Arthroplasty Today最新文献_第3页

Anterior Versus Posterior Approach for Total Hip Arthroplasty in Femoral Neck Fractures 股骨颈骨折全髋关节置换术的前路与后路方法

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-12 DOI: 10.1016/j.artd.2024.101573

Kyle L. McCormick MD, Michael A. Mastroianni MD, Carl H. Herndon MD, Nana O. Sarpong MD, MBA, Roshan P. Shah MD, H. John Cooper MD, Alexander L. Neuwirth MD, Jeffrey A. Geller MD

Background

The purpose of this study was to compare complication rates and clinical outcomes at 1 year or until death based on the surgical approach for total hip replacement in femoral neck fractures.

Methods

This retrospective study was performed on 101 patients with displaced femoral neck fractures at our institution between 2005 and 2022. All surgeries were performed by fellowship-trained arthroplasty surgeons via either a posterior Kocher-Langenbeck approach, an abductor sparing anterolateral approach, or a direct anterior approach. Demographics were collected, as well as intraoperative characteristics, discharge information, and complications.

Results

Thirty-seven patients underwent a direct anterior approach, 42 underwent an abductor sparing anterolateral approach, and 22 underwent a posterior approach, with no significant difference in demographics between the groups. Of patients, 43.3% were able to be discharged home, while 55.4% of patients went to subacute rehab or other nursing home facility. There was a 30.6% complication rate, a 7% reoperation rate, and a 0.9% dislocation rate. The posterior group was more likely to be discharged to rehab instead of home (82.0% compared to 48.6%, P = .0054) and had a significant increase in complication rate (P = .04). There was a 36.3% rate of transfusion in the posterior group compared to a 5.0% rate in the anterior group (P < .0001).

Conclusions

Anterior-based total hip arthroplasty for femoral neck fractures in our series demonstrated a significantly lower rate of postoperative complications, a lower rate of transfusion, and a significantly higher rate of being discharged home.

Level of Evidence

Level III.

背景本研究的目的是根据股骨颈骨折全髋关节置换术的手术方式，比较1年后或死亡前的并发症发生率和临床预后。方法本回顾性研究针对2005年至2022年间本院101例移位性股骨颈骨折患者进行。所有手术均由受过研究员培训的关节置换外科医生通过后Kocher-Langenbeck入路、内收疏松前外侧入路或直接前入路进行。结果37名患者采用了直接前方入路，42名患者采用了内收肌疏松前外侧入路，22名患者采用了后方入路，三组患者的人口统计学特征无显著差异。43.3%的患者可以出院回家，而55.4%的患者则被送往亚急性康复中心或其他疗养院。并发症发生率为30.6%，再次手术率为7%，脱位率为0.9%。后路组患者更有可能出院去康复中心而不是回家（82.0%对48.6%，P = .0054），并发症发生率显著增加（P = .04）。结论在我们的系列研究中，股骨颈骨折的前路全髋关节置换术的术后并发症发生率明显降低，输血率降低，出院回家的比例明显提高。

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引用次数: 0

Impact of Leg Position on Measurements Used to Detect Femoral Component Subsidence in THA 腿部位置对用于检测 THA 中股骨组件下沉的测量值的影响

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-12 DOI: 10.1016/j.artd.2024.101553

Elizabeth S. Kaji BA , Austin F. Grove BA , Eva Lehtonen MD , Kellen L. Mulford PhD , Pouria Rouzrokh MD, MPH, MHPE , Charles P. Hannon MD, MBA , Michael J. Taunton MD , Cody C. Wyles MD

Background

A fully automated artificial intelligence–based tool was developed to detect and quantify femoral component subsidence between serial radiographs. However, it did not account for measurement errors due to leg position differences, such as rotation or flexion, between comparative radiographs. If there are small differences in rotation or flexion of the leg between comparative radiographs, the impact on subsidence measurement is unclear.

Methods

Twenty-five primary total hip arthroplasty procedures were performed by 3 fellowship-trained arthroplasty surgeons using a direct anterior approach. A Hana table allowed precise changes in femur position. Final fluoroscopic images were collected with rotational and flexion changes applied to the femur without moving the C-arm. Subsidence values were manually measured and compared across different positions.

Results

Variations in greater trochanter to tip of the stem measurements between the neutral position and rotations were minimal, measuring <1 mm on an absolute scale and <1% on a relative scale. These differences decreased as the femur was rotated from an external rotation of 20° to an internal rotation of 20°. Notable variances exceeding 5 mm were observed in the 10° flexion position compared to neutral.

Conclusions

Minor changes (20° or less) in leg rotation between serial radiographs are unlikely to significantly affect the greater trochanter to tip of the stem measurement, whereas flexion is highly impactful. These findings suggest that the fully automated artificial intelligence–based tool for detecting and quantifying femoral component subsidence is robust against rotational variations but may be susceptible to significant measurement errors if there are considerable changes in leg flexion between comparative radiographs.

背景开发了一种基于人工智能的全自动工具，用于检测和量化序列X光片之间的股骨组件下沉。然而，它并没有考虑到由于腿部位置差异（如旋转或屈曲）而导致的对比X光片之间的测量误差。方法由3名受过研究培训的关节置换外科医生采用直接前路方法进行了25例初次全髋关节置换术。使用 Hana 台可精确改变股骨位置。在不移动 C 臂的情况下，采集股骨旋转和屈曲变化的最终透视图像。结果股骨大转子至股骨柄顶端的测量值在中立位和旋转位之间的差异极小，绝对值为1毫米，相对值为1%。当股骨从外旋20°旋转到内旋20°时，这些差异会减小。结论连续X光片之间腿部旋转的微小变化（20°或更小）不太可能显著影响大转子到柄尖的测量值，而屈曲则会产生很大影响。这些研究结果表明，基于人工智能的全自动股骨组件下沉检测和量化工具对旋转变化有很强的抵抗力，但如果腿部屈曲度在对比X光片之间有很大变化，则可能会出现明显的测量误差。

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引用次数: 0

Intra-articular Vancomycin Reduces Prosthetic Infection in Primary Hip and Knee Arthroplasty—Response to Queries 关节内万古霉素可减少初次髋关节和膝关节置换术中的假体感染--对询问的答复

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-07 DOI: 10.1016/j.artd.2024.101545

Alexander W.R. Burns MBBS, FRACS, FAOrthA, Paul Smith BMBS, FRACS, FAOrthA, HonDUniv (Prof.), Joseph Lynch BSc (Hons), MSc, PhD

引用次数: 0

Determinants of Salary Variation and the Gender Pay Gap: A Survey of the American Association of Hip and Knee Surgeons (AAHKS) Surgeon Member Workforce 薪酬差异和性别薪酬差距的决定因素：对美国髋关节和膝关节外科医生协会（AAHKS）外科医生成员队伍的调查

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-07 DOI: 10.1016/j.artd.2024.101554

Prem N. Ramkumar MD, MBA , Jenna A. Bernstein MD , David C. Landy MD, PhD , David E. DeMik MD , Justin T. Deen MD , Reena J. Olsen MS , Anna Cohen-Rosenblum MD

Background

The increased emphasis on reimbursement, diversity, and burnout in hip and knee arthroplasty necessitates a foundational understanding of the surgeon workforce. The purpose of the study was to cross sectionally survey a representative sample of the AAHKS surgeon membership on the subject of salary, practice patterns, and demographic factors to establish a baseline framework for future advocacy efforts and initiatives.

Methods

An online survey was sent to AAHKS members between December 20, 2022 and January 19, 2023. Surgeon demographic data, experience, practice geography and type, and annual case volume were solicited. Univariate and multivariate analyses were performed to describe the association of respondent characteristics with reported salary directly from patient care, as well as indirect revenue streams.

Results

A total of 730 AAHKS members responded to the survey. The largest proportion of surgeons performed 251-400 cases annually (36%); 81% (n = 592) and 93% (n = 679) of respondents identified as white and male, respectively. Case volume was the primary determinant for surgeon salary, followed by practice type, years in practice, and gender. After controlling for confounding variables, multivariate analyses revealed the direct salary of women surgeons was 14.4% less than men [95% confidence interval, 0.4%-28.3%]. When considering indirect revenue, the gender pay gap widened. Salary was not associated with reported hours worked per week, geographic location, or ethnicity.

Conclusions

Salary is an important but underdiscussed subject that reflects the realities of our culture and value system in medicine. A direct relationship between salary and modifiable variables like case volume is clear. However, after controlling for confounders, women arthroplasty surgeons still earn 86 cents on the dollar compared to their male colleagues from direct surgical revenue.

背景髋关节和膝关节置换术中的报销、多样性和职业倦怠问题日益受到重视，因此有必要对外科医生队伍进行基本了解。本研究的目的是对AAHKS外科医生成员中具有代表性的样本进行横截面调查，内容涉及薪资、执业模式和人口统计因素，以便为未来的宣传工作和倡议建立基线框架。方法在2022年12月20日至2023年1月19日期间向AAHKS成员发送在线调查。调查内容包括外科医生的人口统计学数据、经验、执业地域和类型以及年病例量。我们进行了单变量和多变量分析，以描述受访者特征与所报告的直接来自患者护理的薪酬以及间接收入流之间的关联。最大比例的外科医生年手术量为 251-400 例（36%）；分别有 81% （n = 592）和 93% （n = 679）的受访者认为自己是白人和男性。病例量是决定外科医生薪酬的主要因素，其次是执业类型、执业年限和性别。在控制了混杂变量后，多变量分析显示女外科医生的直接薪酬比男外科医生低 14.4% [95%置信区间，0.4%-28.3%]。当考虑到间接收入时，性别薪酬差距扩大了。薪资与报告的每周工作时间、地理位置或种族无关。结论薪资是一个重要但讨论不足的话题，它反映了我们的医学文化和价值体系的现实。薪酬与病例量等可修改变量之间的直接关系显而易见。然而，在控制了混杂因素后，女性关节置换外科医生的直接手术收入仍比男性同事少 86 美分。

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引用次数: 0

Perioperative Tranexamic Acid Should Be Considered for Total Joint Arthroplasty Patients Receiving Apixaban for Thromboprophylaxis 接受阿哌沙班预防血栓形成治疗的全关节置换术患者围手术期应考虑使用氨甲环酸

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-06 DOI: 10.1016/j.artd.2024.101548

Sagar Telang BS, Ryan Palmer BS, Andrew Dobitsch MD, Jacob R. Ball MD, Nathanael D. Heckmann MD, Jay R. Lieberman MD

Background

This study aims to investigate if the perioperative administration of tranexamic acid (TXA) for total joint arthroplasty (TJA) patients receiving apixaban for thromboprophylaxis can reduce the risk of postoperative bleeding without increasing the rate of thromboembolic events.

Methods

The Premier Healthcare Database was utilized to identify all primary elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients. Patients receiving apixaban during their in-hospital admission who received TXA on the day of surgery were compared to those who did not receive TXA. Differences in demographics, hospital characteristics, and comorbidities were assessed between groups. Univariate and multivariable regressions were utilized to assess differences in 90-day bleeding, thromboembolic, and medical postoperative outcomes between cohorts.

Results

In total, 118,219 TJA patients were identified (TKA: 65.3%; THA: 34.7%), of which 30,592 (25.9%) received apixaban alone, and 87,627 (74.1%) received apixaban and TXA. Multivariable analyses found that patients who received apixaban and TXA had a reduced risk of aggregate bleeding complications (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI]: 0.81-0.86, P < .001), transfusion (aOR 0.47, 95% CI: 0.43-0.52, P < .001), acute anemia (aOR 0.84, 95% CI: 0.81-0.87, P < .001), deep vein thrombosis (aOR 0.74, 95% CI: 0.66-0.83, P < .001), and pulmonary embolism (aOR 0.84, 95% CI: 0.72-0.96, P = .012). No differences between cohorts were observed for risk of stroke (aOR 1.09, 95% CI: 0.82-1.46, P = .372) and myocardial infarction (aOR 0.94, 95% CI: 0.76-1.16, P = .564).

Conclusions

Perioperative administration of TXA to TJA patients receiving apixaban reduces the risk of bleeding complications without increasing thromboembolic risk. Arthroplasty surgeons should strongly consider providing TXA to TJA patients receiving apixaban.

背景本研究旨在探讨接受阿哌沙班血栓预防治疗的全关节置换术（TJA）患者围手术期服用氨甲环酸（TXA）能否降低术后出血风险，同时不增加血栓栓塞事件的发生率。方法利用Premier医疗保健数据库识别所有初级择期全膝关节置换术（TKA）和全髋关节置换术（THA）患者。将在住院期间接受阿哌沙班治疗并在手术当天接受TXA治疗的患者与未接受TXA治疗的患者进行比较。评估了各组之间在人口统计学、医院特征和合并症方面的差异。结果共确定了118219例TJA患者（TKA：65.3%；THA：34.7%），其中30592例（25.9%）仅接受了阿哌沙班，87627例（74.1%）接受了阿哌沙班和TXA。多变量分析发现，接受阿哌沙班和TXA治疗的患者发生出血并发症的风险降低（调整赔率[aOR]0.83，95%置信区间[CI]：0.81-0.86，P＜0.05）：0.81-0.86, P < .001）、输血（aOR 0.47, 95% CI: 0.43-0.52, P < .001）、急性贫血（aOR 0.84, 95% CI: 0.81-0.87, P < .001）、深静脉血栓（aOR 0.74，95% CI：0.66-0.83，P < .001）和肺栓塞（aOR 0.84，95% CI：0.72-0.96，P = .012）。结论接受阿哌沙班治疗的 TJA 患者围手术期使用 TXA 可降低出血并发症的风险，而不会增加血栓栓塞风险。关节置换外科医生应积极考虑为接受阿哌沙班治疗的 TJA 患者提供 TXA。

{"title":"Perioperative Tranexamic Acid Should Be Considered for Total Joint Arthroplasty Patients Receiving Apixaban for Thromboprophylaxis","authors":"Sagar Telang BS, Ryan Palmer BS, Andrew Dobitsch MD, Jacob R. Ball MD, Nathanael D. Heckmann MD, Jay R. Lieberman MD","doi":"10.1016/j.artd.2024.101548","DOIUrl":"10.1016/j.artd.2024.101548","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to investigate if the perioperative administration of tranexamic acid (TXA) for total joint arthroplasty (TJA) patients receiving apixaban for thromboprophylaxis can reduce the risk of postoperative bleeding without increasing the rate of thromboembolic events.</div></div><div><h3>Methods</h3><div>The Premier Healthcare Database was utilized to identify all primary elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients. Patients receiving apixaban during their in-hospital admission who received TXA on the day of surgery were compared to those who did not receive TXA. Differences in demographics, hospital characteristics, and comorbidities were assessed between groups. Univariate and multivariable regressions were utilized to assess differences in 90-day bleeding, thromboembolic, and medical postoperative outcomes between cohorts.</div></div><div><h3>Results</h3><div>In total, 118,219 TJA patients were identified (TKA: 65.3%; THA: 34.7%), of which 30,592 (25.9%) received apixaban alone, and 87,627 (74.1%) received apixaban and TXA. Multivariable analyses found that patients who received apixaban and TXA had a reduced risk of aggregate bleeding complications (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI]: 0.81-0.86, <em>P</em> < .001), transfusion (aOR 0.47, 95% CI: 0.43-0.52, <em>P</em> < .001), acute anemia (aOR 0.84, 95% CI: 0.81-0.87, <em>P</em> < .001), deep vein thrombosis (aOR 0.74, 95% CI: 0.66-0.83, <em>P</em> < .001), and pulmonary embolism (aOR 0.84, 95% CI: 0.72-0.96, <em>P</em> = .012). No differences between cohorts were observed for risk of stroke (aOR 1.09, 95% CI: 0.82-1.46, <em>P</em> = .372) and myocardial infarction (aOR 0.94, 95% CI: 0.76-1.16, <em>P</em> = .564).</div></div><div><h3>Conclusions</h3><div>Perioperative administration of TXA to TJA patients receiving apixaban reduces the risk of bleeding complications without increasing thromboembolic risk. Arthroplasty surgeons should strongly consider providing TXA to TJA patients receiving apixaban.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101548"},"PeriodicalIF":1.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593774","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}

引用次数: 0

Planned Realignment Osteotomies Ahead of Knee Arthroplasty for Pronounced Joint Malalignment: A Case Report in Hereditary Multiple Exostoses Disease 膝关节置换术前的计划性对位截骨术治疗明显的关节错位：遗传性多发性骨质疏松症病例报告

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-06 DOI: 10.1016/j.artd.2024.101519

Tim Schmid MD , Marietta Schmid MD , Pascal A. Schai MD

Various approaches have been reported to achieve correctly aligned total knee arthroplasty in cases of knee arthritis with pronounced extra-articular bone malalignment. Revision instrumentation and implants have enabled bone correction coincident with knee arthroplasty in notable tibial and/or femoral deviation, however increasing operative complexity and inherent risks. In the presented patient with hereditary multiple exostoses disease and progressing knee arthritis for extra-articular malalignment, elected treatment strategy was to primarily correct joint plane deformity through femoral and tibial osteotomies, ahead of and preparing for later knee arthroplasty. Staged osteotomies prior to total knee arthroplasty are effective for managing severe extra-articular malalignment, improving surgical outcome and prosthetic longevity.

对于关节外骨错位明显的膝关节炎病例，有多种方法可实现正确对齐的全膝关节置换术。翻修器械和植入物可以在进行膝关节置换术的同时对明显的胫骨和/或股骨偏移进行骨矫正，但增加了手术的复杂性和固有风险。这位患者患有遗传性多发性外生骨病，膝关节炎因关节外错位而不断进展，因此选择的治疗策略主要是通过股骨和胫骨截骨术矫正关节面畸形，为日后的膝关节置换术做好准备。在全膝关节置换术前进行分阶段截骨，可有效控制严重的关节外错位，提高手术效果和假体寿命。

引用次数: 0

Letter to Editor: Intraarticular Vancomycin Reduces Prosthetic Infection in Primary Hip and Knee Arthroplasty 致编辑的信：关节腔内万古霉素可减少初次髋关节和膝关节置换术中的假体感染

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-06 DOI: 10.1016/j.artd.2024.101546

Praharsha Mulpur MBBS, DNB (Ortho), Tarun Jayakumar MBBS, MS (Ortho), A.V. Gurava Reddy MBBS, D (Ortho), DNB (Ortho), FRCS (Edinburgh), FRCS (Glasgow), FRCS (London), MCh Ortho (Liverpool)

引用次数: 0

Impact of Benign Prostatic Hyperplasia on Postoperative Complications and Periprosthetic Joint Infections After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis 良性前列腺增生对全关节成形术后并发症和假体周围感染的影响：系统回顾与元分析

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-05 DOI: 10.1016/j.artd.2024.101552

Sina Esmaeili MD, Hannaneh Razaghi MD, Mahda Malekshahi MD, Mohammad Soleimani MD, Seyyed Hossein Shafiei MD, Mohammadreza Golbakhsh MD

Background

Total joint arthroplasty (TJA) is one of the most frequently performed surgical procedures each year, offering considerable cost-effectiveness and numerous benefits. However, certain postoperative complications can be observed following TJA. While the relationship between various comorbidities and these complications has been well-documented, this study aims to specifically investigate the impact of benign prostatic hyperplasia (BPH) on postoperative outcomes.

Methods

For this systematic review, we searched PubMed, Scopus, and Web of Science using terms like "total hip arthroplasty," "total knee arthroplasty," "BPH," and "benign prostatic hypertrophy." Screening of retrieved articles was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies comparing complications in TJA between patients with and without preexisting BPH were eligible for inclusion. Data extraction was performed on the included articles, and their quality was assessed using the Newcastle-Ottawa scale. A meta-analysis was conducted using the Mantel-Haenszel method.

Results

This systematic review encompassed 4 articles evaluating TJA outcomes in men with a history of BPH, involving a total of 75,222 male cases. Among these, 17,183 cases (23%) presented with symptomatic BPH. The meta-analysis revealed that the incidence rate of periprosthetic joint infection did not significantly differ between BPH and non-BPH groups across both total hip and knee arthroplasty cases (odds ratio [OR] (95% confidence interval [CI]) = 1.28 [0.92-1.79]). However, postoperative urinary retention was significantly higher among patients with BPH (OR [95% CI] = 3.43 [2.04-5.78]). Additionally, patients with BPH exhibited a notably elevated incidence of postoperative urinary tract infection (OR [95% CI] = 2.55 [2.33-2.79]), as well as sepsis (OR [95% CI] = 1.31 [1.09-1.58]).

Conclusions

It is noteworthy that while patients with BPH are prone to certain complications, meta-analysis indicate that BPH cannot be considered a comorbidity that increases the risk of periprosthetic joint infection.

背景全关节置换术（TJA）是每年最常见的外科手术之一，具有相当高的成本效益和众多优点。然而，TJA 术后可能会出现某些并发症。虽然各种合并症与这些并发症之间的关系已得到充分证实，但本研究旨在专门调查良性前列腺增生症（BPH）对术后结果的影响。方法在这篇系统性综述中，我们使用 "全髋关节置换术"、"全膝关节置换术"、"BPH "和 "良性前列腺肥大 "等术语检索了 PubMed、Scopus 和 Web of Science。根据《系统综述和元分析首选报告项目》指南对检索到的文章进行筛选。对患有和未患有良性前列腺增生症的患者进行TJA并发症比较的研究符合纳入条件。对纳入的文章进行数据提取，并使用纽卡斯尔-渥太华量表对其质量进行评估。结果该系统性综述包括4篇评估有良性前列腺增生病史的男性TJA结果的文章，共涉及75222例男性病例。其中，17183 例（23%）有症状的良性前列腺增生。荟萃分析显示，在全髋关节和膝关节置换术病例中，BPH 组和非 BPH 组的假体周围关节感染发生率没有显著差异（几率比 [OR] (95% 置信区间 [CI]) = 1.28 [0.92-1.79]）。然而，良性前列腺增生患者的术后尿潴留率明显更高（OR [95% CI] = 3.43 [2.04-5.78]）。此外，良性前列腺增生患者术后尿路感染（OR [95% CI] = 2.55 [2.33-2.79]）和败血症（OR [95% CI] = 1.31 [1.09-1.58]）的发生率明显升高。

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引用次数: 0

A Mathematical Evaluation of the Effects of the Head and Neck Diameter on the Arc of Motion and the Implications in Total Hip Arthroplasty 头颈直径对运动弧度的影响及其在全髋关节置换术中的意义的数学评估

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-05 DOI: 10.1016/j.artd.2024.101556

Stanley E. Asnis MD , Jamie C. Heimroth MD , Todd Goldstein PhD

Background

Instability following total hip arthroplasty (THA) is a leading cause of revisions. Our objective was to evaluate the options that the surgeon has, to gain inherent stability with the use of conventional large femoral and dual mobility systems, and how the arc of motion (AOM) and jump distances (JDs) vary between them.

Methods

The head sizes examined spanned from 22 mm-54 mm, and neck sizes spanned from 10 mm-14 mm. Autodesk Fusion 360 is full-scale computer-aided designsoftware that can run simulations to validate a design. It was employed to calculate the AOM for each model. The JD was calculated with varying head sizes and 10- and 20-degree highwall liners.

Results

Increasing head sizes from 22, 28, 32-36 mm showed a considerable increase in the AOM for every neck size; however, there was substantially less of an increase with head sizes larger than 36 mm. As neck sizes increased from 10-14 mm, the AOM decreased. The JD increased substantially with the addition of 10- and 20-degree highwall liners.

Conclusions

Both classical THA and the dual mobility systems achieve greater AOM than an anatomical normal hip. As the head diameter increases, the AOM and the JD increases. Increases in head size improve range of motion; however, head sizes over 36-40 mm gain little regarding component stability. The more durable and thinner modern polyethylene liners allow for larger conventional femoral heads. When considering between a classical THA or a dual mobility system, the minimal gains with increasing the head size in using a dual mobility system may be far outweighed by the increase in directional stability offered by the large head THA with highwall liners.

背景全髋关节置换术（THA）后的不稳定性是造成翻修的主要原因。我们的目的是评估外科医生在使用传统的大股骨和双活动度系统获得固有稳定性方面有哪些选择，以及它们之间的活动弧度（AOM）和跳跃距离（JDs）是如何变化的。Autodesk Fusion 360 是一款全尺寸计算机辅助设计软件，可以运行模拟来验证设计。它被用来计算每个模型的 AOM。结果头部尺寸从 22 毫米、28 毫米、32 毫米到 36 毫米的增加表明，每种颈部尺寸的 AOM 都有相当大的增加；但是，头部尺寸大于 36 毫米时，增加的幅度要小得多。随着颈围从 10 毫米增加到 14 毫米，AOM 有所下降。结论传统的全髋关节置换和双活动度系统都能获得比解剖正常髋关节更大的AOM。随着髋臼头直径的增加，AOM和JD也随之增加。髋臼头直径增大可改善活动范围；但髋臼头直径超过36-40毫米时，组件的稳定性几乎没有提高。现代聚乙烯内衬更耐用、更薄，因此可以使用更大的传统股骨头。在考虑传统的 THA 还是双活动度系统时，使用双活动度系统增加头部尺寸所带来的微小收益可能远远超过使用高壁内衬的大头部 THA 所带来的方向稳定性的增加。

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引用次数: 0

What Are the Research Highlights of Periprosthetic Joint Infections From the 100 Most Cited Studies? 被引用次数最多的 100 项研究中有哪些关于假体周围关节感染的研究亮点？

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-11-05 DOI: 10.1016/j.artd.2024.101564

Marcos R. Gonzalez MD , Jose I. Acosta BS , Joshua Davis BS , Felipe Larios MD , Adam S. Olsen MD , Antonia F. Chen MD, MBA

Background

Periprosthetic joint infections (PJIs) are a serious complication after total joint arthroplasty. Our study aimed to analyze the characteristics and research highlights of the top 100 most cited studies on PJI from an orthopaedic standpoint. Moreover, we sought to assess whether there has been a change in the level of evidence (LOE) throughout time.

Methods

We conducted a search of the PubMed, Embase, and Web of Science databases to identify the top 100 studies primarily focusing on PJI. Study characteristics assessed included publication year, LOE, journal of publication, and type of study. Research highlights of the included studies were classified into 6 sections. Linear regression was employed to assess correlation between LOE and publication year.

Results

The aggregated citation count of all studies was 19,558 and the median citation number was 129.5. While cohort studies were the most prevalent, articles focusing on analysis of costs associated with PJI care or PJI definition garnered the highest yearly citation counts. The bulk of included studies were concentrated in 3 orthopaedic journals and published in the 2010s. The majority of studies had a LOE II (30%) or III (34%). On regression analysis, LOE was not correlated with publication year (Pearson’s r = 0.013, P = .61).

Conclusions

The most cited PJI articles assessed the definition of PJI and PJI cost. Despite growing interest in PJI, the majority of studies had LOE II or III, highlighting the difficulty of conducting prospective randomized controlled trials in PJI patients.

Level of evidence

IV.

背景人工关节感染（PJI）是全关节成形术后的一种严重并发症。我们的研究旨在从骨科角度分析被引用次数最多的前 100 篇有关 PJI 的研究的特点和研究亮点。方法我们对PubMed、Embase和Web of Science数据库进行了检索，以确定主要关注PJI的前100项研究。评估的研究特征包括发表年份、LOE、发表期刊和研究类型。纳入研究的研究重点分为 6 个部分。结果所有研究的总引用次数为 19,558 次，中位引用次数为 129.5 次。虽然队列研究最为普遍，但侧重于分析与 PJI 护理相关的成本或 PJI 定义的文章每年获得的引用次数最高。大部分纳入的研究集中在 3 种骨科期刊上，发表于 2010 年代。大多数研究的LOE为II（30%）或III（34%）。在回归分析中，LOE与发表年份无关（Pearson's r = 0.013，P = .61）。结论被引用最多的PJI文章评估了PJI的定义和PJI成本。尽管人们对PJI的兴趣与日俱增，但大多数研究的LOE为II或III，这凸显了对PJI患者进行前瞻性随机对照试验的难度。

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引用次数: 0