Pub Date : 2025-12-23DOI: 10.1016/j.artd.2025.101928
Austin G. Hughes MD, James Pate MD, Jordan Dunson MD, Mark G. Freeman MD
Tramadol is an overall safe and increasingly used alternative to traditional opioid medications for pain relief in the acute postoperative period. However, it does have a set of common and rarer, possibly life altering, side effects including severe hallucinations, and more specifically, discrete musical hallucinations. A 79-year-old female status post revision hip arthroplasty was started on Tramadol so that she could stop taking oxycodone. Within 3 days of the initiation of this medication, symptoms of severe musical hallucinations began. The symptoms continued for multiple weeks, were too difficult to assess causation, and resolved within 7 days of the cessation of tramadol use. This case describes a rare adverse effect of Tramadol, musical hallucinations, which led to the patient developing severe anxiety, sleep deprivation, postoperative dissatisfaction, and an increased risk of falls and injury due to fatigue and confusion. Based on this report, the authors recommend that surgeons ensure clinic staff who manage patient calls and messages are familiar with both common and uncommon medication side effects, and that they are trained to discontinue the medication if unusual symptoms arise until appropriate evaluation can be completed.
{"title":"Can’t Stop the Music? Musical Hallucinations From Postoperative Tramadol Use: Case Report and Literature Review","authors":"Austin G. Hughes MD, James Pate MD, Jordan Dunson MD, Mark G. Freeman MD","doi":"10.1016/j.artd.2025.101928","DOIUrl":"10.1016/j.artd.2025.101928","url":null,"abstract":"<div><div>Tramadol is an overall safe and increasingly used alternative to traditional opioid medications for pain relief in the acute postoperative period. However, it does have a set of common and rarer, possibly life altering, side effects including severe hallucinations, and more specifically, discrete musical hallucinations. A 79-year-old female status post revision hip arthroplasty was started on Tramadol so that she could stop taking oxycodone. Within 3 days of the initiation of this medication, symptoms of severe musical hallucinations began. The symptoms continued for multiple weeks, were too difficult to assess causation, and resolved within 7 days of the cessation of tramadol use. This case describes a rare adverse effect of Tramadol, musical hallucinations, which led to the patient developing severe anxiety, sleep deprivation, postoperative dissatisfaction, and an increased risk of falls and injury due to fatigue and confusion. Based on this report, the authors recommend that surgeons ensure clinic staff who manage patient calls and messages are familiar with both common and uncommon medication side effects, and that they are trained to discontinue the medication if unusual symptoms arise until appropriate evaluation can be completed.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101928"},"PeriodicalIF":2.1,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841413","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}
Pub Date : 2025-12-20DOI: 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.
{"title":"Interlaboratory Reliability of Synovial Fluid Analysis in Prosthetic Knee Aspiration","authors":"Richard D. Murray MD , Charles W. Powell MD , Mitchell S. Scull MD , Andrew W. Wilson MS , Mark G. Freeman MD","doi":"10.1016/j.artd.2025.101920","DOIUrl":"10.1016/j.artd.2025.101920","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>In total, 202 consecutive prosthetic knee aspirates were analyzed. Agreement was found in 14 of 20 samples (70%) that tested ≥3000 WBC/μl (<em>k</em> = 0.81; 95% confidence inverval [CI], 0.66-0.96), 9 of 13 samples (69%) that tested ≥80% PMNs (<em>k</em> = 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 (<em>k</em> = 0.94; 95% CI, 0.82-1.00), 3 of 23 cases (13%) with positive culture results (<em>k</em> = 0.18; 95% CI, −0.05-0.40).</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Level III</h3><div>Retrospective Cohort study, Diagnostic.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101920"},"PeriodicalIF":2.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791640","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}
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.
{"title":"Short-term Outcomes of Unrestricted Kinematic Alignment: Total Knee Arthroplasty With a Medial Pivot Implant: A Japanese Multicenter Study","authors":"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","doi":"10.1016/j.artd.2025.101882","DOIUrl":"10.1016/j.artd.2025.101882","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Level of Evidence</h3><div>IV.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101882"},"PeriodicalIF":2.1,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791639","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}
Pub Date : 2025-12-19DOI: 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.
{"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":"2025-12-19","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}
Pub Date : 2025-12-18DOI: 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.
{"title":"Readability Analysis of Commonly Cited Patient-Reported Outcome Measures in the Orthopaedic Joint Literature","authors":"Harjot Uppal MBA, Daniel Garcia BS, Kevin Rezzadeh MD, Nikhil Sahai MD, Andrew McGinniss MD, Arash Emami MD, Aiman Rifai DO","doi":"10.1016/j.artd.2025.101922","DOIUrl":"10.1016/j.artd.2025.101922","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101922"},"PeriodicalIF":2.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791638","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}
Pub Date : 2025-12-16DOI: 10.1016/j.artd.2025.101923
Emma Woodmansey PhD , Frank A. Buttacavoli MD , Aldo Riesgo MD , Christopher Bibbo DO , Nicholas Tedesco DO , David Rodriguez MD , Eric Lebby MD , Jonathan R. Danoff MD , Alberto V. Carli MD
Background
Periprosthetic joint infections remain a serious complication following arthroplasty surgery, causing significant patient morbidity and economic burden to health-care systems. While surgical site infection (SSI) preventive measures have shown effectiveness, there remains a significant gap in literature regarding surgeon intraoperative practice, such as the use of intraoperative wound irrigation (IOWI). While studies highlight the potential in reducing SSIs, variability in clinical application and the lack of standardized, evidence-based guidelines necessitate a comprehensive understanding of current practices.
Methods
A 46-question survey was developed following literature review and validation with high-volume primary and revision arthroplasty surgeons. Deployed via online clinician engagement platform, the survey queried challenges of SSI in relation to IOWI, current IOWI practice, the role of biofilm in periprosthetic joint infections, and ideal properties of irrigation solutions.
Results
A total of 112 orthopaedic surgeons across the United States participated in the survey. Respondents indicated a high level of knowledge regarding the role of IOWI in SSI treatment and prevention. Key attributes of an ideal IOWI varied depending on procedural step (exposure, instrumentation, implantation, and closure) and procedure type (primary or revision). Variation in IOWI practice was evident in irrigant selection and decision rationale, with relatively lower alignment to contact time and residual antimicrobial activity.
Conclusions
This survey highlights the perception that IOWI is an important part of routine SSI reduction measures and suggests variation in practice interventions and solution preference. Our findings support the necessity for a rigorous, evidence-based consensus via expert guidance to address the key surgical challenges to improve consistency of IOWI solution utilization.
{"title":"Intraoperative Wound Irrigation in Orthopaedic Surgery: A Survey of Current Understanding and Practice Across the United States","authors":"Emma Woodmansey PhD , Frank A. Buttacavoli MD , Aldo Riesgo MD , Christopher Bibbo DO , Nicholas Tedesco DO , David Rodriguez MD , Eric Lebby MD , Jonathan R. Danoff MD , Alberto V. Carli MD","doi":"10.1016/j.artd.2025.101923","DOIUrl":"10.1016/j.artd.2025.101923","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infections remain a serious complication following arthroplasty surgery, causing significant patient morbidity and economic burden to health-care systems. While surgical site infection (SSI) preventive measures have shown effectiveness, there remains a significant gap in literature regarding surgeon intraoperative practice, such as the use of intraoperative wound irrigation (IOWI). While studies highlight the potential in reducing SSIs, variability in clinical application and the lack of standardized, evidence-based guidelines necessitate a comprehensive understanding of current practices.</div></div><div><h3>Methods</h3><div>A 46-question survey was developed following literature review and validation with high-volume primary and revision arthroplasty surgeons. Deployed via online clinician engagement platform, the survey queried challenges of SSI in relation to IOWI, current IOWI practice, the role of biofilm in periprosthetic joint infections, and ideal properties of irrigation solutions.</div></div><div><h3>Results</h3><div>A total of 112 orthopaedic surgeons across the United States participated in the survey. Respondents indicated a high level of knowledge regarding the role of IOWI in SSI treatment and prevention. Key attributes of an ideal IOWI varied depending on procedural step (exposure, instrumentation, implantation, and closure) and procedure type (primary or revision). Variation in IOWI practice was evident in irrigant selection and decision rationale, with relatively lower alignment to contact time and residual antimicrobial activity.</div></div><div><h3>Conclusions</h3><div>This survey highlights the perception that IOWI is an important part of routine SSI reduction measures and suggests variation in practice interventions and solution preference. Our findings support the necessity for a rigorous, evidence-based consensus via expert guidance to address the key surgical challenges to improve consistency of IOWI solution utilization.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101923"},"PeriodicalIF":2.1,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791637","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}
Pub Date : 2025-12-15DOI: 10.1016/j.artd.2025.101921
Emma N. Horton BS , David F. Scott MD
Background
The optimal treatment for isolated patellofemoral osteoarthritis (PFOA) remains controversial. Operative management for PFOA includes patellofemoral arthroplasty; however, concerns regarding tibiofemoral disease progression and high revision rates limit its use. Total knee arthroplasty (TKA) is another treatment option, but comparative outcomes between patients with isolated PFOA and those with tibiofemoral osteoarthritis (TFOA) undergoing TKA are not well established. This study compared postoperative outcomes in these 2 populations, hypothesizing that patients with isolated PFOA treated with TKA will achieve similar results to those with TFOA.
Methods
A total of 378 consecutive patients with isolated PFOA (n = 17) and TFOA (n = 361) underwent primary unrestricted caliper-verified kinematic alignment TKA with medial-pivot implants. Patients completed the Forgotten Joint Score, Knee Injury and Osteoarthritis Outcome Score (KOOS-JR), and Knee Society Score (KSS) at preoperative, 6-week, 6-month, and 1-year postoperative visits. Extension and flexion were measured at those visits.
Results
Patients with TFOA had superior KSS Function and Total Composite at 6 weeks (P = .017 and P = .007, respectively). Patients with PFOA had greater preoperative flexion (P = .006). No significant differences were observed in Forgotten Joint Score, KOOS-JR, KSS B Pain, or extension at any time point (P > .05). All outcome measures equalized between groups at 6 months and 1-year postoperative.
Conclusions
Within the limits of the available sample size, patients with isolated PFOA achieved comparable 6-month and 1-year outcomes to those with TFOA following kinematic alignment-TKA with medial-pivot implants, supporting its use as an effective treatment option.
{"title":"Excellent Short-Term Outcomes After Kinematic Alignment, Medial-Pivot Total Knee Arthroplasty for Isolated Patellofemoral Osteoarthritis","authors":"Emma N. Horton BS , David F. Scott MD","doi":"10.1016/j.artd.2025.101921","DOIUrl":"10.1016/j.artd.2025.101921","url":null,"abstract":"<div><h3>Background</h3><div>The optimal treatment for isolated patellofemoral osteoarthritis (PFOA) remains controversial. Operative management for PFOA includes patellofemoral arthroplasty; however, concerns regarding tibiofemoral disease progression and high revision rates limit its use. Total knee arthroplasty (TKA) is another treatment option, but comparative outcomes between patients with isolated PFOA and those with tibiofemoral osteoarthritis (TFOA) undergoing TKA are not well established. This study compared postoperative outcomes in these 2 populations, hypothesizing that patients with isolated PFOA treated with TKA will achieve similar results to those with TFOA.</div></div><div><h3>Methods</h3><div>A total of 378 consecutive patients with isolated PFOA (n = 17) and TFOA (n = 361) underwent primary unrestricted caliper-verified kinematic alignment TKA with medial-pivot implants. Patients completed the Forgotten Joint Score, Knee Injury and Osteoarthritis Outcome Score (KOOS-JR), and Knee Society Score (KSS) at preoperative, 6-week, 6-month, and 1-year postoperative visits. Extension and flexion were measured at those visits.</div></div><div><h3>Results</h3><div>Patients with TFOA had superior KSS Function and Total Composite at 6 weeks (<em>P</em> = .017 and <em>P</em> = .007, respectively). Patients with PFOA had greater preoperative flexion (<em>P</em> = .006). No significant differences were observed in Forgotten Joint Score, KOOS-JR, KSS B Pain, or extension at any time point (<em>P</em> > .05). All outcome measures equalized between groups at 6 months and 1-year postoperative.</div></div><div><h3>Conclusions</h3><div>Within the limits of the available sample size, patients with isolated PFOA achieved comparable 6-month and 1-year outcomes to those with TFOA following kinematic alignment-TKA with medial-pivot implants, supporting its use as an effective treatment option.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101921"},"PeriodicalIF":2.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747854","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}
Pub Date : 2025-12-15DOI: 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.
{"title":"Perioperative Mindfulness Training Does Not Improve Sleep Quality in Patients Undergoing Total Knee Arthroplasty","authors":"Jessica L.H. Phillips MD , Makenna R. Hemmerle MS , Roseann M. Johnson BS , Hayley E. Ennis MD , Jason J. Jennings MD, DPT","doi":"10.1016/j.artd.2025.101918","DOIUrl":"10.1016/j.artd.2025.101918","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> = .24), sex (<em>P</em> = .77), body mass index (<em>P</em> = .18), American Society of Anesthesiologists (<em>P</em> = .17), or length of stay (<em>P</em> = .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; <em>P</em> = .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; <em>P</em> = .33). This persisted at 6 weeks (10.1 ± 4.2 control, 10.0 ± 3.9 preoperative MM, 9.5 ± 4.4 perioperative MM; <em>P</em> = .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; <em>P</em> = .264).</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Level of Evidence</h3><div>Therapeutic Level II.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"37 ","pages":"Article 101918"},"PeriodicalIF":2.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791572","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}
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.
{"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}
Pub Date : 2025-12-01DOI: 10.1016/j.artd.2025.101913
Nimit Vediya , Varun Jain MSc , Praveen Sritharan MD , Aava Param MD , Ajay Shah MD , Darius Luke Lameire MD , Amir Khoshbin MD, MSc, FRCSC
Background
Systematic reviews (SRs) are vital for evidence consolidation in clinical research, utilized for their robust, reproducible methodology. SRs are prone to misrepresentation as they are based on primary studies and the interpretation of their authors. This issue can be particularly significant in arthroplasty, where procedures significantly impact patient quality of life. We aim to determine the prevalence of spin and its associated study characteristics in the top 3 highest impact English arthroplasty specific journals.
Methods
We searched PubMed, MEDLINE, and Embase for SRs and meta-analyses published from March 26, 2015, to March 26, 2025. Two assessors classified spin types based on Yavchitz et al. (2016). Descriptive statistics were computed to determine spin prevalence, and chi-square (χ2) analysis evaluated associations with bibliometric factors.
Results
Spin was present in 48 of 52 SRs (92.3%), with severe spin in 33 of 52 (63.5%). The most common types included type 5 (claims of benefit despite high risk of bias) in 45 of 52 (86.5%) and type 9 (claims of benefit despite reporting bias) in 32 of 52 (61.5%). Type 9 spin was significantly more common in SRs involving randomized controlled trials (88.2%) compared to nonrandomized studies (48.6%, P = .014).
Conclusions
Over the past decade, more than 90% of SRs published in high-impact arthroplasty journals exhibited spin in their abstracts. The most common form involved overstating treatment benefits despite high risk of bias in primary studies, while spin related to reporting bias was significantly more frequent in SRs of randomized evidence.
{"title":"Assessment of “Spin” in the Abstracts of Systematic Reviews in Leading Arthroplasty Journals Over the Past 10 Years: A Cross-Sectional Methodological Study","authors":"Nimit Vediya , Varun Jain MSc , Praveen Sritharan MD , Aava Param MD , Ajay Shah MD , Darius Luke Lameire MD , Amir Khoshbin MD, MSc, FRCSC","doi":"10.1016/j.artd.2025.101913","DOIUrl":"10.1016/j.artd.2025.101913","url":null,"abstract":"<div><h3>Background</h3><div>Systematic reviews (SRs) are vital for evidence consolidation in clinical research, utilized for their robust, reproducible methodology. SRs are prone to misrepresentation as they are based on primary studies and the interpretation of their authors. This issue can be particularly significant in arthroplasty, where procedures significantly impact patient quality of life. We aim to determine the prevalence of spin and its associated study characteristics in the top 3 highest impact English arthroplasty specific journals.</div></div><div><h3>Methods</h3><div>We searched PubMed, MEDLINE, and Embase for SRs and meta-analyses published from March 26, 2015, to March 26, 2025. Two assessors classified spin types based on Yavchitz et al. (2016). Descriptive statistics were computed to determine spin prevalence, and chi-square (χ2) analysis evaluated associations with bibliometric factors.</div></div><div><h3>Results</h3><div>Spin was present in 48 of 52 SRs (92.3%), with severe spin in 33 of 52 (63.5%). The most common types included type 5 (claims of benefit despite high risk of bias) in 45 of 52 (86.5%) and type 9 (claims of benefit despite reporting bias) in 32 of 52 (61.5%). Type 9 spin was significantly more common in SRs involving randomized controlled trials (88.2%) compared to nonrandomized studies (48.6%, <em>P</em> = .014).</div></div><div><h3>Conclusions</h3><div>Over the past decade, more than 90% of SRs published in high-impact arthroplasty journals exhibited spin in their abstracts. The most common form involved overstating treatment benefits despite high risk of bias in primary studies, while spin related to reporting bias was significantly more frequent in SRs of randomized evidence.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101913"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623596","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}
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