Arthroplasty Today最新文献

英文中文

Aspirin for Venous Thromboembolism Prophylaxis and Nonsteroidal Anti-inflammatory Agents Should Be Administered at Least 2 Hours Apart

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-08 DOI: 10.1016/j.artd.2025.101663

Matthew J. Grosso MD

引用次数: 0

Suction-Powered Intramedullary Bone Debridement Technology Compared to Conventional Curettage in Infected Revision Total Knee Arthroplasty

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-06 DOI: 10.1016/j.artd.2025.101648

Joshua Hansen MD, Alexis Sandler MD, Michael Polmear MD, Richard Purcell MD

Background

Revision total knee arthroplasty (TKA) in the United States is an increasingly common procedure, often performed in the setting of prosthetic joint infection. Debridement of the intramedullary canals is traditionally performed with surgical curettes and is technically difficult and time-intensive. A suction-powered bone harvester (SPBH) is designed to improve the quality of debridement in a closed-capture system. This study assesses conventional curettage (CC) versus SPBH in debridement mass and time from intramedullary spaces. We hypothesize that SPBH will increase debridement yield more efficiently than conventional curettes.

Methods

Adult patients undergoing revision TKA were enrolled to participate in the study and were divided into 2 groups. Patients in group 1 received tibial debridement with CC followed by SPBH and femoral canals with SPBH alone. Patients in group 2 received femoral debridement with CC followed by SPBH and tibial canals with SPBH alone.

Results

Data were collected from 30 revision TKA cases in the setting of prosthetic joint infection. In total, 14 femora and 16 tibiae were initially debrided with SPBH, while the opposites were debrided with CC. On average, the intramedullary debridement with SPBH yielded 23.1 g compared to 13.2 g with CC (P = .0017). The intramedullary canal required 1 minute 28 seconds for debridement with SPBH compared to 2 minutes for debridement with CC (P = .0347). Culture data from samples obtained from SPBH were noninferior to CC.

Conclusions

SPBH is an effective tool for debridement of intramedullary canal during revision TKA. SPBH led to a significant increase of debrided mass in significantly less time than CC. There was no difference in positive culture yield between the 2 debridement techniques. This debridement technique merits consideration to reduce bioburden in revision TKA.

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引用次数: 0

Radiographic and Clinical Outcomes After Direct Anterior Versus Mini Posterior Total Hip Arthroplasty

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-05 DOI: 10.1016/j.artd.2025.101650

David A. Hamilton MD , Colin A. McNamara MD, MBA , Austin E. Wininger MD , Thomas C. Sullivan BS , Bradley S. Lambert PhD , Stephen J. Incavo MD , Kwan J. Park MD

Background

Total hip arthroplasty (THA) is a successful surgical treatment for end-stage hip arthritis. There is controversy over whether the surgical approach leads to any differences in implant sizing, implant positioning, and clinical outcomes. This study sought to compare radiographic and clinical outcomes when performing primary THA through the direct anterior approach (DAA) and posterior approach (PA).

Methods

In this retrospective cohort study of patients undergoing primary THA, 198 DAA patients were matched to 198 PA patients. Surgeries were performed by 3 fellowship-trained surgeons. Radiographic parameters analyzed were acetabular cup anteversion and abduction angles, femoral stem coronal alignment, femoral offset, and leg-length discrepancy. Postoperative complications, including periprosthetic joint infection, wound complications, periprosthetic fracture, and dislocation, were extracted from the medical record. Statistical analysis was performed to compare radiographic and clinical outcomes between groups.

Results

There were no statistically significant differences for any postoperative complications between the 2 groups. One dislocation occurred in the PA group, and no dislocations occurred in the DAA group. DAA had a longer operative time (117 vs 79 minutes, P < .01). PA had a higher increase in femoral offset compared to the contralateral limb (2.76 mm vs 1.01 mm, P < .01), higher cup anteversion (26.17° vs 23.44°, P < .001), and higher use of dual mobility components (6.06% vs 1.01%, P = .007).

Conclusions

Both DAA and PA lead to acceptable clinical and radiographic outcomes for primary THA, with significant differences noted for cup position, femoral offset, and use of dual mobility components. These differences likely represent surgeon factors to help mitigate the risk for dislocation.

{"title":"Radiographic and Clinical Outcomes After Direct Anterior Versus Mini Posterior Total Hip Arthroplasty","authors":"David A. Hamilton MD , Colin A. McNamara MD, MBA , Austin E. Wininger MD , Thomas C. Sullivan BS , Bradley S. Lambert PhD , Stephen J. Incavo MD , Kwan J. Park MD","doi":"10.1016/j.artd.2025.101650","DOIUrl":"10.1016/j.artd.2025.101650","url":null,"abstract":"<div><h3>Background</h3><div>Total hip arthroplasty (THA) is a successful surgical treatment for end-stage hip arthritis. There is controversy over whether the surgical approach leads to any differences in implant sizing, implant positioning, and clinical outcomes. This study sought to compare radiographic and clinical outcomes when performing primary THA through the direct anterior approach (DAA) and posterior approach (PA).</div></div><div><h3>Methods</h3><div>In this retrospective cohort study of patients undergoing primary THA, 198 DAA patients were matched to 198 PA patients. Surgeries were performed by 3 fellowship-trained surgeons. Radiographic parameters analyzed were acetabular cup anteversion and abduction angles, femoral stem coronal alignment, femoral offset, and leg-length discrepancy. Postoperative complications, including periprosthetic joint infection, wound complications, periprosthetic fracture, and dislocation, were extracted from the medical record. Statistical analysis was performed to compare radiographic and clinical outcomes between groups.</div></div><div><h3>Results</h3><div>There were no statistically significant differences for any postoperative complications between the 2 groups. One dislocation occurred in the PA group, and no dislocations occurred in the DAA group. DAA had a longer operative time (117 vs 79 minutes, <em>P</em> < .01). PA had a higher increase in femoral offset compared to the contralateral limb (2.76 mm vs 1.01 mm, <em>P</em> < .01), higher cup anteversion (26.17° vs 23.44°, <em>P</em> < .001), and higher use of dual mobility components (6.06% vs 1.01%, <em>P</em> = .007).</div></div><div><h3>Conclusions</h3><div>Both DAA and PA lead to acceptable clinical and radiographic outcomes for primary THA, with significant differences noted for cup position, femoral offset, and use of dual mobility components. These differences likely represent surgeon factors to help mitigate the risk for dislocation.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101650"},"PeriodicalIF":1.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552336","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

Removal of Loose Bodies From the Posterior Aspect of the Knee During Total Knee Arthroplasty: A Technical Note

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-04 DOI: 10.1016/j.artd.2025.101653

Zachary J. Sirois MD, Vibhatsu Amin MD, Robert Steensen MD

In planning total knee arthroplasty (TKA), preoperative radiographs may show calcific bodies in the posterior soft tissues of the knee. We describe a technique in which they can be removed without making a separate skin incision during TKA after femoral and tibial bone resection. This technique involves probing the posteromedial capsule with a clamp to identify the opening to a popliteal cyst. Once identified, the opening is tensioned and incised to allow removal of the loose bodies. If retained, these loose bodies can be a source of patient dissatisfaction, particularly since they are sometimes palpable to the patient. This is the first technique to describe removal of such loose bodies during routine TKA without an additional incision.

引用次数: 0

Defining Clinically Meaningful Thresholds for 12-Month Patient-Reported Outcomes in Total Hip Arthroplasty; Toward Improving Threshold Accuracy

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-03 DOI: 10.1016/j.artd.2025.101649

Julia E.J.W. Geilen MD , Thomay-Claire A. Hoelen MSc , Martijn G.M. Schotanus PhD , Wouter L.W. van Hemert MD, PhD , Anneke Spekenbrink-Spooren MSc , Bert Boonen MD, PhD , Jasper Most PhD

Background

Clinically meaningful thresholds for patient-reported outcomes are relevant to define and predict success of total hip arthroplasties (THAs). Defining and offering thresholds must consider preoperative symptom severity.

Methods

In this retrospective study of 40,213 primary total hip replacements registered in the Dutch Arthroplasty Register (2016-2018), receiver operating curve analysis was used to define minimal clinically important changes and patient-acceptable symptom states with the anchor transition in function. Subgroups were identified for which independent thresholds should be defined. Patient-reported outcome measures were symptoms (pain, Oxford Hip Score [OHS], Hip disability and Osteoarthritis Outcome Score) and quality of life (European Quality of Life 5 Dimensions 3L questionnaire).

Results

94.6% completed the anchor questions, of whom 80.1% reporting “much improved function” 1 year after surgery. Discriminative abilities of thresholds were not good (area under the curve < 0.8). Tercile-specific determination of thresholds improved discrimination and reliability (+10%). Minimal clinically important change values were higher for all outcomes (eg, change in OHS ≥ 24.5 vs ≥ 10.5) in patients with more severe preoperative symptoms. Patient-acceptable symptom state scores for European Quality of Life 5 Dimensions index (≥ 0.809) and OHS (≥ 40.5) showed good discrimination (area under the curve > 0.8). Patients with less symptoms required lower postoperative scores for reporting “much improved function” (postoperative OHS ≥ 38.5 vs 42.5). Tercile-specific thresholds did not improve accuracy of thresholds (Cohens kappa 42%).

Conclusions

The present study demonstrates that patients with more severe preoperative symptoms require greater change scores to achieve clinically relevant improvements than patients with less severe preoperative symptoms. This study suggests that current one-size-fits-all thresholds for success of THA should be replaced with more nuanced thresholds.

Level of evidence

Level III, Therapeutic Study.

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引用次数: 0

Hip and Knee Arthroplasty Patient Perceptions of Nutrition in the Perioperative Episode of Care

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-03 DOI: 10.1016/j.artd.2025.101646

Tom C. Galetti BA, Shaan S. Nagda, Nancy L. Parks MS, Kevin B. Fricka MD

Background

While malnutrition in patients undergoing hip and knee arthroplasty occurs with moderate frequency and can be associated with postoperative complications, enhanced nutrition has been shown to have postoperative benefits. To date, patient knowledge and perceptions of the role of nutrition in recovering from surgery have not been studied.

Methods

A Knowledge, Attitudes, and Practice survey was administered to arthroplasty candidates presenting to a hip and knee orthopaedic clinic. The survey collected information on demographics, surgical history, patient concerns around the time of surgery, and patients’ attitudes toward and perceptions of nutrition.

Results

A total of 500 patients (62.4% women) completed the survey. More than half of patients reported having a physician discuss nutrition with them, but only a third had been asked to modify their nutritional habits. The greatest patient concerns surrounding surgery were pain (59.2% of patients) and accomplishing activities of daily life (53.2%). The fewest patients were concerned with nutrition (7.6%), but most patients (94%) would modify their habits if they knew nutrition would positively impact their recovery. Most patients felt nutrition could help maintain muscle mass and function after surgery.

Conclusions

Candidates for hip and knee replacements generally recognize nutrition’s importance, but few are concerned with their preoperative nutritional status. Current joint replacement literature shows a range of impacts nutrition can have on recovery from surgery. The study findings highlight gaps in patient knowledge regarding nutrition and suggest it would be beneficial for arthroplasty surgeons to actively educate patients on focused perioperative nutrition.

{"title":"Hip and Knee Arthroplasty Patient Perceptions of Nutrition in the Perioperative Episode of Care","authors":"Tom C. Galetti BA, Shaan S. Nagda, Nancy L. Parks MS, Kevin B. Fricka MD","doi":"10.1016/j.artd.2025.101646","DOIUrl":"10.1016/j.artd.2025.101646","url":null,"abstract":"<div><h3>Background</h3><div>While malnutrition in patients undergoing hip and knee arthroplasty occurs with moderate frequency and can be associated with postoperative complications, enhanced nutrition has been shown to have postoperative benefits. To date, patient knowledge and perceptions of the role of nutrition in recovering from surgery have not been studied.</div></div><div><h3>Methods</h3><div>A Knowledge, Attitudes, and Practice survey was administered to arthroplasty candidates presenting to a hip and knee orthopaedic clinic. The survey collected information on demographics, surgical history, patient concerns around the time of surgery, and patients’ attitudes toward and perceptions of nutrition.</div></div><div><h3>Results</h3><div>A total of 500 patients (62.4% women) completed the survey. More than half of patients reported having a physician discuss nutrition with them, but only a third had been asked to modify their nutritional habits. The greatest patient concerns surrounding surgery were pain (59.2% of patients) and accomplishing activities of daily life (53.2%). The fewest patients were concerned with nutrition (7.6%), but most patients (94%) would modify their habits if they knew nutrition would positively impact their recovery. Most patients felt nutrition could help maintain muscle mass and function after surgery.</div></div><div><h3>Conclusions</h3><div>Candidates for hip and knee replacements generally recognize nutrition’s importance, but few are concerned with their preoperative nutritional status. Current joint replacement literature shows a range of impacts nutrition can have on recovery from surgery. The study findings highlight gaps in patient knowledge regarding nutrition and suggest it would be beneficial for arthroplasty surgeons to actively educate patients on focused perioperative nutrition.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101646"},"PeriodicalIF":1.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529568","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

Bilateral Total Hip Arthroplasty in a Patient With Achondroplasia: Challenges and Surgical Strategies

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-03 DOI: 10.1016/j.artd.2025.101654

Danilo Jeremic MD, PhD , Jelena Nesovic Ostojic MD, PhD , Branislav Krivokapic MD, PhD , Zoran Bascarevic MD, PhD , Nikola Zarkovic MD , Nemanja Slavkovic MD, PhD

This case report provides a history of a female patient with achondroplasia who underwent bilateral total hip arthroplasty (THA) using short femoral stem. On preoperative radiography, a severe bilateral hip osteoarthritis was noted, with deformity of the femoral metaphyses. After THA, the gait pattern improved significantly, the range of motion of both hips increased, and limb length discrepancy was corrected. There was also an improvement in Harris Hip Score value from 65 to 87. In patients with achondroplasia who develop end-stage hip osteoarthritis, there is a unique challenge for arthroplasty surgeons, including implant design, sizing, positioning, and soft-tissue balancing. We believe that the use of short femoral stems might represent an acceptable surgical strategy in the setting of complex changes in femoral anatomy.

引用次数: 0

Improved Sleep Associated With Triamcinolone Acetonide Extended-Release Injections for Knee Osteoarthritis: Use of a New Real-World Registry

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-03-01 DOI: 10.1016/j.artd.2025.101655

Michael A. Mont MD , Jennifer H. Lin PhD , Andrew I. Spitzer MD , Vinod Dasa MD , Adam Rivadeneyra MD , David Rogenmoser DO , Andrew L. Concoff MD , Mitchell K. Ng MD , Mary DiGiorgi PhD, MPH , Stan DySart MD , Joshua Urban MD , William M. Mihalko MD, PhD

Background

Since the mid-20th century, knee osteoarthritis (OA) has doubled in prevalence, costing more than $27 billion annually. This study aimed to compare 6 nonoperative treatment options for knee OA (cryoneurolysis with superficial nerve block, cryoneurolysis with deep nerve block, intra-articular hyaluronic acid injections, nonsteroidal inflammatory drug injections, IA corticosteroids, and IA triamcinolone extended release [IA-TA-ER]) over 4 months, analyzing their effects on sleep disturbance, a component of health-related quality of life.

Methods

All patients with knee OA and received nonoperative interventions with at least 4 months of follow-up between 2021 and 2024 were identified from the Innovations in Genicular Outcomes Research registry, a multicenter novel real-world registry. Patient demographics were gathered/analyzed, adjusting for age, sex, study site, Kellgren-Lawrence grade, baseline score of pain severity/function, pain-catastrophizing, and analgesic use in each assessment. Sleep disturbance was assessed via least-square-means relative to the average population, with multivariate linear regressions used to assess changes pretherapy/post-therapy.

Results

Patients administered IA-TA-ER had decreased sleep disturbance relative to other cohorts (least-square-means 52.3; 95% confidence interval: 50.5-54.0; P < .03). Patients receiving IA-TA-ER or IA corticosteroids achieved achieving minimum clinically important difference for sleep disturbance improvement, 63% and 57%, respectively. Pairwise comparison revealed patients receiving IA-TA-ER were 2 times more likely to achieve minimally clinically important difference for improved sleep relative to other cohorts (P < .05).

Conclusions

Extended-release triamcinolone injections are associated with decreased sleep disturbance relative to other treatments, in both degree of improvement and proportion of patients. Further studies should examine the potential beneficial effects of IA-TA-ER on other aspects of health-related quality of life.

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引用次数: 0

Hybrid Fixation Technique for Femoral Stem Revision in B3 Periprosthetic Fractures: A Report of Two Cases

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-28 DOI: 10.1016/j.artd.2025.101645

Moein Akbari Javar MD , Sina Esmaeili MD , Shahram Shokraneh MD , Mohammad Ghorbanzadeh MD , Seyed Mohammad Javad Mortazavi MD

Periprosthetic femoral fractures (PPFs) are challenging complications following total hip arthroplasty, especially in cases with compromised bone stock. We present 2 cases of Vancouver Type B3 PPF treated with a monoblock cementless long-stem prosthesis, using cement only for distal fixation. This technique provided initial stability, allowing early mobilization and eventual fracture healing with bony ingrowth. Radiographic follow-up demonstrated successful outcomes with no significant complications. Our results support the potential of this method for treating complex PPF cases, offering a solution for patients with inadequate bone quality where standard cementless fixation may be insufficient.

引用次数: 0

Does Intramedullary Reaming in Total Knee Arthroplasty Increase Postoperative Bleeding? A Propensity Score–Matched Cohort Study

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-28 DOI: 10.1016/j.artd.2025.101647

Sachiyuki Tsukada MD, PhD, Hiroyuki Ogawa MD, Masayoshi Saito MD, Masahiro Nishino MD, Takuya Kusakabe MD, PhD, Naoyuki Hirasawa MD, PhD

Background

There is conflicting evidence about whether avoiding medullary canal reaming of the femur during total knee arthroplasty (TKA) reduces blood loss. This study aimed to test the hypothesis that total blood loss would decrease in TKA without medullary canal reaming.

Method

This propensity score–matched cohort study included 349 patients, of whom 220 underwent TKA using a femoral intramedullary rod, and 129 underwent TKA using a computer-assisted system without a femoral intramedullary alignment system. For the proximal tibia resection, an intramedullary alignment system was not used in any of the patients. These patients were matched using a one-to-one propensity score method. The primary outcome was perioperative blood loss, calculated from patient blood volume and the difference in hemoglobin levels from preoperative to postoperative measurements.

Results

Compared with 118 propensity score–matched patients undergoing TKA with medullary canal reaming of the femur, perioperative blood loss at 1, 3, and 7 days postoperatively was not significantly different in the 118 matched patients undergoing TKA without medullary canal reaming. In addition, no significant differences were observed in the requirement for allogeneic transfusion or the occurrence of deep venous thrombosis.

Conclusions

Postoperative blood loss did not differ between patients who underwent TKA with femoral intramedullary reaming and those without. This study supports the notion that surgeons can use familiar surgical techniques, including conventional intramedullary rods, without the need for specialized instrument, even for patients at high risk of allogeneic transfusion.

{"title":"Does Intramedullary Reaming in Total Knee Arthroplasty Increase Postoperative Bleeding? A Propensity Score–Matched Cohort Study","authors":"Sachiyuki Tsukada MD, PhD, Hiroyuki Ogawa MD, Masayoshi Saito MD, Masahiro Nishino MD, Takuya Kusakabe MD, PhD, Naoyuki Hirasawa MD, PhD","doi":"10.1016/j.artd.2025.101647","DOIUrl":"10.1016/j.artd.2025.101647","url":null,"abstract":"<div><h3>Background</h3><div>There is conflicting evidence about whether avoiding medullary canal reaming of the femur during total knee arthroplasty (TKA) reduces blood loss. This study aimed to test the hypothesis that total blood loss would decrease in TKA without medullary canal reaming.</div></div><div><h3>Method</h3><div>This propensity score–matched cohort study included 349 patients, of whom 220 underwent TKA using a femoral intramedullary rod, and 129 underwent TKA using a computer-assisted system without a femoral intramedullary alignment system. For the proximal tibia resection, an intramedullary alignment system was not used in any of the patients. These patients were matched using a one-to-one propensity score method. The primary outcome was perioperative blood loss, calculated from patient blood volume and the difference in hemoglobin levels from preoperative to postoperative measurements.</div></div><div><h3>Results</h3><div>Compared with 118 propensity score–matched patients undergoing TKA with medullary canal reaming of the femur, perioperative blood loss at 1, 3, and 7 days postoperatively was not significantly different in the 118 matched patients undergoing TKA without medullary canal reaming. In addition, no significant differences were observed in the requirement for allogeneic transfusion or the occurrence of deep venous thrombosis.</div></div><div><h3>Conclusions</h3><div>Postoperative blood loss did not differ between patients who underwent TKA with femoral intramedullary reaming and those without. This study supports the notion that surgeons can use familiar surgical techniques, including conventional intramedullary rods, without the need for specialized instrument, even for patients at high risk of allogeneic transfusion.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101647"},"PeriodicalIF":1.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510987","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}

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