Pub Date : 2024-10-16DOI: 10.1016/j.artd.2024.101495
Hinge constructs can be used in revision total knee arthroplasty in cases of major collateral ligament deficiency, global knee instability, repeated failure of constrained implants, or large bone defects. Although the success of this construct in revision total knee arthroplasty varies depending on the type of surgery and bone quality, hinged implants can solve a wide array of complex problems while preserving stable flexion-extension motion for ambulation. The most common reasons for re-revision include patellofemoral complications, aseptic loosening, and infection. Most cases of mechanical failure for these hinged constructs occur at the hinge component. Here, we report the first instance of catastrophic femoral component failure in a modular rotating hinge via a low-energy mechanism.
{"title":"Mechanical Failure of Modular Rotating Hinge Femoral Component","authors":"","doi":"10.1016/j.artd.2024.101495","DOIUrl":"10.1016/j.artd.2024.101495","url":null,"abstract":"<div><div>Hinge constructs can be used in revision total knee arthroplasty in cases of major collateral ligament deficiency, global knee instability, repeated failure of constrained implants, or large bone defects. Although the success of this construct in revision total knee arthroplasty varies depending on the type of surgery and bone quality, hinged implants can solve a wide array of complex problems while preserving stable flexion-extension motion for ambulation. The most common reasons for re-revision include patellofemoral complications, aseptic loosening, and infection. Most cases of mechanical failure for these hinged constructs occur at the hinge component. Here, we report the first instance of catastrophic femoral component failure in a modular rotating hinge via a low-energy mechanism.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.1016/j.artd.2024.101491
Background
Venous thromboembolism (VTE) following total hip arthroplasty and total knee arthroplasty (TKA) is linked to immobility, and preoperative prediction remains difficult. We aimed to evaluate whether annual mean length of stay (LOS) is associated with the incidence of VTE and develop a generalizable machine learning model to preoperatively predict the incidence of symptomatic VTE following total hip and TKA using National Surgical Quality Improvement Program.
Methods
Annual incidence of 30-day postoperative VTE, deep vein thrombosis, and pulmonary embolism was calculated over 6 years and tested for trend. Correlation between annual VTE rates and mean LOS was calculated. Predictive models (logistic regression, random forest, and XGBoost) were trained and tested based on year of surgery with different oversampling algorithms used to address data imbalance.
Results
A total of 498,314 patients were included, with 0.88% developing a VTE within 30 days. VTE rates decreased from 1.11% in 2014 to 0.76% in 2019 (P < .001). There was a strong correlation between the yearly incidence of VTE, pulmonary embolism, and deep vein thrombosis and mean LOS (r = 0.96, 0.87, and 0.98, respectively). Univariate analysis demonstrated that TKA, inpatient setting, American Society of Anesthesiologists classification, and various patient comorbidities were significantly associated with VTE. The logistic regression model trained on all data with a balanced loss scoring function performed the best (area under the curve = 0.600).
Conclusions
This study revealed declining VTE rates strongly correlated to decreasing postoperative LOS and identified patient and surgery-specific factors associated with VTE risk. Development of more accurate machine learning models for VTE prediction may improve risk stratification, prevention, and monitoring for arthroplasty patients.
{"title":"Predicting 30-Day Venous Thromboembolism Following Total Joint Arthroplasty: Adjusting for Trends in Annual Length of Stay","authors":"","doi":"10.1016/j.artd.2024.101491","DOIUrl":"10.1016/j.artd.2024.101491","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE) following total hip arthroplasty and total knee arthroplasty (TKA) is linked to immobility, and preoperative prediction remains difficult. We aimed to evaluate whether annual mean length of stay (LOS) is associated with the incidence of VTE and develop a generalizable machine learning model to preoperatively predict the incidence of symptomatic VTE following total hip and TKA using National Surgical Quality Improvement Program.</div></div><div><h3>Methods</h3><div>Annual incidence of 30-day postoperative VTE, deep vein thrombosis, and pulmonary embolism was calculated over 6 years and tested for trend. Correlation between annual VTE rates and mean LOS was calculated. Predictive models (logistic regression, random forest, and XGBoost) were trained and tested based on year of surgery with different oversampling algorithms used to address data imbalance.</div></div><div><h3>Results</h3><div>A total of 498,314 patients were included, with 0.88% developing a VTE within 30 days. VTE rates decreased from 1.11% in 2014 to 0.76% in 2019 (<em>P</em> < .001). There was a strong correlation between the yearly incidence of VTE, pulmonary embolism, and deep vein thrombosis and mean LOS (r = 0.96, 0.87, and 0.98, respectively). Univariate analysis demonstrated that TKA, inpatient setting, American Society of Anesthesiologists classification, and various patient comorbidities were significantly associated with VTE. The logistic regression model trained on all data with a balanced loss scoring function performed the best (area under the curve = 0.600).</div></div><div><h3>Conclusions</h3><div>This study revealed declining VTE rates strongly correlated to decreasing postoperative LOS and identified patient and surgery-specific factors associated with VTE risk. Development of more accurate machine learning models for VTE prediction may improve risk stratification, prevention, and monitoring for arthroplasty patients.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.1016/j.artd.2024.101484
Background
Utilizing conversational analytics in orthopaedic surgery may provide insights into patients’ experiences and outcomes. This study retrospectively assessed how patients interacted with a perioperative chatbot and whether the topic of patients’ queries could offer insight on their outcomes after total knee or hip arthroplasty.
Methods
We identified 1338 patients (746 knees and 592 hips) who enrolled in a short message service chatbot from 2020-2022 with greater than 3 months of follow-up. The total number and topics of patient-generated text responses to the chatbot were recorded. Independent t-tests, chi-squared tests, and linear regressions were performed to determine if specific patient-generated responses to the chatbot or overall chatbot engagement were associated with demographics or outcomes.
Results
Readmitted patients interacted less with the perioperative chatbot than those who were not readmitted (3.9 messages vs 12.7 messages, P < .0001). Return to emergency department (ED) and reoperation rates were not associated with engagement. Patients who visited the ED within 90 days of their surgery were most commonly seeking advice about walking after surgery (P = .0046) and weaning off their opiate pain medications (P = .0281). Patients who were readmitted to the hospital were similarly seeking advice about walking (P = .0188) and weaning off pain medications (P = .0218). Replying “exercise” was associated with no ED visits or readmissions (P = .0009). Patients with a mental health diagnosis were more likely to reply with high-acuity topics (P = .0052).
Conclusions
The topic of chatbot queries and chatbot engagement were associated with patient outcomes after total knee arthroplasty or total hip arthroplasty and may provide insight to patients’ perioperative courses.
{"title":"Conversational Engagement Using a Short Message Service Chatbot After Total Joint Arthroplasty","authors":"","doi":"10.1016/j.artd.2024.101484","DOIUrl":"10.1016/j.artd.2024.101484","url":null,"abstract":"<div><h3>Background</h3><div>Utilizing conversational analytics in orthopaedic surgery may provide insights into patients’ experiences and outcomes. This study retrospectively assessed how patients interacted with a perioperative chatbot and whether the topic of patients’ queries could offer insight on their outcomes after total knee or hip arthroplasty.</div></div><div><h3>Methods</h3><div>We identified 1338 patients (746 knees and 592 hips) who enrolled in a short message service chatbot from 2020-2022 with greater than 3 months of follow-up. The total number and topics of patient-generated text responses to the chatbot were recorded. Independent <em>t</em>-tests, chi-squared tests, and linear regressions were performed to determine if specific patient-generated responses to the chatbot or overall chatbot engagement were associated with demographics or outcomes.</div></div><div><h3>Results</h3><div>Readmitted patients interacted less with the perioperative chatbot than those who were not readmitted (3.9 messages vs 12.7 messages, <em>P</em> < .0001). Return to emergency department (ED) and reoperation rates were not associated with engagement. Patients who visited the ED within 90 days of their surgery were most commonly seeking advice about walking after surgery (<em>P</em> = .0046) and weaning off their opiate pain medications (<em>P</em> = .0281). Patients who were readmitted to the hospital were similarly seeking advice about walking (<em>P</em> = .0188) and weaning off pain medications (<em>P</em> = .0218). Replying “exercise” was associated with no ED visits or readmissions (<em>P</em> = .0009). Patients with a mental health diagnosis were more likely to reply with high-acuity topics (<em>P</em> = .0052).</div></div><div><h3>Conclusions</h3><div>The topic of chatbot queries and chatbot engagement were associated with patient outcomes after total knee arthroplasty or total hip arthroplasty and may provide insight to patients’ perioperative courses.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.1016/j.artd.2024.101494
Background
A desire to control cost and improve patient outcomes following arthroplasty led to the introduction of the Center for Medicare and Medicaid Service Comprehensive Care for Joint Replacement Program. Hemi and total hip arthroplasty for femoral neck fracture has been shown to have worse outcomes than those for osteoarthritis. However, little has been studied about the effect of comorbidities on costs associated with arthroplasty for femoral neck fracture. This study investigates how the number of comorbidities influence 90-day outcomes and cost following hemi or total hip arthroplasty for displaced femoral neck fracture in patients covered by the Comprehensive Care for Joint Replacement bundle.
Methods
We reviewed all Medicare hip fracture patients undergoing hemi or total hip arthroplasty at our institution between April 2016 and November 2020. Basic demographic and perioperative information was collected. The primary outcome was hospital readmission within 90 days. The data set captured 90-day readmission to any institution, not just within our system. Secondary outcomes included 90-day reoperation and outpatient complications. Multiple logistic regression was used to examine the influence of number of comorbidities on the primary and secondary outcomes while controlling for other variables.
Results
The cohort comprised 378 patients (72% female), mean age 82 (±9) years, mean body mass index 23.4 (±4.7) kg/m2. For every additional comorbidity, the odds of related readmission without reoperation increased by 1.261 (95% confidence interval [1.055-1.507], P = .011). Odds of reoperation and odds of outpatient complication did not show statistical significance with the available numbers.
Conclusions
Increasing preoperative comorbidities results in a higher odd of readmission within 90 days following arthroplasty for femoral neck fracture in this Medicare population.
{"title":"Higher Comorbidities are Correlated With Readmission Following Arthroplasty for Femoral Neck Fracture","authors":"","doi":"10.1016/j.artd.2024.101494","DOIUrl":"10.1016/j.artd.2024.101494","url":null,"abstract":"<div><h3>Background</h3><div>A desire to control cost and improve patient outcomes following arthroplasty led to the introduction of the Center for Medicare and Medicaid Service Comprehensive Care for Joint Replacement Program. Hemi and total hip arthroplasty for femoral neck fracture has been shown to have worse outcomes than those for osteoarthritis. However, little has been studied about the effect of comorbidities on costs associated with arthroplasty for femoral neck fracture. This study investigates how the number of comorbidities influence 90-day outcomes and cost following hemi or total hip arthroplasty for displaced femoral neck fracture in patients covered by the Comprehensive Care for Joint Replacement bundle.</div></div><div><h3>Methods</h3><div>We reviewed all Medicare hip fracture patients undergoing hemi or total hip arthroplasty at our institution between April 2016 and November 2020. Basic demographic and perioperative information was collected. The primary outcome was hospital readmission within 90 days. The data set captured 90-day readmission to any institution, not just within our system. Secondary outcomes included 90-day reoperation and outpatient complications. Multiple logistic regression was used to examine the influence of number of comorbidities on the primary and secondary outcomes while controlling for other variables.</div></div><div><h3>Results</h3><div>The cohort comprised 378 patients (72% female), mean age 82 (±9) years, mean body mass index 23.4 (±4.7) kg/m<sup>2</sup>. For every additional comorbidity, the odds of related readmission without reoperation increased by 1.261 (95% confidence interval [1.055-1.507], <em>P</em> = .011). Odds of reoperation and odds of outpatient complication did not show statistical significance with the available numbers.</div></div><div><h3>Conclusions</h3><div>Increasing preoperative comorbidities results in a higher odd of readmission within 90 days following arthroplasty for femoral neck fracture in this Medicare population.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.1016/j.artd.2024.101487
Background
Hip dislocation represents a significant complication encountered following hip arthroplasty procedures. In this investigation, we conducted a comparative analysis of the biomechanical characteristics exhibited by the piriformis and the conjoined tendon after total hip arthroplasty (THA) via the direct anterior approach (DAA), utilizing cadaveric specimens. The objective is to ascertain the relative significance of the piriformis muscle and the conjoined tendon in mitigating hip dislocation.
Methods
A total of 16 hip joints from 8 freshly frozen cadavers were selected and stratified into 2 groups: the piriformis tendon (PT) group and the conjoined tendon (CT) group. Following THA via the DAA, measurements were taken to record the torque required to induce hip dislocation under various conditions. Torque readings were obtained with the tendon in its intact state (intact group) and after preservation or reconstruction of either the PT or the CT.
Results
The torques of anterior and posterior dislocation in PT group were 22.24 ± 4.53 N.m and 30.7 ± 15.5 N.m following tendon severed, and 20.04 ± 2.67 N.m and 17.5 ± 6.7 N.m following reconstruction. There were no differences compared to the intact group. The torque decreased in the CT group after CT was severed with the torques dropping from 31.2 ± 7.6 N.m to 8.18 ± 2.6 N.m (P < .0001) for anterior dislocation, and from 34.9 ± 8.3 N.m to 9.8 ± 2.8 N.m (P < .0001) for posterior dislocation. Following reconstruction, the torque required for dislocation significantly increased (P < .0001).
Conclusions
This study underscores the preeminent role of the CT in ensuring hip stability following THA via DAA, highlighting the cruciality of its preservation and reconstruction during surgical interventions.
{"title":"Role of the Conjoined Tendon in Hip Stability Post-Total Hip Arthroplasty: Insights From a Direct Anterior Approach Cadaver Study","authors":"","doi":"10.1016/j.artd.2024.101487","DOIUrl":"10.1016/j.artd.2024.101487","url":null,"abstract":"<div><h3>Background</h3><div>Hip dislocation represents a significant complication encountered following hip arthroplasty procedures. In this investigation, we conducted a comparative analysis of the biomechanical characteristics exhibited by the piriformis and the conjoined tendon after total hip arthroplasty (THA) via the direct anterior approach (DAA), utilizing cadaveric specimens. The objective is to ascertain the relative significance of the piriformis muscle and the conjoined tendon in mitigating hip dislocation.</div></div><div><h3>Methods</h3><div>A total of 16 hip joints from 8 freshly frozen cadavers were selected and stratified into 2 groups: the piriformis tendon (PT) group and the conjoined tendon (CT) group. Following THA via the DAA, measurements were taken to record the torque required to induce hip dislocation under various conditions. Torque readings were obtained with the tendon in its intact state (intact group) and after preservation or reconstruction of either the PT or the CT.</div></div><div><h3>Results</h3><div>The torques of anterior and posterior dislocation in PT group were 22.24 ± 4.53 N.m and 30.7 ± 15.5 N.m following tendon severed, and 20.04 ± 2.67 N.m and 17.5 ± 6.7 N.m following reconstruction. There were no differences compared to the intact group. The torque decreased in the CT group after CT was severed with the torques dropping from 31.2 ± 7.6 N.m to 8.18 ± 2.6 N.m (<em>P</em> < .0001) for anterior dislocation, and from 34.9 ± 8.3 N.m to 9.8 ± 2.8 N.m (<em>P</em> < .0001) for posterior dislocation. Following reconstruction, the torque required for dislocation significantly increased (<em>P</em> < .0001).</div></div><div><h3>Conclusions</h3><div>This study underscores the preeminent role of the CT in ensuring hip stability following THA via DAA, highlighting the cruciality of its preservation and reconstruction during surgical interventions.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14DOI: 10.1016/j.artd.2024.101501
Background
There are high reported rates of burnout and job turnover among orthopedic surgeons. The purpose of this study was to investigate the prevalence of job change among early-career adult reconstruction surgeons and to examine which demographic or practice factors influenced job change.
Methods
An electronic survey was distributed to all practicing surgeon members of the American Association of Hip and Knee Surgeons Young Arthroplasty Group. The survey included questions about practice type, demographics, job change, and a validated burnout questionnaire. Survey responses were collected using a secure database. Statistical analysis was performed to examine relationships between respondent characteristics and job change.
Results
There were 201/389 responses (51.7%). The most common motivators for job change were better workplace culture (64%), opportunities for career growth (52%), and better alignment with values of the department/institution (45%). There were few female respondents; however, they trended toward reporting higher rates of job change (35.6% female vs 21.3% male, P = .3). Respondents who were considering changing jobs but had not done so were significantly more likely to report symptoms of burnout in all studied subscales: emotional exhaustion (P < .0001), depersonalization (P = .0002), and sense of personal accomplishment (P = .007).
Conclusions
Surgeons changing jobs cited social factors such as workplace culture as reasons for leaving. Burnout symptoms were higher in surgeons considering changing jobs but improved in those who had already changed jobs. It is important to identify factors that lead to job change to guide young surgeons in job selection and improve retention.
{"title":"Why Do Early-Career Adult Reconstruction Surgeons Change Jobs? An American Association of Hip and Knee Surgeons Young Arthroplasty Group Survey Study","authors":"","doi":"10.1016/j.artd.2024.101501","DOIUrl":"10.1016/j.artd.2024.101501","url":null,"abstract":"<div><h3>Background</h3><div>There are high reported rates of burnout and job turnover among orthopedic surgeons. The purpose of this study was to investigate the prevalence of job change among early-career adult reconstruction surgeons and to examine which demographic or practice factors influenced job change.</div></div><div><h3>Methods</h3><div>An electronic survey was distributed to all practicing surgeon members of the American Association of Hip and Knee Surgeons Young Arthroplasty Group. The survey included questions about practice type, demographics, job change, and a validated burnout questionnaire. Survey responses were collected using a secure database. Statistical analysis was performed to examine relationships between respondent characteristics and job change.</div></div><div><h3>Results</h3><div>There were 201/389 responses (51.7%). The most common motivators for job change were better workplace culture (64%), opportunities for career growth (52%), and better alignment with values of the department/institution (45%). There were few female respondents; however, they trended toward reporting higher rates of job change (35.6% female vs 21.3% male, <em>P</em> = .3). Respondents who were considering changing jobs but had not done so were significantly more likely to report symptoms of burnout in all studied subscales: emotional exhaustion (<em>P</em> < .0001), depersonalization (<em>P</em> = .0002), and sense of personal accomplishment (<em>P</em> = .007).</div></div><div><h3>Conclusions</h3><div>Surgeons changing jobs cited social factors such as workplace culture as reasons for leaving. Burnout symptoms were higher in surgeons considering changing jobs but improved in those who had already changed jobs. It is important to identify factors that lead to job change to guide young surgeons in job selection and improve retention.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14DOI: 10.1016/j.artd.2024.101478
Background
Arthroplasty registries play a critical role in improving the quality of care and performing post-market surveillance of medical devices. We report the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) findings specific to the Biomet Vanguard XP bicruciate-retaining total knee implant.
Methods
Data were collected from MARCQI’s 2019 report (February 15, 2012, through December 31, 2018). Demographic data were analyzed to determine differences between Vanguard XP and all other implants. The cumulative percent revision (CPR) was computed from the survival function, S(t), using CPR(t) = 100∗(1 − S(t)). A log-rank test was used to assess differences in the CPR curve for the Vanguard XP and all other implants.
Results
There were 148,832 knee arthroplasty cases in the MARCQI registry and 507 using Vanguard XP implant combinations. The unadjusted cumulative percent revision curve up to 5 years postoperatively for the Vanguard XP differed from all other implants (P < .0001). The hazard ratios for the 3 factors included in the Cox proportional hazards model were all significantly different from unity: implant (2.76, 95% CI: 1.98-3.86), sex (0.80, 95% CI: 0.74-0.85), and age (0.96, 95% CI: 0.96-0.97). The top 3 reasons for revision were pain, arthrofibrosis, and aseptic loosening. All surgeons who used the Vanguard XP experienced higher failure rates.
Conclusions
The Vanguard XP experienced higher early failure rates than other TKA implants within the MARCQI registry. The development of thresholds and benchmarks for registry reporting in collaboration with industry could potentially save patients from the morbidity caused by implants that do not perform as well as anticipated.
{"title":"Early Identification of Poorly Performing Implants in Michigan With the Example of the Vanguard XP","authors":"","doi":"10.1016/j.artd.2024.101478","DOIUrl":"10.1016/j.artd.2024.101478","url":null,"abstract":"<div><h3>Background</h3><div>Arthroplasty registries play a critical role in improving the quality of care and performing post-market surveillance of medical devices. We report the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) findings specific to the Biomet Vanguard XP bicruciate-retaining total knee implant.</div></div><div><h3>Methods</h3><div>Data were collected from MARCQI’s 2019 report (February 15, 2012, through December 31, 2018). Demographic data were analyzed to determine differences between Vanguard XP and all other implants. The cumulative percent revision (CPR) was computed from the survival function, S(t), using CPR(t) = 100∗(1 − S(t)). A log-rank test was used to assess differences in the CPR curve for the Vanguard XP and all other implants.</div></div><div><h3>Results</h3><div>There were 148,832 knee arthroplasty cases in the MARCQI registry and 507 using Vanguard XP implant combinations. The unadjusted cumulative percent revision curve up to 5 years postoperatively for the Vanguard XP differed from all other implants (<em>P</em> < .0001). The hazard ratios for the 3 factors included in the Cox proportional hazards model were all significantly different from unity: implant (2.76, 95% CI: 1.98-3.86), sex (0.80, 95% CI: 0.74-0.85), and age (0.96, 95% CI: 0.96-0.97). The top 3 reasons for revision were pain, arthrofibrosis, and aseptic loosening. All surgeons who used the Vanguard XP experienced higher failure rates.</div></div><div><h3>Conclusions</h3><div>The Vanguard XP experienced higher early failure rates than other TKA implants within the MARCQI registry. The development of thresholds and benchmarks for registry reporting in collaboration with industry could potentially save patients from the morbidity caused by implants that do not perform as well as anticipated.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14DOI: 10.1016/j.artd.2024.101492
Background
Leg-length discrepancy (LLD) can lead to patient dissatisfaction and decreased function after total hip arthroplasty (THA). This study examines the impact of intraoperative fluoroscopy on the magnitude and incidence of LLD after THA.
Methods
Patients undergoing primary THA were identified and stratified into cohorts based on one out of 4 surgical approaches and intraoperative fluoroscopy use. The most recent 100 patients matching each cohort were included. Preoperative and postoperative LLD was assessed radiographically via an interteardrop reference line to lesser trochanter measurement.Magnitude of LLD and the proportion of patients in each cohort with LLD >5 mm, >10 mm, and 15 mm were analyzed.
Results
Four hundred patients were stratified into 4 equal cohorts. Overall, THA done with fluoroscopy yielded fewer leg length discrepancies than THA done without fluoroscopy. The anterior-based muscle sparing (ABMS) approach with fluoroscopy had significantly less postoperative LLD than the posterior approach without fluoroscopy (3.4 vs 5.1 mm, P < .01) and the ABMS approach in the lateral position without fluoroscopy (3.4 vs 4.8 mm, P = .03). For LLD >5 mm, the ABMS approach with fluoroscopy cohort had significantly fewer patients compared to the ABMS approach without fluoroscopy (23 vs 41, P < .01). For LLD >10 mm, the ABMS approach with fluoroscopy cohort had significantly fewer patients compared to the posterior approach without fluoroscopy (2 vs 15, P < .01). For LLD >15 mm, relative to the posterior approach without fluoroscopy, all other cohorts had significantly fewer outliers (P < .02).
Conclusions
This study supplies evidence that use of intraoperative fluoroscopy is likely beneficial in reducing the magnitude of LLD following THA and reducing the incidence of outlier LLDs >5 mm, >10 mm, and <15 mm.
{"title":"Intraoperative Fluoroscopy Decreases Magnitude and Incidence of Leg-Length Discrepancy Following Total Hip Arthroplasty","authors":"","doi":"10.1016/j.artd.2024.101492","DOIUrl":"10.1016/j.artd.2024.101492","url":null,"abstract":"<div><h3>Background</h3><div>Leg-length discrepancy (LLD) can lead to patient dissatisfaction and decreased function after total hip arthroplasty (THA). This study examines the impact of intraoperative fluoroscopy on the magnitude and incidence of LLD after THA.</div></div><div><h3>Methods</h3><div>Patients undergoing primary THA were identified and stratified into cohorts based on one out of 4 surgical approaches and intraoperative fluoroscopy use. The most recent 100 patients matching each cohort were included. Preoperative and postoperative LLD was assessed radiographically via an interteardrop reference line to lesser trochanter measurement.Magnitude of LLD and the proportion of patients in each cohort with LLD >5 mm, >10 mm, and 15 mm were analyzed.</div></div><div><h3>Results</h3><div>Four hundred patients were stratified into 4 equal cohorts. Overall, THA done with fluoroscopy yielded fewer leg length discrepancies than THA done without fluoroscopy. The anterior-based muscle sparing (ABMS) approach with fluoroscopy had significantly less postoperative LLD than the posterior approach without fluoroscopy (3.4 vs 5.1 mm, <em>P</em> < .01) and the ABMS approach in the lateral position without fluoroscopy (3.4 vs 4.8 mm, <em>P</em> = .03). For LLD >5 mm, the ABMS approach with fluoroscopy cohort had significantly fewer patients compared to the ABMS approach without fluoroscopy (23 vs 41, <em>P</em> < .01). For LLD >10 mm, the ABMS approach with fluoroscopy cohort had significantly fewer patients compared to the posterior approach without fluoroscopy (2 vs 15, <em>P</em> < .01). For LLD >15 mm, relative to the posterior approach without fluoroscopy, all other cohorts had significantly fewer outliers (<em>P</em> < .02).</div></div><div><h3>Conclusions</h3><div>This study supplies evidence that use of intraoperative fluoroscopy is likely beneficial in reducing the magnitude of LLD following THA and reducing the incidence of outlier LLDs >5 mm, >10 mm, and <15 mm.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14DOI: 10.1016/j.artd.2024.101524
Multiple epiphyseal dysplasia is a rare congenital disorder characterized by irregular, delayed ossification at multiple epiphyses, typically in the lower extremity. In this arthroplasty in rare conditions case report, we present a 14-year-old female with multiple epiphyseal dysplasia and borderline acetabular dysplasia who developed progressive bilateral femoral head avascular necrosis. She presented with a worsening antalgic gait and bilateral hip pain starting at 10 years of age, which was refractory to nonoperative measures. She was treated with staged bilateral total hip arthroplasty when her triradiate cartilage was closed and is presenting with 3 years of clinical follow-up with excellent reported outcomes. The goal of this case presentation is to discuss the specific surgical challenges related to this patient population and highlight important considerations in the adolescent population undergoing total hip arthroplasty.
{"title":"Staged Bilateral Total Hip Arthroplasty in an Adolescent Patient With Multiple Epiphyseal Dysplasia and Bilateral Avascular Necrosis","authors":"","doi":"10.1016/j.artd.2024.101524","DOIUrl":"10.1016/j.artd.2024.101524","url":null,"abstract":"<div><div>Multiple epiphyseal dysplasia is a rare congenital disorder characterized by irregular, delayed ossification at multiple epiphyses, typically in the lower extremity. In this arthroplasty in rare conditions case report, we present a 14-year-old female with multiple epiphyseal dysplasia and borderline acetabular dysplasia who developed progressive bilateral femoral head avascular necrosis. She presented with a worsening antalgic gait and bilateral hip pain starting at 10 years of age, which was refractory to nonoperative measures. She was treated with staged bilateral total hip arthroplasty when her triradiate cartilage was closed and is presenting with 3 years of clinical follow-up with excellent reported outcomes. The goal of this case presentation is to discuss the specific surgical challenges related to this patient population and highlight important considerations in the adolescent population undergoing total hip arthroplasty.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14DOI: 10.1016/j.artd.2024.101479
Since the early 2000s, oxidized zirconium implants have emerged as a valuable option in total hip and knee arthroplasty due to their wear resistance and suitability for patients with metal hypersensitivity. The surface of these components is created through a heating and oxidation process of a zirconium alloy, resulting in a thin layer with favorable wear properties. However, there have been few reports of severe metallosis resulting from inadvertent wear of oxidized zirconium components through various mechanisms, including dissociation of the polyethylene liner and joint instability. We present a case involving a dramatic failure of an oxidized zirconium total knee arthroplasty, necessitating a staged revision arthroplasty.
{"title":"Dramatic Failure of an OXINIUM Total Knee Arthroplasty With a Massive Pseudotumor Formation","authors":"","doi":"10.1016/j.artd.2024.101479","DOIUrl":"10.1016/j.artd.2024.101479","url":null,"abstract":"<div><div>Since the early 2000s, oxidized zirconium implants have emerged as a valuable option in total hip and knee arthroplasty due to their wear resistance and suitability for patients with metal hypersensitivity. The surface of these components is created through a heating and oxidation process of a zirconium alloy, resulting in a thin layer with favorable wear properties. However, there have been few reports of severe metallosis resulting from inadvertent wear of oxidized zirconium components through various mechanisms, including dissociation of the polyethylene liner and joint instability. We present a case involving a dramatic failure of an oxidized zirconium total knee arthroplasty, necessitating a staged revision arthroplasty.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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