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Combined Patellofemoral Arthroplasty With Patellar Realignment: Surgical Technique and Clinical Outcomes in a Retrospective Case Series 联合髌股关节置换术与髌骨复位：回顾性病例系列的手术技术和临床结果

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-02-01 Epub Date: 2026-01-24 DOI: 10.1016/j.artd.2025.101951

Paul B. Walker MD, Lisa Su MD, MS, Mathangi Sridharan MD, Murray Wong MD, MSc, Matthew Dipane BA, Guillermo Araujo-Espinoza MD, Kristofer J. Jones MD, Adam A. Sassoon MD, MS

Background

Isolated patellofemoral joint arthritis with patellar malalignment in young patients presents a unique challenge, as these patients typically wish to avoid early total knee arthroplasty. The purpose of this retrospective case series is to describe a standardized dual-surgeon technique for combined patellofemoral arthroplasty (PFA) with patellar realignment using medial patellofemoral ligament reconstruction or tibial tubercle osteotomy and to evaluate early clinical and patient-reported outcomes.

Methods

A retrospective review was conducted on patients who underwent combined PFA and patellar realignment by a fellowship-trained arthroplasty surgeon and fellowship-trained sports surgeon. Outcomes including implant survivorship, functional outcomes, complications, and patient-reported measures (Knee Injury and Osteoarthritis Outcome Score Joint Replacement, Patient Reported Outcomes Measurement Information System (PROMIS), Global Physical Health, PROMIS Global Mental Health, and Forgotten Joint Score) were assessed.

Results

Eleven knees in 9 patients were included (55.5% female; median age 41 ± 13.4 years; median body mass index 26 ± 6.2). All knees had isolated patellofemoral arthritis. Nine knees underwent PFA with medial patellofemoral ligament reconstruction for instability or dislocation, while 2 underwent PFA with tibial tubercle osteotomy for patella alta. Two patellae were chronically dislocated, additionally requiring lateral release. Six knees had prior failed stabilizing procedures. The mean operative time was 121 minutes (94–161), with a mean follow-up of 24.0 ± 11.5 months. One patient experienced a periprosthetic patellar fracture at 10 months, followed by a refracture at 14 months, requiring open reduction and internal fixation and extensor mechanism repair. No cases of re-dislocation, maltracking, infections, wound complications, or other medical issues occurred. Knee Injury and Osteoarthritis Outcome Score Joint Replacement scores improved by an average of 14.8 ± 11 points.

Conclusions

Combined PFA and patellar realignment surgery can be done efficiently and is associated with improved patient-reported outcomes, with complications limited to a single case of periprosthetic patellar fracture.

背景：年轻患者伴髌骨错位的离体髌股关节关节炎是一个独特的挑战，因为这些患者通常希望避免早期全膝关节置换术。本回顾性病例系列的目的是描述一种标准化的双外科技术，用于联合髌股关节成形术（PFA），采用内侧髌股韧带重建或胫骨结节截骨术进行髌骨调整，并评估早期临床和患者报告的结果。方法回顾性分析由联合培训的关节置换外科医生和联合培训的运动外科医生进行PFA和髌骨复位的患者。结果包括植入物存活、功能结果、并发症和患者报告的措施（膝关节损伤和骨关节炎结果评分关节置换术、患者报告的结果测量信息系统（PROMIS）、全球身体健康、PROMIS全球心理健康和遗忘关节评分）进行评估。结果9例患者均双膝，女性55.5%，中位年龄（41±13.4岁），中位体重指数（26±6.2）。所有膝关节均有孤立性髌骨关节炎。9例膝关节因不稳或脱位行PFA合并髌股内侧韧带重建，2例膝关节行PFA合并胫骨结节截骨术治疗髌骨高位。两个髌骨慢性脱位，另外需要外侧松解。之前有6个膝关节稳定手术失败。平均手术时间121分钟（94 ~ 161），平均随访24.0±11.5个月。1例患者在10个月时发生假体周围髌骨骨折，随后在14个月时再次骨折，需要切开复位、内固定和伸肌机制修复。没有再脱位、跟踪不良、感染、伤口并发症或其他医疗问题发生。膝关节损伤和骨关节炎结局评分关节置换术评分平均提高14.8±11分。结论联合PFA和髌骨复位手术可以有效地完成，并且与患者报告的预后改善有关，并发症仅限于一例假体周围髌骨骨折。

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引用次数: 0

Divergent Sign: a Case Series Describing a Novel Radiographic Finding of Posteromedial Hip Osteoarthritis 发散征象：一个描述髋关节后内侧骨关节炎新影像学表现的病例系列

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-02-01 Epub Date: 2026-01-12 DOI: 10.1016/j.artd.2025.101945

Jibanananda Satpathy MD , Laura Giambra PA-C , Brady Ernst MD , Brigitte Lieu BA , John Krumme MD , Gregory Golladay MD

While hip osteoarthritis (OA) is often diagnosed by plain films, posteromedial hip OA is harder to visualize, thus risking underdiagnosis among patients with symptomatic posteromedial hip OA but unremarkable plain hip and pelvis radiographs. The divergent sign, or apparent asymmetric widening of the superolateral joint space on anteroposterior view, may be a useful indicator of posteromedial OA. We present a case series of 19 patients with posteromedial hip OA diagnosable via the divergent sign and confirmed with magnetic resonance imaging and intraoperative findings. Seventeen of these patients underwent total hip arthroplasty with successful outcomes and minimal postoperative complications, while the other 2 elected conservative management. We propose this radiographic sign should prompt clinicians to better evaluate for posteromedial hip OA with advanced imaging to sooner diagnose this condition.

虽然髋关节骨关节炎（OA）通常通过平片诊断，但髋关节后内侧骨关节炎很难可视化，因此在有症状的髋关节后内侧骨关节炎但髋关节和骨盆平片不明显的患者中存在漏诊的风险。发散征象，或正位上外侧关节间隙明显不对称变宽，可能是内侧后骨关节炎的有用指标。我们报告了19例通过发散征诊断并经磁共振成像和术中表现证实的髋后内侧骨关节炎患者的病例系列。其中17例患者接受了全髋关节置换术，结果成功，术后并发症最小，而另外2例患者选择保守治疗。我们建议，这一影像学征象应促使临床医生更好地评估髋后内侧OA，并采用先进的成像技术，以便更快地诊断这种疾病。

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 : 2026-02-01 Epub 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

Managing Knee Arthrodesis Conversion to Arthroplasty in a Young Patient: Surgical Strategy, Challenges, and Functional Recovery After 1 Year 年轻患者膝关节置换术的治疗：手术策略、挑战和1年后的功能恢复

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-02-01 Epub Date: 2026-01-14 DOI: 10.1016/j.artd.2025.101943

Aurimas Sirka MD, PhD , Gintare Lukoseviciute MD , Tomas Kadusauskas MD , Donatas Daublys PhD , Aurelijus Domeika PhD , Rimtautas Gudas PhD , Augustinas Rimkunas MD

Conversion of knee arthrodesis to total knee arthroplasty is a technically demanding procedure, particularly in young patients with a history of trauma and infection. This report outlines the surgical strategy and 1-year functional outcome of a 24-year-old patient who underwent total knee arthroplasty 4 years after knee fusion. Management included soft tissue reconstruction, tibial tubercle osteotomy, gastrocnemius flap coverage, and rotating hinge knee implantation. At 1-year follow-up, the patient showed marked clinical improvement, with improved in KOOS and WOMAC scores, pain relief, and quality of life. Markerless 3D kinematic gait analysis was also performed post-conversion. This report describes key surgical considerations and preoperative work-up for the successful conversion of knee arthrodesis to arthroplasty.

膝关节置换术到全膝关节置换术的转换是一项技术要求很高的手术，特别是在有创伤和感染史的年轻患者中。本报告概述了一名24岁患者在膝关节融合4年后接受全膝关节置换术的手术策略和1年的功能结果。治疗方法包括软组织重建、胫骨结节截骨、腓肠肌瓣覆盖和旋转铰链膝关节植入。随访1年，患者临床表现明显改善，kos和WOMAC评分改善，疼痛缓解，生活质量改善。转换后进行无标记三维运动学步态分析。本报告描述了成功将膝关节置换术转为关节置换术的关键手术注意事项和术前检查。

引用次数: 0

Readability Analysis of Commonly Cited Patient-Reported Outcome Measures in the Orthopaedic Joint Literature 骨科关节文献中常被引用的患者报告的预后指标的可读性分析

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-02-01 Epub Date: 2025-12-18 DOI: 10.1016/j.artd.2025.101922

Harjot Uppal MBA, Daniel Garcia BS, Kevin Rezzadeh MD, Nikhil Sahai MD, Andrew McGinniss MD, Arash Emami MD, Aiman Rifai DO

Background

Patient-reported outcome measures (PROMs) are vital for assessing surgical effectiveness and capturing patient perspectives on function, symptoms, and quality of life. To ensure patients can accurately complete these tools, readability is essential. The National Institutes of Health and American Medical Association recommend patient materials be written at or below a 6th-grade reading level. This study evaluated the readability of commonly cited PROMs in the orthopaedic joint literature to assess compliance with these standards.

Methods

Thirty-five PROMs were analyzed using 2 validated readability metrics: the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) Index. A FRES ≥80 or SMOG <7 indicated 6th-grade readability. Scores were calculated using an online readability calculator and compared to National Institutes of Health and American Medical Association guidelines.

Results

The average FRES was 67 (range, 21–90), and the average SMOG Index was 8 (range, 6–12), indicating an overall 8th- to 9th-grade reading level. Only 6 PROMs (17%) met the readability threshold. Among the least readable were the University of California, Los Angeles Activity Score, Modified Cincinnati Knee Rating System, Hamilton Depression Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index, Kujala Score, International Knee Documentation Committee score, and Tampa Scale of Kinesiophobia.

Conclusions

Most PROMs commonly cited in the orthopaedic joint literature are written above the recommended 6th-grade level, which may compromise patient understanding and data quality. Improving readability through revision or development of new tools may enhance patient accessibility and the accuracy of reported outcomes.

患者报告的结果测量（PROMs）对于评估手术效果和获取患者对功能、症状和生活质量的看法至关重要。为了确保患者能够准确地完成这些工具，可读性是必不可少的。美国国立卫生研究院和美国医学协会建议，病人的材料应达到或低于六年级的阅读水平。本研究评估了骨科关节文献中常用的prom的可读性，以评估其是否符合这些标准。方法采用两种经验证的可读性指标：Flesch Reading Ease Score （FRES）和Simple Measure of Gobbledygook (SMOG) Index对35篇论文进行分析。FRES≥80或SMOG <；7表示可读性为6级。分数是通过在线可读性计算器计算出来的，并与美国国立卫生研究院和美国医学协会的指导方针进行了比较。结果学生的平均FRES为67（范围21-90），平均SMOG指数为8（范围6-12），表明学生的整体阅读水平为8 - 9年级。只有6个prom（17%）达到了可读性阈值。最难读的是加州大学洛杉矶活动评分、改良辛辛那提膝关节评分系统、汉密尔顿抑郁评分量表、西安大略和麦克马斯特大学骨关节炎指数、Kujala评分、国际膝关节文献委员会评分和坦帕运动恐惧症量表。结论骨科关节文献中大多数常见的prom都写在推荐的6级以上，这可能会影响患者的理解和数据质量。通过修订或开发新工具来提高可读性，可以提高患者的可及性和报告结果的准确性。

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引用次数: 0

Short-term Outcomes of Unrestricted Kinematic Alignment: Total Knee Arthroplasty With a Medial Pivot Implant: A Japanese Multicenter Study 无限制运动对齐的短期结果：全膝关节置换术与内侧枢轴植入物：一项日本多中心研究

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-02-01 Epub Date: 2025-12-19 DOI: 10.1016/j.artd.2025.101882

Mitsuhiro Nakamura MD, PhD , Yoshinori Soda MD, PhD , Takao Yamamoto MD , Shigenobu Fukushima MD , Takanori Hayashi MD , Kazutaka Sugimoto MD , Shinji Satake MD , Shigeru Nakagawa MD, PhD , Kazuhiko Michishita MD

Background

This study investigated the short-term postoperative radiological and clinical results of unrestricted kinematic alignment (unKA)-total knee arthroplasty (TKA) using medial pivot (MP) knee prosthesis in a Japanese population.

Methods

This multicenter prospective study included 1950 knees (from 384 males and 1566 females; mean age 74.7 years) with complete radiographs, range of motion (ROM) measurements, and minimum 1-year follow-up from a cohort of 2388 knees (462 males and 1926 females; mean age 74.3 years) that underwent unKA-MP-TKA. We classified all patients into the R group (n = 876) within safe ranges (177°≤ hip–knee–ankle angle ≤183°; 85°≤ medial proximal tibial angle ≤95°; 85°≤ lateral distal femoral angle ≤95°) and O group (n = 1074) outside those ranges. Postoperative radiographic and clinical outcomes were compared.

Results

The coronal plane alignment of the knee classification changed in 1053 knees (53.1%) preoperatively and postoperatively. Type I to type II was most common (350 knees; 33.8%). ROM significantly improved from −9.2 ± 7.7° and 120.6 ± 16.2° preoperatively to −1.2 ± 3.1° and 122.5 ± 11.8° at the 1-year follow-up. Three knees required reoperation because of patellofemoral joint problems within 1-year postoperatively. ROM outcomes were similar in both groups. Revision surgery owing to tibiofemoral joint complications was not required.

Conclusions

UnKA-MP-TKA resulted in the femoral component being placed in valgus, the tibial component in varus, and lower-limb alignment in varus. No revision surgery owing to tibiofemoral joint complications was needed. The short-term postoperative outcomes of unKA-MP-TKA in the Japanese population, who exhibit a high prevalence of varus knee alignment, were favorable whether within or outside the safe ranges. However, the follow-up period was only 1-year, and continued long-term observation is crucial and necessary.

Level of Evidence

IV.

本研究调查了日本人群中使用内侧枢轴（MP）膝关节假体的无限制运动学对齐(unKA)-全膝关节置换术（TKA）的短期术后放射学和临床结果。这项多中心前瞻性研究包括1950个膝关节（来自384名男性和1566名女性，平均年龄74.7岁），完整的x线片，活动范围（ROM）测量，以及至少1年的随访，来自2388个膝关节（462名男性和1926名女性，平均年龄74.3岁），接受了unKA-MP-TKA。我们将所有患者分为安全范围内（177°≤髋关节-膝关节-踝关节角≤183°；85°≤胫骨内侧近端角≤95°；85°≤股骨外侧远端角≤95°）的R组（n = 876）和安全范围外（n = 1074）的O组（n = 1074）。比较术后影像学和临床结果。结果1053例（53.1%）膝关节冠状面排列在术前和术后发生改变。I型至II型最常见（350个膝关节，33.8%）。ROM从术前的- 9.2±7.7°和120.6±16.2°显著改善至1年随访时的- 1.2±3.1°和122.5±11.8°。3膝术后1年内因髌股关节问题再次手术。两组的ROM结果相似。由于胫股关节并发症不需要翻修手术。结论sunka - mp - tka可使股骨假体外翻，胫骨假体内翻，下肢内翻对准。没有因胫股关节并发症而需要翻修手术。在日本人群中，unKA-MP-TKA的短期术后结果，无论是在安全范围内还是在安全范围外，都是有利的。然而，随访期仅为1年，持续的长期观察至关重要。证据水平

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引用次数: 0

The Effect of Subcutaneous Fat Tissue Length and Area on Postoperative Wound Drainage in Patients Undergoing Hemiarthroplasty for Femoral Neck Fracture 股骨颈骨折半关节置换术患者皮下脂肪组织长度和面积对术后伤口引流的影响

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-02-01 Epub Date: 2026-01-13 DOI: 10.1016/j.artd.2025.101932

Mehmet Önüt MD , Olgun Bingöl MD , Güzelali Özdemir MD , Mehmet Fatih Savaş MD , Barış Yağbasan MD , Enver Kılıç MD , Utku Eren Özkaya MD

Background

The aim of this study was to investigate whether subcutaneous adipose tissue (SAT) length by radiograph and SAT area by computed tomography (CT) before femoral neck fracture surgery are associated with surgical wound drainage (SWD) in elderly female patients.

Methods

We prospectively evaluated 87 female patients who underwent hemiarthroplasty surgery at a level 1 trauma center between May 2024 and January 2025. The patients were classified into 2 groups: those with SWD within 90 days after surgery (group 1) and those without (group 2). SAT area and SAT length were evaluated using CT and hip radiograph imaging, respectively, and the differences between the 2 groups were analyzed. Additionally, we compared demographic data, body mass index, the Charlson comorbidity index, monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, neutrophil-to-albumin ratio, albumin values and surgical incision length.

Results

No statistically significant difference in the length of the peritrochanteric SAT was found between fractured and nonfractured hips across the groups. However, CT scans revealed that the SAT area around the greater trochanter was 102.5 cm² (range: 25–175.4) in group 1 and 71.1 cm² (range: 20–190) in group 2, indicating a statistically significant difference (P < .001). Similarly, the SAT area around the anterior superior iliac spine was found to be 132.4 cm² (81.6–172 cm²) in group 1 and 82.3 cm² (17–179 cm²) in group 2; this difference was also statistically significant (P < .001).

Conclusions

The area of SAT is an effective predictor of postoperative SWD in elderly female patients undergoing hemiarthroplasty due to a femoral neck fracture.

本研究的目的是探讨老年女性股骨颈骨折手术前皮下脂肪组织（SAT） x线片长度和计算机断层扫描（CT）面积是否与手术伤口引流（SWD）有关。方法前瞻性评价2024年5月至2025年1月在某一级创伤中心行半关节置换术的87例女性患者。将患者分为术后90天内出现SWD的患者（1组）和未出现SWD的患者（2组）。分别采用CT和髋关节x线片评估SAT面积和SAT长度，并分析两组间的差异。此外，我们比较了人口统计学数据、体重指数、Charlson合并症指数、单核细胞与淋巴细胞比值、中性粒细胞与淋巴细胞比值、中性粒细胞与白蛋白比值、白蛋白值和手术切口长度。结果两组骨折髋与非骨折髋的股骨转子周围SAT长度差异无统计学意义。然而，CT扫描显示，1组大转子周围的SAT面积为102.5 cm2（范围：25-175.4），2组为71.1 cm2（范围：20-190），差异有统计学意义（P < .001）。同样，第1组髂前上棘周围的SAT面积为132.4 cm2 (81.6-172 cm2)，第2组为82.3 cm2 (17-179 cm2)；差异也有统计学意义（P < .001）。结论SAT面积是老年女性股骨颈骨折半关节置换术患者术后SWD的有效预测指标。

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引用次数: 0

Perioperative Mindfulness Training Does Not Improve Sleep Quality in Patients Undergoing Total Knee Arthroplasty 围手术期正念训练不能改善全膝关节置换术患者的睡眠质量

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-02-01 Epub Date: 2025-12-15 DOI: 10.1016/j.artd.2025.101918

Jessica L.H. Phillips MD , Makenna R. Hemmerle MS , Roseann M. Johnson BS , Hayley E. Ennis MD , Jason J. Jennings MD, DPT

Background

Sleep quality declines in the immediate postoperative period following total knee arthroplasty (TKA). No prior study has prospectively analyzed the impact of mindfulness meditation (MM) on sleep quality following TKA. The purpose of this study was to determine whether MM administered in conjunction with TKA results in any improvement in Pittsburgh Sleep Quality Index (PSQI) at 2, 6, or 12 weeks postoperatively.

Methods

Patients undergoing primary unilateral TKA were prospectively enrolled and randomized into 3 cohorts. The perioperative MM cohort received MM at the preoperative visit, the day preceding surgery, 3 days postoperatively, and 2 weeks postoperatively. The preoperative MM group only received MM at the preoperative visit. Controls received no MM. MM consisted of a video of 2 licensed professional psychologists guiding viewers through a 15-minute MM. Demographic data were collected and questionnaires completed at 2, 6, and 12 weeks postoperatively. Patients were excluded on the basis of prior alcohol/drug dependence and inability to present to in-person visits. An a priori analysis required 75 patients per cohort to achieve 80% power.

Results

Two hundred eighty-two patients were enrolled and randomized to 3 groups: control (n = 94), preoperative MM (n = 94), and perioperative MM (n = 94). There were no differences between cohorts in age (P = .24), sex (P = .77), body mass index (P = .18), American Society of Anesthesiologists (P = .17), or length of stay (P = .18). No differences between cohorts in preoperative PSQI scores were noted (8.4 ± 4.1 control, 7.9 ± 3.8 preoperative MM, 7.8 ± 4.3 perioperative MM; P = .58). Two weeks postoperatively, there remained no PSQI differences between groups (10.7 ± 4.3 control, 10.8 ± 4.4 preoperative MM, 9.9 ± 4.4 perioperative MM; P = .33). This persisted at 6 weeks (10.1 ± 4.2 control, 10.0 ± 3.9 preoperative MM, 9.5 ± 4.4 perioperative MM; P = .62). At 12 weeks, PSQI returned to preoperative levels and there remained no difference among cohorts (8.7 ± 4.4 control, 8.3 ± 4.2 preoperative MM, 7.8 ± 4.1 perioperative MM; P = .264).

Conclusions

Mindfulness training did not improve postoperative sleep quality at any time point following TKA. Further studies are warranted, as improving sleep quality may enhance TKA rehabilitation.

Level of Evidence

Therapeutic Level II.

背景：全膝关节置换术（TKA）术后即刻睡眠质量下降。目前尚无研究前瞻性分析正念冥想（MM）对TKA后睡眠质量的影响。本研究的目的是确定MM联合TKA是否能在术后2周、6周或12周改善匹兹堡睡眠质量指数（PSQI）。方法前瞻性纳入原发性单侧TKA患者，随机分为3组。围手术期MM组分别在术前、术前1天、术后3天和术后2周接受MM治疗。术前MM组仅在术前访视时接受MM治疗。对照组不接受MM。MM由2名有执照的专业心理学家指导观众通过15分钟的MM视频组成。在术后2周、6周和12周收集人口统计数据并完成问卷调查。患者被排除在先前的酒精/药物依赖和无法亲自就诊的基础上。一项先验分析需要每组75名患者才能达到80%的疗效。结果共纳入282例患者，随机分为对照组（n = 94）、术前MM组（n = 94）、围手术期MM组（n = 94）。在年龄（P = 0.24）、性别（P = 0.77）、体重指数（P = 0.18）、美国麻醉医师协会（P = 0.17）或住院时间（P = 0.18）方面，各队列之间没有差异。各组间术前PSQI评分差异无统计学意义（对照组8.4±4.1，术前MM 7.9±3.8，围手术期MM 7.8±4.3,P = 0.58）。术后2周，两组间PSQI差异无统计学意义（对照组10.7±4.3 MM，术前10.8±4.4 MM，围手术期9.9±4.4 MM; P = 0.33）。这种情况持续到6周（对照组10.1±4.2 MM，术前10.0±3.9 MM，围手术期9.5±4.4 MM; P = 0.62）。12周时，PSQI恢复到术前水平，各组间无差异（对照组8.7±4.4 MM，术前8.3±4.2 MM，围手术期7.8±4.1 MM; P = .264）。结论正念训练对TKA术后任何时间点的睡眠质量均无改善作用。进一步的研究是有必要的，因为改善睡眠质量可能会促进TKA的康复。证据水平：治疗性二级。

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引用次数: 0

Identification of Combined Anteversion Targets to Optimize Impingement-free Range of Motion Across Femoral Head Sizes: A Simulation Study 确定联合前倾目标以优化股骨头大小的无碰撞运动范围：一项模拟研究

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-02-01 Epub Date: 2025-12-19 DOI: 10.1016/j.artd.2025.101925

Sergio F. Guarin Perez MD , Heather J. Roberts MD , Diego J. Restrepo MD , Timothy L. Rossman MS , Ta-Wei Tai MD, PhD , Mark W. Pagnano MD , Rafael J. Sierra MD

Background

Dislocation remains a risk following total hip arthroplasty (THA). While prior studies have proposed optimal combined anteversion (CA) ranges to maximize impingement-free range of motion (IFROM), the influence of bony impingement and femoral head size remains underexplored. This study utilized computed tomography–based robotic planning software to identify a target CA that optimized IFROM and to evaluate the effect of head size.

Methods

Five patients (mean age: 63.2 years) who underwent robotic-assisted THA were included. Using computed tomography–based planning software, femoral and acetabular version were systematically adjusted from 0° to 37°, simulating bony and implant impingement in flexion and internal rotation and extension and external rotation. Simulations were performed with 28-, 32-, 36-, and 40-mm heads, totaling 57,750 tests. Functional range of motion (ROM) was defined as ≥40° internal rotation at 90° flexion and ≥10° external rotation at 20° extension. For each head size, maximum IFROM and acceptable CA configurations meeting functional ROM criteria were recorded. A mathematical formula was developed to describe optimal CA per head size.

Results

For all patients and head sizes, the optimal CA was described by (acetabular anteversion+(0.7×femoral anteversion) = 36 and was independent of native version. Larger femoral heads were associated with broader functional ROM. Acceptable CA angles increased by 158% from 28 to 32 mm, 86% from 32 to 36 mm, and 31% from 36 to 40 mm.

Conclusions

Larger femoral head sizes increase IFROM and expand the range of CA positions achieving functional ROM. These findings highlight the importance of head size selection in optimizing IFROM and surgical planning for THA.

背景：全髋关节置换术后脱位仍然存在风险。虽然先前的研究提出了最佳的联合前倾（CA）范围以最大化无撞击运动范围（IFROM），但骨撞击和股骨头大小的影响仍未得到充分探讨。本研究利用基于计算机层析成像的机器人规划软件来确定优化IFROM的目标CA，并评估头部尺寸的影响。方法选取5例行机器人辅助THA的患者，平均年龄63.2岁。利用基于计算机断层扫描的规划软件，系统地将股骨和髋臼版本从0°调整到37°，模拟骨和假体在屈曲和内旋以及伸展和外旋时的撞击。用28毫米、32毫米、36毫米和40毫米的封头进行了模拟，总共进行了57,750次试验。功能活动范围（ROM）定义为90°屈曲时内旋≥40°，20°伸曲时外旋≥10°。对于每个头尺寸，记录最大IFROM和满足功能ROM标准的可接受CA配置。建立了一个数学公式来描述每个头的最佳CA大小。结果对于所有患者和头部大小，最佳CA描述为(髋臼前倾+（0.7×femoral前倾）= 36，与本机版本无关。更大的股骨头与更广泛的功能ROM相关。可接受的CA角度从28到32 mm增加了158%，从32到36 mm增加了86%，从36到40 mm增加了31%。结论更大的股骨头尺寸增加了IFROM并扩大了CA位置范围以实现功能性ROM。这些发现强调了股骨头尺寸选择在优化IFROM和THA手术计划中的重要性。

{"title":"Identification of Combined Anteversion Targets to Optimize Impingement-free Range of Motion Across Femoral Head Sizes: A Simulation Study","authors":"Sergio F. Guarin Perez MD , Heather J. Roberts MD , Diego J. Restrepo MD , Timothy L. Rossman MS , Ta-Wei Tai MD, PhD , Mark W. Pagnano MD , Rafael J. Sierra MD","doi":"10.1016/j.artd.2025.101925","DOIUrl":"10.1016/j.artd.2025.101925","url":null,"abstract":"<div><h3>Background</h3><div>Dislocation remains a risk following total hip arthroplasty (THA). While prior studies have proposed optimal combined anteversion (CA) ranges to maximize impingement-free range of motion (IFROM), the influence of bony impingement and femoral head size remains underexplored. This study utilized computed tomography–based robotic planning software to identify a target CA that optimized IFROM and to evaluate the effect of head size.</div></div><div><h3>Methods</h3><div>Five patients (mean age: 63.2 years) who underwent robotic-assisted THA were included. Using computed tomography–based planning software, femoral and acetabular version were systematically adjusted from 0° to 37°, simulating bony and implant impingement in flexion and internal rotation and extension and external rotation. Simulations were performed with 28-, 32-, 36-, and 40-mm heads, totaling 57,750 tests. Functional range of motion (ROM) was defined as ≥40° internal rotation at 90° flexion and ≥10° external rotation at 20° extension. For each head size, maximum IFROM and acceptable CA configurations meeting functional ROM criteria were recorded. A mathematical formula was developed to describe optimal CA per head size.</div></div><div><h3>Results</h3><div>For all patients and head sizes, the optimal CA was described by (acetabular anteversion+(0.7×femoral anteversion) = 36 and was independent of native version. Larger femoral heads were associated with broader functional ROM. Acceptable CA angles increased by 158% from 28 to 32 mm, 86% from 32 to 36 mm, and 31% from 36 to 40 mm.</div></div><div><h3>Conclusions</h3><div>Larger femoral head sizes increase IFROM and expand the range of CA positions achieving functional ROM. These findings highlight the importance of head size selection in optimizing IFROM and surgical planning for THA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101925"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791573","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

Interlaboratory Reliability of Synovial Fluid Analysis in Prosthetic Knee Aspiration 假膝抽吸中滑液分析的实验室间可靠性

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-02-01 Epub Date: 2025-12-20 DOI: 10.1016/j.artd.2025.101920

Richard D. Murray MD , Charles W. Powell MD , Mitchell S. Scull MD , Andrew W. Wilson MS , Mark G. Freeman MD

Background

Synovial fluid analysis is a critical step in the diagnosis of periprosthetic knee joint infection. We hypothesized that clinically meaningful differences between white blood cell (WBC) count, polymorphonuclear leukocyte (PMN) cell percentage, and culture results would exist between 2 independent laboratories when the same synovial fluid aspirate is analyzed.

Methods

A retrospective chart review was completed on total knee arthroplasty patients who underwent knee arthrocentesis between 2017 and 2025. The synovial fluid aspirate from a single knee arthrocentesis was divided into identical samples and analyzed by 2 independent laboratories. WBC count, PMN percentage, and culture results were recorded.

Results

In total, 202 consecutive prosthetic knee aspirates were analyzed. Agreement was found in 14 of 20 samples (70%) that tested ≥3000 WBC/μl (k = 0.81; 95% confidence inverval [CI], 0.66-0.96), 9 of 13 samples (69%) that tested ≥80% PMNs (k = 0.81; 95% CI, 0.62-0.99), 7 of 12 cases (58%) reported both ≥80% PMNs and ≥3000 WBC/μl, 8 of 9 cases (89%) that tested ≥90% PMNs (k = 0.94; 95% CI, 0.82-1.00), 3 of 23 cases (13%) with positive culture results (k = 0.18; 95% CI, −0.05-0.40).

Conclusions

Two independent laboratories displayed clinically meaningful variability in WBC count, PMN percentage, and culture results. The difficulty in diagnosing periprosthetic joint infection may at least in part be due to poor interlaboratory reliability concerning synovial fluid analysis. Refinement of interlaboratory agreement, further research into advanced diagnostic methods, and measures to improve the accuracy of synovial fluid analysis are all critical steps toward refining the diagnosis of periprosthetic joint infection.

Level III

Retrospective Cohort study, Diagnostic.

背景：滑液分析是诊断假体周围膝关节感染的关键步骤。我们假设在分析相同的滑液抽吸时，在两个独立的实验室之间，白细胞（WBC）计数、多形核白细胞（PMN）细胞百分比和培养结果之间存在临床意义的差异。方法回顾性分析2017 - 2025年全膝关节置换术患者的资料。从单个膝关节穿刺中抽取的滑液被分成相同的样本，并由两个独立的实验室进行分析。记录WBC计数、PMN百分比和培养结果。结果共分析了202例连续人工膝关节抽吸。20例样本中有14例（70%）WBC/μl≥3000 (k = 0.81, 95%置信区间[CI]， 0.66-0.96)， 13例样本中有9例（69%）PMNs≥80% (k = 0.81, 95% CI, 0.62-0.99)， 12例中有7例（58%）PMNs≥80%和≥3000 WBC/μl， 9例中有8例（89%）PMNs≥90% (k = 0.94, 95% CI, 0.82-1.00)， 23例中有3例（13%）培养结果呈阳性（k = 0.18, 95% CI, - 0.05-0.40）。结论：两个独立的实验室显示WBC计数、PMN百分比和培养结果具有临床意义的差异。诊断假体周围关节感染的困难可能至少部分是由于实验室间关于滑液分析的可靠性差。实验室间协议的细化，对先进诊断方法的进一步研究，以及提高滑液分析准确性的措施，都是改进假体周围关节感染诊断的关键步骤。iii级：诊断性回顾性队列研究。

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引用次数: 0