机对照试验，纳入78例单侧TKA患者（每组26例）。患者随机分为不注射组（对照组）、传统PAI组和GNI靶向3个膝神经的PAI组。两组均使用布比卡因。主要结果包括休息和运动时的视觉模拟疼痛评分。次要结果是阿片类药物的消耗、活动范围、修改后的安大略省西部和麦克马斯特大学骨关节炎评分和不良事件。分别在术后24小时、48小时、2周和6周评估结果。结果各组间基线特征具有可比性。PAI组和GNI组在24小时和48小时的休息和运动疼痛评分、阿片类药物消耗和主动膝关节伸展方面的结果均明显优于对照组（P < 0.05）。PAI组和GNI组之间的结果具有可比性。结论术中GNI作为PAI的一部分可有效减少全膝关节置换术后膝关节疼痛，减少阿片类药物的使用，改善膝关节伸展。GNI为传统PAI技术提供了一种有针对性的、一致的、可能简化的替代方案。

{"title":"Intraoperative Genicular Nerve Infiltration Offers Comparable Pain Control to Traditional Periarticular Injection After Total Knee Arthroplasty: A Randomized Controlled Trial","authors":"Jirayu Phaliphot MD , Apisit Aoimoon MD , Chidchanok Ruengorn PhD , Kamolsak Sukhonthamarn MD","doi":"10.1016/j.artd.2025.101927","DOIUrl":"10.1016/j.artd.2025.101927","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative pain in total knee arthroplasty (TKA) can hinder rehabilitation and impair functional outcomes. Periarticular injection (PAI) is commonly used method to mitigate postoperative pain. However, the optimal injection sites and volumes remain inconclusive. Genicular nerve infiltration (GNI), targeting 3 of the 6 primary genicular nerve branches, has shown promise in nonoperative osteoarthritis treatment. This study aimed to evaluate the efficacy of intraoperative PAI with GNI in reducing postoperative pain following TKA.</div></div><div><h3>Methods</h3><div>This single-center, double-blinded, 3-arm randomized controlled trial enrolled 78 patients undergoing unilateral TKA (n = 26 per group). Patients were randomized to receive no injection (control), traditional PAI, or PAI with GNI targeting 3 genicular nerves. Bupivacaine was used in both injection groups. Primary outcomes included visual analog scale pain scores at rest and during motion. Secondary outcomes were opioid consumption, range of motion, modified Western Ontario and McMaster Universities Osteoarthritis scores, and adverse events. Outcomes were assessed at 24 and 48 hours and at 2 and 6 weeks postoperatively.</div></div><div><h3>Results</h3><div>Baseline characteristics were comparable among groups. Both PAI and GNI groups had significantly better outcomes than the control group regarding pain scores at rest and motion, opioid consumption, and active knee extension at 24 and 48 hours (<em>P</em> < .05). Outcomes between the PAI and GNI groups were comparable.</div></div><div><h3>Conclusions</h3><div>Intraoperative GNI as part of PAI may be effective in reducing postoperative knee pain, opioid use, and improving knee extension following TKA. GNI offers a targeted, consistent, and potentially simplified alternative to conventional PAI techniques.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101927"},"PeriodicalIF":2.1,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0