Pub Date : 2025-12-01DOI: 10.1016/j.artd.2025.101913
Nimit Vediya , Varun Jain MSc , Praveen Sritharan MD , Aava Param MD , Ajay Shah MD , Darius Luke Lameire MD , Amir Khoshbin MD, MSc, FRCSC
Background
Systematic reviews (SRs) are vital for evidence consolidation in clinical research, utilized for their robust, reproducible methodology. SRs are prone to misrepresentation as they are based on primary studies and the interpretation of their authors. This issue can be particularly significant in arthroplasty, where procedures significantly impact patient quality of life. We aim to determine the prevalence of spin and its associated study characteristics in the top 3 highest impact English arthroplasty specific journals.
Methods
We searched PubMed, MEDLINE, and Embase for SRs and meta-analyses published from March 26, 2015, to March 26, 2025. Two assessors classified spin types based on Yavchitz et al. (2016). Descriptive statistics were computed to determine spin prevalence, and chi-square (χ2) analysis evaluated associations with bibliometric factors.
Results
Spin was present in 48 of 52 SRs (92.3%), with severe spin in 33 of 52 (63.5%). The most common types included type 5 (claims of benefit despite high risk of bias) in 45 of 52 (86.5%) and type 9 (claims of benefit despite reporting bias) in 32 of 52 (61.5%). Type 9 spin was significantly more common in SRs involving randomized controlled trials (88.2%) compared to nonrandomized studies (48.6%, P = .014).
Conclusions
Over the past decade, more than 90% of SRs published in high-impact arthroplasty journals exhibited spin in their abstracts. The most common form involved overstating treatment benefits despite high risk of bias in primary studies, while spin related to reporting bias was significantly more frequent in SRs of randomized evidence.
{"title":"Assessment of “Spin” in the Abstracts of Systematic Reviews in Leading Arthroplasty Journals Over the Past 10 Years: A Cross-Sectional Methodological Study","authors":"Nimit Vediya , Varun Jain MSc , Praveen Sritharan MD , Aava Param MD , Ajay Shah MD , Darius Luke Lameire MD , Amir Khoshbin MD, MSc, FRCSC","doi":"10.1016/j.artd.2025.101913","DOIUrl":"10.1016/j.artd.2025.101913","url":null,"abstract":"<div><h3>Background</h3><div>Systematic reviews (SRs) are vital for evidence consolidation in clinical research, utilized for their robust, reproducible methodology. SRs are prone to misrepresentation as they are based on primary studies and the interpretation of their authors. This issue can be particularly significant in arthroplasty, where procedures significantly impact patient quality of life. We aim to determine the prevalence of spin and its associated study characteristics in the top 3 highest impact English arthroplasty specific journals.</div></div><div><h3>Methods</h3><div>We searched PubMed, MEDLINE, and Embase for SRs and meta-analyses published from March 26, 2015, to March 26, 2025. Two assessors classified spin types based on Yavchitz et al. (2016). Descriptive statistics were computed to determine spin prevalence, and chi-square (χ2) analysis evaluated associations with bibliometric factors.</div></div><div><h3>Results</h3><div>Spin was present in 48 of 52 SRs (92.3%), with severe spin in 33 of 52 (63.5%). The most common types included type 5 (claims of benefit despite high risk of bias) in 45 of 52 (86.5%) and type 9 (claims of benefit despite reporting bias) in 32 of 52 (61.5%). Type 9 spin was significantly more common in SRs involving randomized controlled trials (88.2%) compared to nonrandomized studies (48.6%, <em>P</em> = .014).</div></div><div><h3>Conclusions</h3><div>Over the past decade, more than 90% of SRs published in high-impact arthroplasty journals exhibited spin in their abstracts. The most common form involved overstating treatment benefits despite high risk of bias in primary studies, while spin related to reporting bias was significantly more frequent in SRs of randomized evidence.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101913"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.artd.2025.101907
Ravi K. Bashyal MD , Avinash Inabathula MD , Samantha Lariosa BS , S. David Stulberg MD
Background
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.
Methods
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.
Results
Overall, the PJI rate was 0% (0 of 1042) in the XP group and 0.6% (6/1045) in the povidone-iodine group (P = .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 (P = .11).
Conclusions
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.
背景原发性髋关节和膝关节置换术中假体周围关节感染（PJI）的预防仍然是关节置换术中的一个重要挑战。外用稀聚维酮碘，然后用无菌生理盐水冲洗，广泛用于术中冲洗和手术感染预防。美国食品和药物管理局（Food and Drug Administration）最近发布了一项提醒，提醒人们在深度手术伤口中使用局部碘制剂的非无菌性。因此，我们的机构寻求一种绝育的替代方案。我们研究了一种具有最小细胞毒性、对生物膜有效且无需二次冲洗的终末无菌冲洗剂。方法：本研究是一项单一外科医生回顾性队列研究，在一家大城市社区医院进行了至少1年随访的2087例连续原发性全髋关节和膝关节置换术。对照组1045例，先用稀聚维酮碘浸泡，再用生理盐水冲洗。试验组1042例患者采用新型冲洗剂XPerience (XP)，不进行二次冲洗。2018年国际共识会议推荐了用于诊断PJI的算法和标准。结果总的来说，XP组的PJI率为0%(0 / 1042)，聚维酮碘组为0.6% (6/1045)（P = 0.017）。XP组总手术室回复率为0.5%（1042例中的5例），对照组为1.1%（1045例中的12例）（P = 0.11）。结论新型溶液在我们的队列中具有较低的感染率。我们的结论是，它是一种与聚维酮碘相当的替代品。一项正在进行的前瞻性随机对照试验和成本效益分析可能为外科医生提供更强的指导。
{"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 , Avinash Inabathula MD , Samantha Lariosa BS , 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}
Pub Date : 2025-12-01DOI: 10.1016/j.artd.2025.101910
Ayesha Abdeen MD , Nelson Merchan MD , Marcos R. Gonzalez MD , Joshua B. Davis BS , Jacob Drew MD , Rubén Monárrez MD , Antonia F. Chen MD, MBA , Edward K. Rodriguez MD
Background
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.
Methods
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.
Results
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 (P = .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, P < .001). The revision rate was 46% in the metallosis and PJI group and 24% in the control group (P = .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, (P = .21).
Conclusions
Metallosis may increase the likelihood of initial false negative culture results and delay PJI diagnosis in patients undergoing revision THA.
{"title":"Presence of Metallosis Can Interfere With Culture Positivity in Prosthetic Joint Infection of the Hip","authors":"Ayesha Abdeen MD , Nelson Merchan MD , Marcos R. Gonzalez MD , Joshua B. Davis BS , Jacob Drew MD , Rubén Monárrez MD , Antonia F. Chen MD, MBA , 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> < .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}
Pub Date : 2025-12-01DOI: 10.1016/j.artd.2025.101914
Andrew Ni MD, Shawn Dripchak MD, Coltin Gerhart MD, Victor Martinez DO, Zachary Jodoin MD, Chance Moore MD, Frank Buttacavoli MD
Background
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.
Methods
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 < 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.
Results
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, P ≤ 0.001) and rTKA patients (HR = 1.20, 95% CI, 1.03-1.41, P = .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, P = .009) and (HR = 0.72, 95% CI, 0.53-0.97, P = .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.
Conclusions
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.
{"title":"Preoperative Malnutrition Is Associated With Increased Rates of Periprosthetic Fractures in Total Knee Arthroplasty","authors":"Andrew Ni MD, Shawn Dripchak MD, Coltin Gerhart MD, Victor Martinez DO, Zachary Jodoin MD, Chance Moore MD, 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 < 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}
Pub Date : 2025-12-01DOI: 10.1016/j.artd.2025.101890
Bailey J. Ross MD , Jacob Glassman BS , Grayson Nour BS , Jacob M. Wilson MD , Jose A. Rodriguez MD , Ajay Premkumar MD, MPH
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.
{"title":"Utilization of an Anteromedial Cortical Window for Tibial Component Removal During Revision Total Knee Arthroplasty","authors":"Bailey J. Ross MD , Jacob Glassman BS , Grayson Nour BS , Jacob M. Wilson MD , Jose A. Rodriguez MD , 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}
Pub Date : 2025-12-01DOI: 10.1016/j.artd.2025.101919
Zachary Gapinski MD, Nichole Perry MD, Reese Courington MD, Ameer Tabbaa MD, Cody Green MD, George Haidukewych MD
Background
Patellar height changes may have significant clinical implications, particularly in the setting of revision total knee arthroplasty (rTKA). True patella baja (PB) is due to patellar tendon shortening, whereas pseudo-PB (PPB) is distal displacement of the patella due to joint line elevation. Our purpose was to examine the incidence and risk factors associated with PB and PPB following rTKA.
Methods
A retrospective analysis of 415 rTKAs by a single surgeon between 2009 and 2019 was conducted. PB was defined by an Insall-Salvati ratio less than 0.8 and a Blackburne-Peel ratio less than 0.54. PPB was characterized by a relatively lower patella position compared to the joint line, but within the normal range of Insall-Salvati ratio (0.8-1.2) with a Blackburne-Peel ratio less than 0.54. Univariate and multiple regression analysis identified risk factors for PB and PPB.
Results
After rTKA of 375 included knees, incidence of PB was 24% and PPB was 14%. Patients revised for infection were 9 times more likely to develop PB compared to other indications (P = .002). Number of prior surgeries and preoperative PB also increased the risk of postoperative PB (OR, 2.18; P = .013; OR, 319.90; P < .001). PB and PPB groups showed minimal change in range of motion from preoperative to final follow-up (−1.6 and 0.6°), whereas patients with normal patella height showed an average range of motion increase of 7.2°.
Conclusions
Identifying risk factors for PB and PPB such as preoperative patella height, number of previous surgeries, and revision indication of infection may help surgeons to address this difficult problem.
{"title":"Patella Baja Incidence, Risk Factors and Motion After Revision Total Knee Arthroplasty","authors":"Zachary Gapinski MD, Nichole Perry MD, Reese Courington MD, Ameer Tabbaa MD, Cody Green MD, George Haidukewych MD","doi":"10.1016/j.artd.2025.101919","DOIUrl":"10.1016/j.artd.2025.101919","url":null,"abstract":"<div><h3>Background</h3><div>Patellar height changes may have significant clinical implications, particularly in the setting of revision total knee arthroplasty (rTKA). True patella baja (PB) is due to patellar tendon shortening, whereas pseudo-PB (PPB) is distal displacement of the patella due to joint line elevation. Our purpose was to examine the incidence and risk factors associated with PB and PPB following rTKA.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 415 rTKAs by a single surgeon between 2009 and 2019 was conducted. PB was defined by an Insall-Salvati ratio less than 0.8 and a Blackburne-Peel ratio less than 0.54. PPB was characterized by a relatively lower patella position compared to the joint line, but within the normal range of Insall-Salvati ratio (0.8-1.2) with a Blackburne-Peel ratio less than 0.54. Univariate and multiple regression analysis identified risk factors for PB and PPB.</div></div><div><h3>Results</h3><div>After rTKA of 375 included knees, incidence of PB was 24% and PPB was 14%. Patients revised for infection were 9 times more likely to develop PB compared to other indications (<em>P</em> = .002). Number of prior surgeries and preoperative PB also increased the risk of postoperative PB (OR, 2.18; <em>P</em> = .013; OR, 319.90; <em>P</em> < .001). PB and PPB groups showed minimal change in range of motion from preoperative to final follow-up (−1.6 and 0.6°), whereas patients with normal patella height showed an average range of motion increase of 7.2°.</div></div><div><h3>Conclusions</h3><div>Identifying risk factors for PB and PPB such as preoperative patella height, number of previous surgeries, and revision indication of infection may help surgeons to address this difficult problem.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101919"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.artd.2025.101915
Yasushi Oshima MD, PhD, Tokifumi Majima MD, PhD
Background
Total knee arthroplasty (TKA) for severe varus knee deformity with an uncontained medial tibial bone defect remains challenging for orthopaedic surgeons because additional bone resection to remove the bone defect area, application of metal augmentation, and adjustment of soft tissue balancing are technically difficult. Robotic technology has been demonstrated to achieve accurate bone resection and optimal soft tissue balancing in TKA. This study aimed to present a case series of the application of robotic-assisted TKA with metal augmentation for severe varus knee.
Methods
Fifteen patients with 22 affected knees and postoperative follow-up of longer than 12 months were included in this study. Primary TKA with metal block augmentation was performed using robotic technology, and the implant positions, soft tissue balancing, and clinical outcomes were evaluated.
Results
The visual analog scale score and knee injury and osteoarthritis outcome score were significantly improved. In addition, the lower extremity alignment and implant positions in the coronal and sagittal planes were radiographically accurate. Moreover, the medial knee stability was maintained, and lateral looseness diminished postoperatively.
Conclusions
To resect the bone defect area perfectly the same as the depth of metal augmentations was technically difficult in conventional TKA. However, besides the primary bone resections, residual bone defect evaluation, soft tissue balancing adjustment, and additional bone resection to remove the bone defect area were performed easily and accurately using robotic technology. Therefore, robotic technology provides potential benefits for TKA with metal block augmentation in severe varus knees with medial tibial bone defects.
{"title":"Robotic-Assisted Total Knee Arthroplasty With Metal Block Augmentation for Severe Varus Knee With Tibial Defect","authors":"Yasushi Oshima MD, PhD, Tokifumi Majima MD, PhD","doi":"10.1016/j.artd.2025.101915","DOIUrl":"10.1016/j.artd.2025.101915","url":null,"abstract":"<div><h3>Background</h3><div>Total knee arthroplasty (TKA) for severe varus knee deformity with an uncontained medial tibial bone defect remains challenging for orthopaedic surgeons because additional bone resection to remove the bone defect area, application of metal augmentation, and adjustment of soft tissue balancing are technically difficult. Robotic technology has been demonstrated to achieve accurate bone resection and optimal soft tissue balancing in TKA. This study aimed to present a case series of the application of robotic-assisted TKA with metal augmentation for severe varus knee.</div></div><div><h3>Methods</h3><div>Fifteen patients with 22 affected knees and postoperative follow-up of longer than 12 months were included in this study. Primary TKA with metal block augmentation was performed using robotic technology, and the implant positions, soft tissue balancing, and clinical outcomes were evaluated.</div></div><div><h3>Results</h3><div>The visual analog scale score and knee injury and osteoarthritis outcome score were significantly improved. In addition, the lower extremity alignment and implant positions in the coronal and sagittal planes were radiographically accurate. Moreover, the medial knee stability was maintained, and lateral looseness diminished postoperatively.</div></div><div><h3>Conclusions</h3><div>To resect the bone defect area perfectly the same as the depth of metal augmentations was technically difficult in conventional TKA. However, besides the primary bone resections, residual bone defect evaluation, soft tissue balancing adjustment, and additional bone resection to remove the bone defect area were performed easily and accurately using robotic technology. Therefore, robotic technology provides potential benefits for TKA with metal block augmentation in severe varus knees with medial tibial bone defects.</div></div><div><h3>Level of evidence</h3><div>Level IV case series study.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101915"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.artd.2025.101866
Mia J. Fowler BS , Allina A. Nocon PhD, MPH , Yu-fen Chiu MS , Kathleen Tam MPH , Alberto V. Carli MD, MSc
Background
Extended oral antibiotic prophylaxis (EOAP) has gained popularity after a study showed an 81% reduction in periprosthetic joint infection (PJI) among “high-risk” patients undergoing total joint arthroplasty (TJA). However, subsequent studies report inconsistent efficacy, particularly in revision TJA (rTJA) where PJI risk is higher. EOAP also conflicts with antibiotic stewardship principles. To optimize EOAP use, consensus on “high-risk” patients is needed. This study determined which preoperative comorbidities from the Inabathula comorbidities (IC) actually increase PJI risk in aseptic rTJA patients.
Methods
1995 consecutive aseptic rTJAs (1014 hips, 981 knees) met criteria for retrospective analysis. International Classification of Diseases-10 codes identified IC comorbidities, including autoimmune diseases, smoking, among others. Reoperations for PJI at 90 days and 1 year were recorded. Chi-squared/Fisher’s exact tests analyzed associations between IC and PJI. Multivariable logistic regressions evaluated specific comorbidities’ contributions to PJI risk.
Results
502 (50%) revision hips and 580 (60%) revision knees had at least 1 IC. Having at least 1 IC did not significantly increase the risk of developing PJI for revision hips. Only body mass index >35 kg/m2 (90-day RR = 3.5; P = .011; 1-year RR = 3.0; P = .014) and chronic kidney disease (90-day RR = 4.1; P = .016; 1-year RR = 4.0; P = .006) were the comorbidities significantly associated with developing PJI for revision hip cases. Meanwhile for knees, having at least 1 IC produced a 3.6x-fold increased relative risk for developing PJI at 1 year (P = .010). However, on multivariate analysis, diabetes mellitus was the only comorbidity significantly associated (90-day odds ratio = 3.5; 95% confidence interval [1.3-9.4]; 1-year odds ratio = 3.3; 95% confidence interval [1.4-7.7]) with developing PJI for revision knee cases. In hips and knees, having >3 IC comorbidities conferred the highest odds of PJI.
Conclusions
Although over half of rTJA patients meet IC and could be eligible for EOAP, very few comorbidities significantly confer increased PJI risk. Prospective EOAP studies should consider using indications that are stricter than the IC to avoid unnecessary antibiotic use.
一项研究显示，在接受全关节置换术（TJA）的“高风险”患者中，延长口服抗生素预防（EOAP）已得到普及，假体周围关节感染（PJI）减少81%。然而，随后的研究报告了不一致的疗效，特别是在PJI风险较高的改良TJA （rTJA）中。EOAP也与抗生素管理原则相冲突。为了优化EOAP的使用，需要对“高危”患者达成共识。本研究确定了Inabathula合并症（IC）中的哪些术前合并症实际上增加了无菌性rTJA患者PJI的风险。方法回顾性分析1995例符合标准的连续无菌rTJAs（1014髋，981膝）。国际疾病分类-10个代码确定了IC合并症，包括自身免疫性疾病，吸烟等。记录第90天和第1年PJI再手术情况。卡方/费雪精确检验分析了IC和PJI之间的关联。多变量logistic回归评估了特定合并症对PJI风险的贡献。结果502例（50%）翻修髋关节和580例（60%）翻修膝关节至少有1个IC。至少有1个IC并未显著增加翻修髋关节发生PJI的风险。只有体重指数35 kg/m2（90天RR = 3.5; P = 0.011； 1年RR = 3.0; P = 0.014）和慢性肾脏疾病（90天RR = 4.1; P = 0.016； 1年RR = 4.0; P = 0.006）是髋关节翻修患者发生PJI的合并症。与此同时，对于膝关节，至少有1个IC导致1年内发生PJI的相对风险增加3.6倍（P = 0.010）。然而，在多因素分析中，糖尿病是唯一与膝关节翻修病例发生PJI显著相关的合并症（90天优势比= 3.5；95%可信区间[1.3-9.4]；1年优势比= 3.3；95%可信区间[1.4-7.7]）。在髋关节和膝关节，有3种IC合并症的患者患PJI的几率最高。结论：虽然超过一半的rTJA患者符合IC并有资格接受EOAP，但很少有合并症显著增加PJI风险。前瞻性EOAP研究应考虑使用比IC更严格的适应症，以避免不必要的抗生素使用。
{"title":"Clarifying Potential Candidates for Extended Oral Antibiotic Prophylaxis: A Retrospective Analysis of Risk Factors for Infection Following Revision Hip and Knee Arthroplasty","authors":"Mia J. Fowler BS , Allina A. Nocon PhD, MPH , Yu-fen Chiu MS , Kathleen Tam MPH , Alberto V. Carli MD, MSc","doi":"10.1016/j.artd.2025.101866","DOIUrl":"10.1016/j.artd.2025.101866","url":null,"abstract":"<div><h3>Background</h3><div>Extended oral antibiotic prophylaxis (EOAP) has gained popularity after a study showed an 81% reduction in periprosthetic joint infection (PJI) among “high-risk” patients undergoing total joint arthroplasty (TJA). However, subsequent studies report inconsistent efficacy, particularly in revision TJA (rTJA) where PJI risk is higher. EOAP also conflicts with antibiotic stewardship principles. To optimize EOAP use, consensus on “high-risk” patients is needed. This study determined which preoperative comorbidities from the Inabathula comorbidities (IC) actually increase PJI risk in aseptic rTJA patients.</div></div><div><h3>Methods</h3><div>1995 consecutive aseptic rTJAs (1014 hips, 981 knees) met criteria for retrospective analysis. International Classification of Diseases-10 codes identified IC comorbidities, including autoimmune diseases, smoking, among others. Reoperations for PJI at 90 days and 1 year were recorded. Chi-squared/Fisher’s exact tests analyzed associations between IC and PJI. Multivariable logistic regressions evaluated specific comorbidities’ contributions to PJI risk.</div></div><div><h3>Results</h3><div>502 (50%) revision hips and 580 (60%) revision knees had at least 1 IC. Having at least 1 IC did not significantly increase the risk of developing PJI for revision hips. Only body mass index >35 kg/m<sup>2</sup> (90-day RR = 3.5; <em>P</em> = .011; 1-year RR = 3.0; <em>P</em> = .014) and chronic kidney disease (90-day RR = 4.1; <em>P</em> = .016; 1-year RR = 4.0; <em>P</em> = .006) were the comorbidities significantly associated with developing PJI for revision hip cases. Meanwhile for knees, having at least 1 IC produced a 3.6x-fold increased relative risk for developing PJI at 1 year (<em>P</em> = .010). However, on multivariate analysis, diabetes mellitus was the only comorbidity significantly associated (90-day odds ratio = 3.5; 95% confidence interval [1.3-9.4]; 1-year odds ratio = 3.3; 95% confidence interval [1.4-7.7]) with developing PJI for revision knee cases. In hips and knees, having >3 IC comorbidities conferred the highest odds of PJI.</div></div><div><h3>Conclusions</h3><div>Although over half of rTJA patients meet IC and could be eligible for EOAP, very few comorbidities significantly confer increased PJI risk. Prospective EOAP studies should consider using indications that are stricter than the IC to avoid unnecessary antibiotic use.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101866"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.artd.2025.101931
Elizabeth Lieberman MD
{"title":"Replace the Joint, Preserve the Surgeon: The Importance of Maintaining Physical and Emotional Health as an Arthroplasty Surgeon","authors":"Elizabeth Lieberman MD","doi":"10.1016/j.artd.2025.101931","DOIUrl":"10.1016/j.artd.2025.101931","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101931"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.artd.2025.101906
Nelo J.Z. Chihal Lima MD, Vasfi Karatosun MD
Background
Proximal femoral replacement (PFR) has gained popularity in nononcological reconstruction surgeries over recent decades. However, there is sparse literature on its application in extensive bone defects following 2-stage revision treatment for periprosthetic joint infection (PJI). This study retrospectively evaluates the clinical and functional outcomes, complication rates, and prosthesis survivorship in patients undergoing PFR surgery for severe bone defects due to 2-stage PJI treatment.
Method
This single-center retrospective study analyzed patients who underwent PFR as part of a 2-stage treatment for hip arthroplasty-related PJI between 2010 and 2020. All patients had extensive proximal femoral bone loss (Paprosky type 3B and 4) before the PFR surgery. Inclusion required a minimum follow-up period of 24 months. Functional outcomes were evaluated using the Musculoskeletal Tumor Society Score (MSTS), while PFR prosthesis failure was classified according to Henderson's Classification. Combined PFR and acetabular prosthesis survival was determined using Kaplan–Meier survival curves.
Results
Thirty-four patients (21 women and 13 men, average age 72.9) were included in the study. The mean follow-up was 75 months (range: 24-132). Pre-PFR surgeries averaged 3.88 per patient (range: 2-13). Mechanical complications were present in 7 patients (20.6%), nonmechanical complications in 8 (23.5%), and 2 patients (5.9%) had both. The mean MSTS score was 66.74%. The all-cause complication-free survival rate was 80% in the second year and decreased to 52% by the fifth year. The all-cause revision-free rate was 73 % in the second year and decreased to 47% by the fifth year.
Conclusions
PFR is effective for limb salvage in complex cases but comes with high mechanical and non-mechanical complications and moderate to poor survival rates. While larger femoral heads and constrained liners help reduce dislocation, infection remains a significant issue. The gap between high MSTS scores and difficulties in daily activities signals a need for improved functional assessment tools. These findings highlight the persistent challenges in managing PJIs.
{"title":"Extensive Femoral Bone Loss Following Two-Stage Periprosthetic Joint Infection Treatment: Persistent Challenges in Proximal Femoral Replacement","authors":"Nelo J.Z. Chihal Lima MD, Vasfi Karatosun MD","doi":"10.1016/j.artd.2025.101906","DOIUrl":"10.1016/j.artd.2025.101906","url":null,"abstract":"<div><h3>Background</h3><div>Proximal femoral replacement (PFR) has gained popularity in nononcological reconstruction surgeries over recent decades. However, there is sparse literature on its application in extensive bone defects following 2-stage revision treatment for periprosthetic joint infection (PJI). This study retrospectively evaluates the clinical and functional outcomes, complication rates, and prosthesis survivorship in patients undergoing PFR surgery for severe bone defects due to 2-stage PJI treatment.</div></div><div><h3>Method</h3><div>This single-center retrospective study analyzed patients who underwent PFR as part of a 2-stage treatment for hip arthroplasty-related PJI between 2010 and 2020. All patients had extensive proximal femoral bone loss (Paprosky type 3B and 4) before the PFR surgery. Inclusion required a minimum follow-up period of 24 months. Functional outcomes were evaluated using the Musculoskeletal Tumor Society Score (MSTS), while PFR prosthesis failure was classified according to Henderson's Classification. Combined PFR and acetabular prosthesis survival was determined using Kaplan–Meier survival curves.</div></div><div><h3>Results</h3><div>Thirty-four patients (21 women and 13 men, average age 72.9) were included in the study. The mean follow-up was 75 months (range: 24-132). Pre-PFR surgeries averaged 3.88 per patient (range: 2-13). Mechanical complications were present in 7 patients (20.6%), nonmechanical complications in 8 (23.5%), and 2 patients (5.9%) had both. The mean MSTS score was 66.74%. The all-cause complication-free survival rate was 80% in the second year and decreased to 52% by the fifth year. The all-cause revision-free rate was 73 % in the second year and decreased to 47% by the fifth year.</div></div><div><h3>Conclusions</h3><div>PFR is effective for limb salvage in complex cases but comes with high mechanical and non-mechanical complications and moderate to poor survival rates. While larger femoral heads and constrained liners help reduce dislocation, infection remains a significant issue. The gap between high MSTS scores and difficulties in daily activities signals a need for improved functional assessment tools. These findings highlight the persistent challenges in managing PJIs.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101906"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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