Arthroplasty Today最新文献_第3页

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 : 2026-02-01 Epub 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。

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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 : 2026-02-01 Epub 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

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 : 2026-02-01 Epub 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

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 : 2026-02-01 Epub 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。

{"title":"Primary Versus Salvage Distal Femoral Endoprosthetic Replacement Following Native Distal Femur Fracture: A Systematic Review and Meta-Analysis","authors":"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)","doi":"10.1016/j.artd.2025.101939","DOIUrl":"10.1016/j.artd.2025.101939","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Patients undergoing pDFR were significantly older (mean 79.3 vs 64.9 years; <em>P</em> < .001) and more comorbid (American Society of Anesthesiologists score: mean 2.99 vs 2.34; <em>P</em> < .001). Despite this, pDFR was associated with significantly lower reoperation (12.2% vs 23.5%; <em>P</em> = .04) and complication rates (15.7% vs 43.1%; <em>P</em> < .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%; <em>P</em> = .09).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101939"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927158","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

Switching From a 6° to a 20° Valgus Prosthetic Trochlear Groove Improved the Forgotten Joint and Oxford Knee Scores After Kinematically Aligned Total Knee Arthroplasty 从6°外翻到20°外翻假体滑车槽改善了运动学对齐全膝关节置换术后遗忘关节和牛津膝关节评分

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-02-01 Epub Date: 2025-12-26 DOI: 10.1016/j.artd.2025.101930

Stephen M. Howell MD , Ahmed Zabiba BS , Alexander J. Nedopil MD , Maury L. Hull PhD

Background

In kinematically aligned (KA) total knee arthroplasty (TKA) using a femoral component with the traditional 6° valgus prosthetic trochlear groove (PTG), patients reported a lower Forgotten Joint Score (FJS) when the quadriceps line of pull was laterally misaligned to the groove, with an incidence of 89%. It remains unclear whether switching to a KA-optimized femoral component with a 20° valgus PTG, which properly aligns the quadriceps line of pull, can improve the FJS and the Oxford Knee Score (OKS).

Methods

The analysis of single-surgeon series of KA TKAs included 145 cases with a KA-optimized 20° valgus PTG and 292 cases with a 6° valgus PTG. Each participant reported their FJS and OKS at 2 years and underwent a postoperative coronal long-leg scan.

Results

The 20° group had a 6-point higher FJS (79) and a 16% lower incidence of poor FJS (<40) (8%) compared to the 6° group. Additionally, 73% and 22% achieved an excellent (48-42) or good (41-34) OKS, compared to 64% and 20% with a 6° valgus PTG. The FJS in the 20° group was 7 and 20 points higher in the coronal plane alignment of the knee (CPAK) types 2 and 3.

Conclusions

Surgeons performing KA TKA should consider switching to a KA-optimized femoral component with a 20° valgus PTG, as this option improves the FJS and OKS, lowers the risk of a poor FJS, and is especially useful for CPAK 2 and 3, with no apparent disadvantages in CPAK 1, 4, and 5.

Level of Evidence

III.

背景：在采用传统6°外翻假体滑车沟（PTG）的股骨假体进行运动学对齐（KA）全膝关节置换术（TKA）中，当股四头肌牵引线与沟侧向错位时，患者报告的遗忘关节评分（FJS）较低，发生率为89%。目前尚不清楚切换到ka优化的股骨假体和20°外翻PTG是否可以改善FJS和牛津膝关节评分（OKS），该假体可以正确对齐股四头肌牵拉线。方法分析单外科医生的KA系列tka，包括145例KA优化的20°外翻PTG和292例6°外翻PTG。每位参与者在2年时报告了他们的FJS和OKS，并进行了术后冠状长腿扫描。结果与6°组相比，20°组FJS评分高6点（79），不良FJS发生率低16%（8%）。此外，73%和22%的患者获得了优秀（48-42）或良好（41-34）的OKS，而6°外翻PTG的患者分别为64%和20%。20°组的FJS在膝关节冠状面排列（CPAK） 2型和3型中分别高出7点和20点。结论实施KA- TKA的外科医生应考虑改用KA-优化的股骨假体和20°外翻PTG，因为这种选择可以改善FJS和OKS，降低FJS不良的风险，并且对CPAK 2和3特别有用，而对CPAK 1、4和5没有明显的缺点。证据水平ⅱ。

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引用次数: 0

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 : 2026-02-01 Epub 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。

{"title":"Mid-Term Outcomes of Cement-In-Cement Revision for Aseptic Loosening Versus Infection: A Comparative Study in a Small Retrospective Cohort","authors":"Junyan Li MD , Shengqun Zhang MD , Weiliang Cai MD , Xianzhe Huang MD , Shuo Jie MD , Hui Li MD , Hongxing Li MD , Xinzhan Mao MD","doi":"10.1016/j.artd.2025.101934","DOIUrl":"10.1016/j.artd.2025.101934","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 ((<em>P</em> < .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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101934"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978537","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

If I Had a Hammer: The Role of Automated Impactors in Transforming Total Hip Arthroplasty Procedures and Recovery 如果我有一把锤子：自动撞击器在全髋关节置换术和康复中的作用

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2026-02-01 Epub Date: 2026-01-12 DOI: 10.1016/j.artd.2025.101911

Todd C. Kelley MD, Andrew J. Webber Ph.D., MPAS, PA-C

Background

Impaction during total hip arthroplasty (THA) is physically demanding and places considerable stress on surgeons, contributing to fatigue and musculoskeletal injury. Automated impactor systems have emerged as a potential solution to reduce these physical demands. This study explores the dual benefits of such a system in THA, focusing on both surgeon well-being and patient recovery outcomes.

Methods

The research combines wearable sensing technology and mobile sensing applications across two complementary studies. The Surgeon Exertion arm of the study assessed surgeon exertion and well-being during THA procedures performed with a traditional mallet vs an automated impactor system, measuring physiological stress markers and recovery indicators with the use of wearable sensing technology. The Postoperative Patient Outcomes arm evaluated patient recovery outcomes, leveraging mobile sensing technology to passively collect real-world data on physical activity, pain, and mood pre- and post-THA.

Results

Surgeon Exertion results indicate significantly lower physiological stress markers and improved sleep quality for the surgeon when the automated impactor system was used for the day’s surgical cases compared to the traditional mallet (IMPACTOR: 108.8 bpm vs MALLET: 121.2 bpm; P < .0001; 7.6 h vs 6.3 h sleep; P < .0005). Postoperative Patient Outcomes demonstrated enhanced functional outcomes and increased daily mobility postoperatively in patients treated with the automated impactor system compared to patients treated with a traditional mallet THA (P = .03 for function and steps; P = .04 for walking distance), highlighting the device’s potential to improve patient recovery trajectories.

Conclusions

The integration of an automated impactor system in THA surgeries offers significant benefits for both surgeon well-being and patient outcomes, including improved hip function, greater daily mobility, and increased walking distance. The study’s innovative use of mobile sensing and wearable technologies provides a robust framework for understanding the impacts of surgical innovations in real-world settings.

背景全髋关节置换术（THA）期间的碰撞对身体的要求很高，给外科医生带来了相当大的压力，导致疲劳和肌肉骨骼损伤。自动化冲击系统已经成为减少这些物理需求的潜在解决方案。本研究探讨了这种系统在THA中的双重好处，重点是外科医生的福祉和患者的康复结果。方法本研究将可穿戴式传感技术与移动传感应用相结合，进行两个互补研究。该研究的外科医生运动臂评估了外科医生在使用传统木槌和自动冲击器系统进行THA手术时的运动和健康状况，使用可穿戴传感技术测量生理应激标志物和恢复指标。术后患者预后组评估患者恢复结果，利用移动传感技术被动收集tha前后身体活动、疼痛和情绪的真实数据。结果外科医生的运动结果表明，与传统的木槌相比，在当天的手术病例中使用自动冲击器系统时，外科医生的生理应激指标明显降低，睡眠质量得到改善（impactor: 108.8 bpm vs mallet: 121.2 bpm; P < 0.0001; 7.6 h vs 6.3 h睡眠；P < 0.0005）。术后患者结果显示，与传统木槌THA治疗的患者相比，使用自动冲击器系统治疗的患者术后功能改善，日常活动能力增加（功能和步骤P = 0.03，步行距离P = 0.04），突出了该设备改善患者康复轨迹的潜力。结论：在全髋关节置换术中集成自动冲击器系统对外科医生的健康和患者的预后都有显著的好处，包括改善髋关节功能、提高日常活动能力和增加步行距离。该研究对移动传感和可穿戴技术的创新应用为理解外科创新在现实环境中的影响提供了一个强大的框架。

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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 : 2026-02-01 Epub 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。

{"title":"Complications and Reoperation Rates of Total Knee Arthroplasty After High Tibial Osteotomy: A Matched Cohort Analysis From a Nationwide Database","authors":"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","doi":"10.1016/j.artd.2025.101941","DOIUrl":"10.1016/j.artd.2025.101941","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, <em>P</em> < .0001) and wound disruption (6.0% vs 1.7%, OR = 3.7, 95% CI 2.4-5.7, <em>P</em> < .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, <em>P</em> = .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, <em>P</em> < .0001).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101941"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927002","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

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 : 2026-02-01 Epub 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。

{"title":"Tendency of Tibial Component Placement and Short-Term Outcomes in ROSA-Assisted Unicompartmental Knee Arthroplasty Using the Persona Partial Knee System","authors":"Daichi Ishimaru MD, PhD, Kazuki Sohmiya MD, Nobuo Terabayashi MD, PhD, Kazu Matsumoto MD, PhD","doi":"10.1016/j.artd.2025.101938","DOIUrl":"10.1016/j.artd.2025.101938","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 <em>P</em> < .0001).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101938"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926990","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

Femoral Cancellisation Following Total Hip Arthroplasty With a Curved Triple Taper Polished Cemented Stem 全髋关节置换术后股骨取消与弯曲三锥度抛光骨水泥柄

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-12-01 Epub Date: 2025-12-05 DOI: 10.1016/j.artd.2025.101917

Fumi Hirose MD, Tomohiro Yoshizawa MD, PhD, Shota Yasunaga MD, Koshiro Shimasaki MD, Ryunosuke Watanabe MD, PhD, Tomofumi Nishino MD, PhD, Hajime Mishima MD, PhD

Background

Cancellisation is a radiolucent change occasionally observed at the bone–cement interface in cemented stems after total hip arthroplasty (THA). It is thought to reflect cortical bone remodeling due to osteoporosis or altered mechanical stress. This study aimed to investigate the characteristics, contributing factors, and mechanisms of cancellisation following THA using a curved triple-taper polished cemented stem.

Methods

We retrospectively reviewed 61 hips who underwent primary THA with the curved triple-taper polished cemented stem between October 2012 and September 2019, with a minimum follow-up of 5 years. Cancellisation was assessed radiographically, and patients were grouped by its presence. Between-group comparisons included age, sex, body weight, femoral morphology, preoperative lumbar and femoral neck bone mineral density (BMD), bone turnover markers, stress shielding, changes in periprosthetic BMD, stem subsidence, and clinical outcomes score.

Results

Cancellisation was found in 39 hips (64%), mainly in Gruen Zones 2, 3, and 6. No significant differences in age, sex, or body weight were observed between groups. The stovepipe femoral morphology was more frequent in the cancellisation group. The cancellisation group showed significantly lower BMD and elevated bone turnover marker. Stress shielding was more advanced and the bone density ratios around the stem were significantly reduced in zones 2, 3, 6, and 7. Moreover, there were no significant differences in stem subsidence or clinical outcome scores.

Conclusions

Cancellisation is strongly associated with low systemic BMD and high bone turnover, suggesting a localized osteoporotic response. Its development may be influenced by altered load transmission from cemented stem fixation.

背景消除是全髋关节置换术（THA）后骨水泥接口处偶尔观察到的一种放射性改变。它被认为反映了骨质疏松症或机械应力改变引起的皮质骨重塑。本研究旨在研究THA后使用弯曲三锥度抛光胶结管柱的特点、影响因素和消除机制。方法回顾性分析了2012年10月至2019年9月间61例采用弯曲三锥度抛光骨水泥柄行原发性全髋关节置换术的髋关节，随访时间至少为5年。影像学评估消除，并根据其存在对患者进行分组。组间比较包括年龄、性别、体重、股骨形态、术前腰椎和股骨颈骨密度（BMD）、骨转换标志物、应力屏蔽、假体周围骨密度变化、骨干下沉和临床结局评分。结果39例（64%）髋部出现细胞清除，主要发生在Gruen区2、3和6。各组之间在年龄、性别或体重方面没有显著差异。炉管状股骨形态在取消组更常见。取消治疗组骨密度明显降低，骨转换指标升高。应力屏蔽更为先进，骨干周围2、3、6和7区的骨密度比显著降低。此外，两组在茎下陷或临床结局评分方面没有显著差异。结论骨细胞化与低全身骨密度和高骨转换密切相关，提示局部骨质疏松反应。其发展可能受到骨水泥固定改变载荷传递的影响。

{"title":"Femoral Cancellisation Following Total Hip Arthroplasty With a Curved Triple Taper Polished Cemented Stem","authors":"Fumi Hirose MD, Tomohiro Yoshizawa MD, PhD, Shota Yasunaga MD, Koshiro Shimasaki MD, Ryunosuke Watanabe MD, PhD, Tomofumi Nishino MD, PhD, Hajime Mishima MD, PhD","doi":"10.1016/j.artd.2025.101917","DOIUrl":"10.1016/j.artd.2025.101917","url":null,"abstract":"<div><h3>Background</h3><div>Cancellisation is a radiolucent change occasionally observed at the bone–cement interface in cemented stems after total hip arthroplasty (THA). It is thought to reflect cortical bone remodeling due to osteoporosis or altered mechanical stress. This study aimed to investigate the characteristics, contributing factors, and mechanisms of cancellisation following THA using a curved triple-taper polished cemented stem.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 61 hips who underwent primary THA with the curved triple-taper polished cemented stem between October 2012 and September 2019, with a minimum follow-up of 5 years. Cancellisation was assessed radiographically, and patients were grouped by its presence. Between-group comparisons included age, sex, body weight, femoral morphology, preoperative lumbar and femoral neck bone mineral density (BMD), bone turnover markers, stress shielding, changes in periprosthetic BMD, stem subsidence, and clinical outcomes score.</div></div><div><h3>Results</h3><div>Cancellisation was found in 39 hips (64%), mainly in Gruen Zones 2, 3, and 6. No significant differences in age, sex, or body weight were observed between groups. The stovepipe femoral morphology was more frequent in the cancellisation group. The cancellisation group showed significantly lower BMD and elevated bone turnover marker. Stress shielding was more advanced and the bone density ratios around the stem were significantly reduced in zones 2, 3, 6, and 7. Moreover, there were no significant differences in stem subsidence or clinical outcome scores.</div></div><div><h3>Conclusions</h3><div>Cancellisation is strongly associated with low systemic BMD and high bone turnover, suggesting a localized osteoporotic response. Its development may be influenced by altered load transmission from cemented stem fixation.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101917"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690311","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