Arthroplasty Today最新文献

{"title":"Readability Analysis of Commonly Cited Patient-Reported Outcome Measures in the Orthopaedic Joint Literature","authors":"Harjot Uppal MBA,&nbsp;Daniel Garcia BS,&nbsp;Kevin Rezzadeh MD,&nbsp;Nikhil Sahai MD,&nbsp;Andrew McGinniss MD,&nbsp;Arash Emami MD,&nbsp;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 &lt;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}

{"title":"Intraoperative Wound Irrigation in Orthopaedic Surgery: A Survey of Current Understanding and Practice Across the United States","authors":"Emma Woodmansey PhD ,&nbsp;Frank A. Buttacavoli MD ,&nbsp;Aldo Riesgo MD ,&nbsp;Christopher Bibbo DO ,&nbsp;Nicholas Tedesco DO ,&nbsp;David Rodriguez MD ,&nbsp;Eric Lebby MD ,&nbsp;Jonathan R. Danoff MD ,&nbsp;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}

{"title":"Excellent Short-Term Outcomes After Kinematic Alignment, Medial-Pivot Total Knee Arthroplasty for Isolated Patellofemoral Osteoarthritis","authors":"Emma N. Horton BS ,&nbsp;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> &gt; .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}

{"title":"Perioperative Mindfulness Training Does Not Improve Sleep Quality in Patients Undergoing Total Knee Arthroplasty","authors":"Jessica L.H. Phillips MD ,&nbsp;Makenna R. Hemmerle MS ,&nbsp;Roseann M. Johnson BS ,&nbsp;Hayley E. Ennis MD ,&nbsp;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}

{"title":"Femoral Cancellisation Following Total Hip Arthroplasty With a Curved Triple Taper Polished Cemented Stem","authors":"Fumi Hirose MD,&nbsp;Tomohiro Yoshizawa MD, PhD,&nbsp;Shota Yasunaga MD,&nbsp;Koshiro Shimasaki MD,&nbsp;Ryunosuke Watanabe MD, PhD,&nbsp;Tomofumi Nishino MD, PhD,&nbsp;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}

{"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 ,&nbsp;Varun Jain MSc ,&nbsp;Praveen Sritharan MD ,&nbsp;Aava Param MD ,&nbsp;Ajay Shah MD ,&nbsp;Darius Luke Lameire MD ,&nbsp;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}

{"title":"Use of a Novel Surgical Irrigant Significantly Reduces Rate of Infection in Primary Hip and Knee Arthroplasty at 1 year","authors":"Ravi K. Bashyal MD ,&nbsp;Avinash Inabathula MD ,&nbsp;Samantha Lariosa BS ,&nbsp;S. David Stulberg MD","doi":"10.1016/j.artd.2025.101907","DOIUrl":"10.1016/j.artd.2025.101907","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infection (PJI) prevention in primary hip and knee arthroplasty remains an important challenge in arthroplasty. Dilute topical povidone–iodine followed by a sterile saline rinse is widely used for intraoperative irrigation and infection prophylaxis in surgery. The Food and Drug Administration recently issued a reminder about the nonsterility of topical iodine preparations used in deep surgical wounds. Thus, our institution sought a terminally sterilized alternative. We investigated a terminally sterile irrigant with minimal cytotoxicity, efficacy against biofilm, and no required secondary rinse.</div></div><div><h3>Methods</h3><div>This was a single-surgeon retrospective cohort study of 2087 consecutive primary total hip and knee arthroplasties with minimum 1-year follow-up in a major metropolitan community hospital. The control group of 1045 patients received a dilute povidone-iodine soak followed by saline rinse. The experimental group of 1042 patients received the new irrigant (XPerience (XP)) without secondary rinse. The International Consensus Meeting 2018 recommended algorithm and criteria were used to diagnose PJI.</div></div><div><h3>Results</h3><div>Overall, the PJI rate was 0% (0 of 1042) in the XP group and 0.6% (6/1045) in the povidone-iodine group (<em>P</em> = .017). The overall return to operating room rate was 0.5% (5 of 1042) in the XP group and 1.1% (12 of 1045) in the control group (<em>P</em> = .11).</div></div><div><h3>Conclusions</h3><div>The novel solution had a lower infection rate in our cohort. We conclude that it is a comparable alternative to povidone–iodine. An ongoing prospective randomized control trial and a cost-benefit analysis may provide stronger guidance for surgeons.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101907"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623501","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}

{"title":"Presence of Metallosis Can Interfere With Culture Positivity in Prosthetic Joint Infection of the Hip","authors":"Ayesha Abdeen MD ,&nbsp;Nelson Merchan MD ,&nbsp;Marcos R. Gonzalez MD ,&nbsp;Joshua B. Davis BS ,&nbsp;Jacob Drew MD ,&nbsp;Rubén Monárrez MD ,&nbsp;Antonia F. Chen MD, MBA ,&nbsp;Edward K. Rodriguez MD","doi":"10.1016/j.artd.2025.101910","DOIUrl":"10.1016/j.artd.2025.101910","url":null,"abstract":"<div><h3>Background</h3><div>Metallosis is a well-described complication of total hip arthroplasty (THA); however, its impact on periprosthetic joint infection (PJI) diagnosis and treatment remains unknown. We assessed whether coexisting metallosis at the time of revision THA is associated with delayed diagnosis and poorer PJI treatment outcomes.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients undergoing revision THA due to chronic and acute hematogenous PJI with coexisting metallosis (metallosis and PJI group). A matched cohort of patients with chronic and acute hematogenous PJI without metallosis was established (control group). The 2018 International Consensus Meeting criteria were used to define PJI. Metallosis was diagnosed based on the intraoperative findings or serum chromium/cobalt levels. The primary outcomes were culture positivity and survival free of reoperation or revision. Thirteen and 42 patients were included in the metallosis and PJI and the control groups, respectively.</div></div><div><h3>Results</h3><div>The initial set of cultures was negative in 38% of patients in the metallosis and PJI group, compared to only 12% in the control group (<em>P</em> = .03). Time elapsed between presentation of symptoms and first positive culture was significantly longer in the metallosis and PJI group compared to the control (14.5 vs 0 days, <em>P</em> &lt; .001). The revision rate was 46% in the metallosis and PJI group and 24% in the control group (<em>P</em> = .12). Revision-free survival in patients treated with debridement, antibiotics, and implant retention was 28% in the metallosis and PJI group and 79.7% in the control group, (<em>P</em> = .21).</div></div><div><h3>Conclusions</h3><div>Metallosis may increase the likelihood of initial false negative culture results and delay PJI diagnosis in patients undergoing revision THA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101910"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623597","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}

{"title":"Preoperative Malnutrition Is Associated With Increased Rates of Periprosthetic Fractures in Total Knee Arthroplasty","authors":"Andrew Ni MD,&nbsp;Shawn Dripchak MD,&nbsp;Coltin Gerhart MD,&nbsp;Victor Martinez DO,&nbsp;Zachary Jodoin MD,&nbsp;Chance Moore MD,&nbsp;Frank Buttacavoli MD","doi":"10.1016/j.artd.2025.101914","DOIUrl":"10.1016/j.artd.2025.101914","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic fractures (PPFx) after total knee arthroplasty (TKA) are associated with high morbidity and mortality. While previous studies have shown the potential role of malnutrition as a predictor of PPFx in total hip arthroplasty, no studies have evaluated malnutrition as a risk factor for PPFx in TKA patients. This study aims to evaluate the relationship between preoperative nutrition status and PPFx after TKA.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from the TriNetX Registry to identify patients who underwent primary TKA or revision TKA (rTKA) from 2005 to 2025. Preoperative nutrition status was assessed using albumin levels within 3 months prior to TKA based on prior arthroplasty and nutrition literature. Hypoalbuminemia was defined as &lt; 3.5 g/dl. The primary outcome was PPFx occurring at least 1 day after TKA surgery, thereby excluding intraoperative PPFx. Cox proportional hazard models were used to determine hazard ratios (HRs) for each cohort.</div></div><div><h3>Results</h3><div>There were 176,662 TKA patients and 1301 (0.74%) patients with subsequent PPFx during this study period. Preoperative malnutrition was identified in 19,500 patients (11.5%) in the primary TKA group and 1138 patients (17.9%) in the rTKA group. Both primary TKA (hazard ratio [HR] = 1.37, 95% confidence interval [CI], 1.23-1.52, <em>P</em> ≤ 0.001) and rTKA patients (HR = 1.20, 95% CI, 1.03-1.41, <em>P</em> = .022) with preoperative hypoalbuminemia were at an increased risk of PPFx while albumin levels of greater than 3.5 g/dl were protective against PPFx ((HR = 0.73, 95% CI, 0.58-0.93, <em>P</em> = .009) and (HR = 0.72, 95% CI, 0.53-0.97, <em>P</em> = .029) for primary TKA and rTKA respectively). Other nutritional labs including increased prealbumin and higher lymphocyte percentage were statistically significantly associated with a decreased risk for PPFx. Independent risk factors for PPFx following TKA included diabetes, obesity, female sex, and increased age.</div></div><div><h3>Conclusions</h3><div>Our study shows that poor preoperative nutrition status is associated with statistically significant increased risks of PPFx following TKA in both primary TKA and rTKA. Optimization of nutrition may help prevent PPFx following TKA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101914"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690310","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}

{"title":"Utilization of an Anteromedial Cortical Window for Tibial Component Removal During Revision Total Knee Arthroplasty","authors":"Bailey J. Ross MD ,&nbsp;Jacob Glassman BS ,&nbsp;Grayson Nour BS ,&nbsp;Jacob M. Wilson MD ,&nbsp;Jose A. Rodriguez MD ,&nbsp;Ajay Premkumar MD, MPH","doi":"10.1016/j.artd.2025.101890","DOIUrl":"10.1016/j.artd.2025.101890","url":null,"abstract":"<div><div>Revision total knee arthroplasty often entails removal of well-fixed components. Tibial component removal is particularly challenging due to (I) mechanical barriers that limit circumferential disruption when pegs, keels, or stems are present; (II) restricted access to implant-cement and cement-bone interfaces within the proximal canal; and (III) the proximity of critical structures, including the collateral ligaments, patellar tendon, popliteal artery, and distal femur. We present a novel anteromedial cortical window technique that facilitates removal of well-fixed tibial components by improving access to the implant-cement, burr-cement, and cement-bone interfaces within the proximal tibial metaphysis. This technique is suited for cases not requiring posterolateral exposure, offering a less morbid alternative to tibial tubercle osteotomy with the option for conversion if greater exposure is needed.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101890"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736314","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}