Arthroplasty Today最新文献_第4页

Cefazolin Alone Versus Cefazolin With Tobramycin or Gentamicin as Intraoperative Antibiotic Prophylaxis for Total Joint Arthroplasty

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2024.101613

Meera M. Dhodapkar MD, MHS, Scott J. Halperin MD, MHS, Zachary Radford MD, Lee E. Rubin MD, FAAOS, FAOA, Jonathan N. Grauer MD, Mengnai Li FAAOS, MD, PhD

Background

Prosthetic joint infection is a serious complication of total knee arthroplasty (TKA) and total hip arthroplasty (THA). While cefazolin is the standard prophylactic antibiotic, some groups have considered adding aminoglycosides (gentamycin or tobramycin) to this regimen.

Methods

Adult primary THA and TKA patients were identified from 2010-2021 Q1 PearlDiver M151 database. Inclusion criteria were activity in the database ≥ 90 days postoperative and no infectious, neoplastic, or traumatic diagnoses within 90 days preoperative. Intraoperative antibiotic prophylaxis regimens were determined using Current Procedural Terminology J codes. For both THA and TKA, 2 subcohorts were created: (1) Patients who received cefazolin alone and (2) cefazolin and tobramycin or gentamicin. Differences in 90-day postoperative adverse outcomes were assessed with multivariable logistic regression controlling for age, sex, and Elixhauser Comorbidity Index. Five-year implant survival was assessed using Kaplan-Meier analysis and log-rank tests.

Results

For THA, 32,882 patients were identified, prophylactic cefazolin alone was given to 30,527 (92.8%), and cefazolin + gentamicin/tobramycin was given to 2355 (7.2%). For TKA, 119,611 patients were identified, prophylactic cefazolin alone was given to 110,469 (92.4%), and cefazolin + gentamicin/tobramycin was given to 9142 (7.6%). Overall SSI rate for THA was 1.1% and for TKA 0.8%. For both THA and TKA, antibiotic subgroups were clinically similar with regard to age, sex, and Elixhauser Comorbidity Index. On univariable and multivariable analysis, no 90-day outcomes varied significantly. Five-year implant survivals were not significantly different.

Conclusions

For THA and TKA, cefazolin alone vs cefazolin + gentamicin/tobramycin were not found to have differences in rates of perioperative adverse outcomes (including SSI/prosthetic joint infection) or 5-year revision rates.

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引用次数: 0

Routine Pathologic Examination of Femoral Heads is Not Warranted

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2025.101624

Brian Curtin MD, Brett Levine MD, MS, Sumon Nandi MD, MBA

引用次数: 0

Ascorbic Acid Reduces the Blood Boss After Total Knee Arthroplasty: Insights From a Randomized Controlled Trial

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2025.101618

Pooya Hosseini-Monfared MD , Alireza Mirahmadi MD , Mohammad Mehdi Sarzaeem MD , Soheil Pourshahryari MD , Parisa Aminnia MD , Mohammad Poursalehian MD , Seyed Morteza Kazemi MD

Background

Blood loss is among the main complications of total knee arthroplasty (TKA) and oxidative stress, and hemolysis caused by reactive oxygen species are one of the causes of hemoglobin (Hb) drop. Ascorbic acid is a potent antioxidant that can protect against reactive oxygen species. In this study, we aim to explore the antioxidant effect of ascorbic acid on blood loss and patient-reported outcomes following outpatient TKA.

Methods

Patients scheduled for outpatient primary TKA were enrolled in this randomized, double-blind clinical trial and were assigned to 1 of the 2 groups. The patients in the ascorbic acid group received intravenous vitamin C perioperatively. Patients in the placebo group received only normal saline. We calculated the blood loss using the Hb drop. Patient-reported outcomes such as Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score, and Forgotten Joint Score were used to evaluate the postoperative pain and function in the 6-month follow-up.

Results

The patients who have received ascorbic acid had lower Hb drop (g/dL) (1.30 ± 0.72 vs 1.91 ± 0.84, P value < .001) and total blood loss in the first postoperative day (463.60 ± 274.37 vs 732.11 ± 347.78, P value < .001). Also, fewer patients reached the minimum clinically important difference level for Hb drop in the ascorbic acid group. The patients’ postoperative functional and pain scores were not different between the 2 groups.

Conclusions

Our findings demonstrated that perioperative use of ascorbic acid can reduce blood loss by nearly 36% on the first postoperative day and should be considered as an effective blood-preserving agent in conjunction with tranexamic acid during TKA.

{"title":"Ascorbic Acid Reduces the Blood Boss After Total Knee Arthroplasty: Insights From a Randomized Controlled Trial","authors":"Pooya Hosseini-Monfared MD , Alireza Mirahmadi MD , Mohammad Mehdi Sarzaeem MD , Soheil Pourshahryari MD , Parisa Aminnia MD , Mohammad Poursalehian MD , Seyed Morteza Kazemi MD","doi":"10.1016/j.artd.2025.101618","DOIUrl":"10.1016/j.artd.2025.101618","url":null,"abstract":"<div><h3>Background</h3><div>Blood loss is among the main complications of total knee arthroplasty (TKA) and oxidative stress, and hemolysis caused by reactive oxygen species are one of the causes of hemoglobin (Hb) drop. Ascorbic acid is a potent antioxidant that can protect against reactive oxygen species. In this study, we aim to explore the antioxidant effect of ascorbic acid on blood loss and patient-reported outcomes following outpatient TKA.</div></div><div><h3>Methods</h3><div>Patients scheduled for outpatient primary TKA were enrolled in this randomized, double-blind clinical trial and were assigned to 1 of the 2 groups. The patients in the ascorbic acid group received intravenous vitamin C perioperatively. Patients in the placebo group received only normal saline. We calculated the blood loss using the Hb drop. Patient-reported outcomes such as Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score, and Forgotten Joint Score were used to evaluate the postoperative pain and function in the 6-month follow-up.</div></div><div><h3>Results</h3><div>The patients who have received ascorbic acid had lower Hb drop (g/dL) (1.30 ± 0.72 vs 1.91 ± 0.84, <em>P</em> value < .001) and total blood loss in the first postoperative day (463.60 ± 274.37 vs 732.11 ± 347.78, <em>P</em> value < .001). Also, fewer patients reached the minimum clinically important difference level for Hb drop in the ascorbic acid group. The patients’ postoperative functional and pain scores were not different between the 2 groups.</div></div><div><h3>Conclusions</h3><div>Our findings demonstrated that perioperative use of ascorbic acid can reduce blood loss by nearly 36% on the first postoperative day and should be considered as an effective blood-preserving agent in conjunction with tranexamic acid during TKA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101618"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143092285","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

Age- and Sex-Specific Risks of Major Cardiovascular Complications and All-Cause Mortality Following Elective Hip and Knee Arthroplasty in the Netherlands: A Dutch Hospital Data Registry Study

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2024.101597

Mark J.R. Smeets MD , Maaike G.J. Gademan PhD , Rob G.H.H. Nelissen MD, PhD , Suzanne C. Cannegieter MD, PhD , Banne Nemeth MD, PhD

Background

Age and sex are well-known risk factors for cardiovascular complications and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Yet, stratified up-to-date absolute risk estimates, which are needed to optimize prevention, are lacking.

Methods

All Dutch patients who had a first primary THA and TKA for osteoarthritis between 2015 and 2021 were included. Data on baseline characteristics, procedures, and outcomes were obtained from the Dutch Hospital Data and Population registries, after linkage. Overall risks for venous thromboembolism, arterial thromboembolism, bleeding, and all-cause mortality were estimated at 30 and 90 days following surgery. Time trends were assessed by plotting 90-day risks by year. Lastly, 90-day risks were stratified by age and sex categories.

Results

A total of 123,809 THA and 132,726 TKA patients were included. Females accounted for 63% and 65% of THA and TKA patients, respectively. At 90 days, overall risks were all below 1%. We observed no clear time trends in the risks over recent years. The stratified analysis showed that especially men older than 80 have a complication risk of at least 3%. Interestingly, the risk of venous thromboembolism and bleeding, following a THA, was observed to be relatively high in men and women in the youngest age category.

Conclusions

Generally, the 90-day incidence of cardiovascular complications and all-cause mortality is low but can be at least 3% for men in the highest age category. With this knowledge, perioperative preventive measures can be targeted more precisely, and shared decision-making improved.

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引用次数: 0

Evaluation of Active Intraoperative Nerve Monitoring in Severe Developmental Dysplasia of the Hip Patients Undergoing Total Hip Arthroplasty

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2024.101612

Alireza Manafi Rasi MD , Sina Afzal Dr. MD , Mojtaba Baroutkoub MD , Hasan Shakiba MD , Pooya Kalani MD , Mehdi Tavassoli MD , Reza Zarei MD

Background

Total hip arthroplasty (THA) stands as the standard treatment in neglected developmental dysplasia of the hip (DDH), and its application in severe cases may be linked to debilitating outcomes, including nerve damage. Here, we aimed to report the results of intraoperative nerve monitoring (IONM) via an active method.

Methods

In this retrospective cohort study, we recruited patients with Crowe types III and IV DDH, who underwent THA. The study comprised 2 cohorts: one without nerve monitoring and the other with active IONM under epidural anesthesia. The primary study outcomes included the incidence of neural complications, the extent of achieved leg lengthening, and the necessity for femoral osteotomy.

Results

A total of 183 patients were included in this study as the cases underwent THA under epidural anesthesia and IONM, along with 156 historical cohorts of controls. In the group with IONM, no clinically postoperative nerve injury was detected, while in the control group, 6 (3.8%) patients experienced neural complications (P = .08). The mean achieved limb lengthening was significantly greater in the monitoring group as 4.2 cm (range = 2.4-5.6) than in the control group as 3.56 cm (range = 2.2-5.6) (P = .04). The rate of femoral osteotomy was significantly lower in the monitoring group (13.6%, 25/183) compared to the control group (27.5%, 43/156) (P < .005).

Conclusions

The utilization of active IONM in patients under epidural anesthesia during THA for severe DDH proves to be an effective approach. This method allows for real-time assessment of nerve function throughout the surgical procedure, demonstrating its potential to minimize postoperative complications.

{"title":"Evaluation of Active Intraoperative Nerve Monitoring in Severe Developmental Dysplasia of the Hip Patients Undergoing Total Hip Arthroplasty","authors":"Alireza Manafi Rasi MD , Sina Afzal Dr. MD , Mojtaba Baroutkoub MD , Hasan Shakiba MD , Pooya Kalani MD , Mehdi Tavassoli MD , Reza Zarei MD","doi":"10.1016/j.artd.2024.101612","DOIUrl":"10.1016/j.artd.2024.101612","url":null,"abstract":"<div><h3>Background</h3><div>Total hip arthroplasty (THA) stands as the standard treatment in neglected developmental dysplasia of the hip (DDH), and its application in severe cases may be linked to debilitating outcomes, including nerve damage. Here, we aimed to report the results of intraoperative nerve monitoring (IONM) via an active method.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we recruited patients with Crowe types III and IV DDH, who underwent THA. The study comprised 2 cohorts: one without nerve monitoring and the other with active IONM under epidural anesthesia. The primary study outcomes included the incidence of neural complications, the extent of achieved leg lengthening, and the necessity for femoral osteotomy.</div></div><div><h3>Results</h3><div>A total of 183 patients were included in this study as the cases underwent THA under epidural anesthesia and IONM, along with 156 historical cohorts of controls. In the group with IONM, no clinically postoperative nerve injury was detected, while in the control group, 6 (3.8%) patients experienced neural complications (<em>P</em> = .08). The mean achieved limb lengthening was significantly greater in the monitoring group as 4.2 cm (range = 2.4-5.6) than in the control group as 3.56 cm (range = 2.2-5.6) (<em>P</em> = .04). The rate of femoral osteotomy was significantly lower in the monitoring group (13.6%, 25/183) compared to the control group (27.5%, 43/156) (<em>P</em> < .005).</div></div><div><h3>Conclusions</h3><div>The utilization of active IONM in patients under epidural anesthesia during THA for severe DDH proves to be an effective approach. This method allows for real-time assessment of nerve function throughout the surgical procedure, demonstrating its potential to minimize postoperative complications.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"31 ","pages":"Article 101612"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081007","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

Patient Perspective on Robotic-Assisted Total Joint Arthroplasty 患者对机器人辅助全关节成形术的看法。

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2024.101598

Siddhartha Dandamudi BBA , Kyleen Jan MD , Madelyn Malvitz BS , Anne DeBenedetti MSc , Omar Behery MD, MPH , Brett R. Levine MD, MS

Background

Robotic-assisted total joint arthroplasty (TJA) has gained popularity in recent years. Despite mixed patient and surgeon perceptions, conflicting evidence regarding efficacy and cost-effectiveness in comparison to manual TJA exists. Patients' beliefs surrounding robotic-assisted TJA remain unclear. This study aims to assess patients' expectations on robotic technology in TJA.

Methods

A 9-question survey assessing patient understanding and expectations of the use of robotics in TJA was distributed to preoperative and postoperative hip and knee patients of five surgeons at a high-volume academic center. Responses were descriptively analyzed.

Results

A total of 498 responses were collected. Of all respondents, 69.1% are aware of robotic usage in TJA, 68.5% are interested but unsure of the benefits, and only 19.5% feel it is superior to manual surgery. Most patients did not consider robotic TJA as minimally invasive surgery, with 61.7% stating they are not the same. In addition, 52.3% were not comfortable with extra or longer incisions for robotic procedures. Regarding surgeon choice, 94.9% did not consider if the surgeon is able to perform robotic TJA, 74.4% wanted their surgeon proficient in manual TJA, and 72.4% felt that surgeons who use robotic technology are not more capable than manual surgeons.

Conclusions

Awareness and curiosity of robotic-assisted TJA exists; however, most patients did not appear to acknowledge superiority or benefits over manual surgery. Furthermore, patients appear to prefer surgeon proficiency in manual techniques, which may influence training programs in the future. Surgeons should weigh patient goals, expectations, outcomes, and costs when choosing to perform robotic TJA.

背景：机器人辅助全关节置换术（TJA）近年来越来越受欢迎。尽管患者和外科医生的看法不一，但与手工TJA相比，关于疗效和成本效益的证据相互矛盾。患者对机器人辅助TJA的看法尚不清楚。本研究旨在评估患者对机器人技术在TJA中的期望。方法：对某大容量学术中心的5位外科医生的髋关节和膝关节术前和术后患者进行9个问题的调查，评估患者对机器人技术在TJA中使用的理解和期望。对反馈进行描述性分析。结果：共收集问卷498份。在所有受访者中，69.1%的人知道机器人在TJA中的使用，68.5%的人感兴趣但不确定好处，只有19.5%的人认为它优于人工手术。大多数患者不认为机器人TJA是微创手术，61.7%的患者表示他们不一样。此外，52.3%的人对机器人手术的额外或更长的切口感到不舒服。在选择外科医生时，94.9%的人不考虑外科医生是否会进行机器人TJA， 74.4%的人希望他们的外科医生熟练进行手动TJA， 72.4%的人认为使用机器人技术的外科医生并不比手动外科医生更有能力。结论：存在机器人辅助TJA的意识和好奇心；然而，大多数患者似乎并不承认人工手术的优越性或益处。此外，患者似乎更喜欢外科医生熟练掌握手工技术，这可能会影响未来的培训计划。在选择机器人TJA时，外科医生应该权衡患者的目标、期望、结果和成本。

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引用次数: 0

Operative Time Learning Curve for an Image-Free Robotic Arm Assisted Total Knee Arthroplasty: A Cumulative Sum Analysis 无图像机械臂辅助全膝关节置换术的手术时间学习曲线：累积和分析。

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2024.101588

Cale A. Pagan MD , Theofilos Karasavvidis MD , Breana Siljander MD , Eytan M. Debbi MD, PhD , Charles A. DeCook MD , Jonathan Vigdorchik MD

Background

Robotic arm assisted total knee arthroplasty (RA-TKA) aims to improve accuracy in bone resection, implant positioning, and joint alignment compared to manual TKA (M-TKA). However, the learning curve of RA-TKA can disrupt operating room efficiency, increase complications, and raise costs. This study examines the operative time learning curve of RA-TKA using a single robotic system.

Methods

The study analyzed the first 80 RA-TKA and the last 80 M-TKA cases performed by a single surgeon using the VELYS robotic system after transitioning from M-TKA. Cases were subdivided into groups of 20 and compared to M-TKA cases. A cumulative summation analysis identified the learning curve phases.

Results

Three phases were identified: Phase 1 (initial learning, cases 1-9), Phase 2 (increased competence, plateau from cases 10-52), and Phase 3 (post-learning, optimized performance from cases 53-80). Mean surgical time for RA-TKA was 42.4 ± 8.7 minutes, compared to 35.3 ± 7.0 minutes for M-TKA (P < .001). Early RA-TKA cases (1-20) had significantly longer times than late RA-TKA cases (61-80) and M-TKA cases (P < .05). Late RA-TKA times were comparable to M-TKA (P = .06).

Conclusions

RA-TKA is an enabling surgical tool that can be integrated efficiently into a surgical workflow with a rapid learning curve of 9 cases.

背景：与人工全膝关节置换术（M-TKA）相比，机械臂辅助全膝关节置换术（RA-TKA）旨在提高骨切除、植入物定位和关节对齐的准确性。然而，RA-TKA的学习曲线可能会破坏手术室效率，增加并发症并提高成本。本研究考察了使用单一机器人系统的RA-TKA的手术时间学习曲线。方法：对由M-TKA过渡到VELYS机器人系统的80例RA-TKA和80例M-TKA患者进行分析。病例被细分为20组，并与M-TKA病例进行比较。累积求和分析确定了学习曲线阶段。结果：确定了三个阶段：阶段1（初始学习，案例1-9），阶段2（能力提升，案例10-52的平台期），阶段3（学习后，案例53-80的绩效优化）。RA-TKA的平均手术时间为42.4±8.7分钟，M-TKA的平均手术时间为35.3±7.0分钟（P < 0.001）。早期RA-TKA病例（1 ~ 20例）比晚期RA-TKA病例（61 ~ 80例）和中期RA-TKA病例（P < 0.05）明显延长。晚期RA-TKA时间与M-TKA时间相当（P = .06）。结论：RA-TKA是一种有利的手术工具，可以有效地整合到手术流程中，具有9例的快速学习曲线。

{"title":"Operative Time Learning Curve for an Image-Free Robotic Arm Assisted Total Knee Arthroplasty: A Cumulative Sum Analysis","authors":"Cale A. Pagan MD , Theofilos Karasavvidis MD , Breana Siljander MD , Eytan M. Debbi MD, PhD , Charles A. DeCook MD , Jonathan Vigdorchik MD","doi":"10.1016/j.artd.2024.101588","DOIUrl":"10.1016/j.artd.2024.101588","url":null,"abstract":"<div><h3>Background</h3><div>Robotic arm assisted total knee arthroplasty (RA-TKA) aims to improve accuracy in bone resection, implant positioning, and joint alignment compared to manual TKA (M-TKA). However, the learning curve of RA-TKA can disrupt operating room efficiency, increase complications, and raise costs. This study examines the operative time learning curve of RA-TKA using a single robotic system.</div></div><div><h3>Methods</h3><div>The study analyzed the first 80 RA-TKA and the last 80 M-TKA cases performed by a single surgeon using the VELYS robotic system after transitioning from M-TKA. Cases were subdivided into groups of 20 and compared to M-TKA cases. A cumulative summation analysis identified the learning curve phases.</div></div><div><h3>Results</h3><div>Three phases were identified: Phase 1 (initial learning, cases 1-9), Phase 2 (increased competence, plateau from cases 10-52), and Phase 3 (post-learning, optimized performance from cases 53-80). Mean surgical time for RA-TKA was 42.4 ± 8.7 minutes, compared to 35.3 ± 7.0 minutes for M-TKA (<em>P</em> < .001). Early RA-TKA cases (1-20) had significantly longer times than late RA-TKA cases (61-80) and M-TKA cases (<em>P</em> < .05). Late RA-TKA times were comparable to M-TKA (<em>P</em> = .06).</div></div><div><h3>Conclusions</h3><div>RA-TKA is an enabling surgical tool that can be integrated efficiently into a surgical workflow with a rapid learning curve of 9 cases.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"31 ","pages":"Article 101588"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984743","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

Distal Femoral Replacement With a Metaphyseal Sleeve: Outcomes and Risk Factors for Subsidence

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2024.101403

David Alexander George MBChB, BMedSc, FRCS (Tr & Orth), Christopher Lee Buckle MBBS, BSc, MSc (Oxon), FRCS (Tr & Orth), Abtin Alvand BSc (Hons), MBBS, DPhil (PhD), FRCS (Tr & Orth), William Jackson MBBS, BSc, FRCS (Tr & Orth), Adrian Taylor MBBS, FRCS (Orth), Ben Kendrick DPhil (PhD), FRCS (Tr & Orth)

In this study, we report on the outcomes of our experience using a metaphyseal sleeve with a distal femoral replacement (DFR) and review the risk factors for sleeve subsidence over a 3 year period.

引用次数: 0

Postoperative Pain and Opiate Requirement is Increased Following Second-Side Surgery Among Patients Undergoing Staged Total Knee Arthroplasty 在分期全膝关节置换术的患者中，术后疼痛和阿片类药物需求增加。

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2024.101591

Vivek P. Chadayammuri MD, Shuvalaxmi D. Haselton MS, Elizabeth Diaz PA-C, Roger H. Emerson MD

Background

Primary total knee arthroplasty (TKA) continues to grow exponentially, with a significant subset of patients requiring staged bilateral procedures. The optimal interval between staged procedures and effective strategies to minimize postoperative pain to enhance rehabilitation and mobility remain poorly understood.

Methods

160 consecutive patients undergoing staged bilateral TKA between August 2017 and January-2021 was retrospectively reviewed. Patients with a history of chronic opioid dependency were excluded. Baseline demographics, primary outcome measures, including visual analog scale (VAS) pain scores, perioperative opioid utilization (MME/day), and surgical satisfaction were evaluated. All patients had a minimum follow-up of 1-year-postoperatively. All univariate and multivariate statistical analyses were performed with significance given by P < .05.

Results

The mean interval between staged TKA was 8-weeks (standard deviation, 4.9-weeks). Preoperative VAS pain scores were significantly higher for the initial TKA, confirming that the more symptomatic knee was addressed first. Despite this, VAS pain scores were significantly increased following second-side TKA at 6-months postoperatively (P = .001). Multivariate analysis identified weekly interval duration between staged procedures as the single-most predictive factor of increased pain following second-side TKA (β = −0.106; P < .01). Female patients were increasingly susceptible to elevated pain levels following second-side TKA (β = 0.372; P = .057).

Conclusions

Postoperative pain increases after second-side TKA in staged-bilateral procedures, despite the more symptomatic side being addressed first. Our study identified weekly interval between staged procedures as the single-most predictive factor of pain, and female patients being predisposed to heightened pain following second-side TKA; implicating nociceptive pathways require weeks to normalize, necessitating gender-specific pain management and extended intervals.

背景：原发性全膝关节置换术（TKA）持续呈指数增长，有相当一部分患者需要分阶段双侧手术。分阶段手术之间的最佳间隔和减少术后疼痛以增强康复和活动能力的有效策略仍然知之甚少。方法：回顾性分析2017年8月至2021年1月期间160例连续接受分阶段双侧TKA的患者。排除有慢性阿片类药物依赖史的患者。评估基线人口统计学、主要结局指标，包括视觉模拟量表（VAS）疼痛评分、围手术期阿片类药物使用（MME/day）和手术满意度。所有患者术后至少随访1年。所有单因素和多因素统计分析均以P < 0.05为显著性。结果：TKA分期的平均间隔时间为8周（标准差为4.9周）。术前VAS疼痛评分明显高于初始TKA，证实首先解决了更有症状的膝关节。尽管如此，术后6个月第二侧TKA后VAS疼痛评分显著升高（P = 0.001）。多变量分析发现，分期手术之间的每周间隔时间是第二侧TKA后疼痛增加的最单一预测因素(β = -0.106；P < 0.01)。女性患者在第二侧TKA后越来越容易出现疼痛水平升高(β = 0.372；P = .057)。结论：在分阶段双侧手术中，尽管首先解决了更有症状的一侧，但第二侧TKA术后疼痛增加。我们的研究确定分期手术之间的每周间隔时间是疼痛的最单一预测因素，女性患者易在第二侧TKA后加剧疼痛；暗示的伤害通路需要数周的时间才能正常化，需要针对性别的疼痛管理和延长的间隔。

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引用次数: 0

What Is the Prevalence of Hip Abductor Pathology in Patients Undergoing Total Hip Arthroplasty? 全髋关节置换术患者髋关节内收肌病变的发病率是多少？

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2024.101601

David A. Brethouwer DO , Matthew L. Brown MD , Julie C. McCauley MPH , William D. Bugbee MD , Eric Y. Chang MD , Alecio F. Lombardi MD , Brian J. Rebolledo MD

Background

Total hip arthroplasty (THA) is generally considered a successful operation for patients with advanced hip arthritis. Hip abductor pathology can lead to diminished outcomes. The prevalence of hip abductor pathology in patients undergoing THA is not well described.

Methods

Our institution’s arthroplasty registry was queried to identify patients undergoing THA who had preoperative magnetic resonance imaging (MRI) of the hip or pelvis. MRIs were reviewed for presence of abductor (gluteus medius or gluteus minimus) tendon injury. Dysfunction of the abductor musculotendinous units was assessed by grading fatty infiltration of the muscle bellies using the Goutallier/Fuchs classification.

Results

A total of 1090 primary THAs were performed during the study period, and 118 (10.8%) patients had a preoperative MRI of the hip or pelvis ≤12 months prior to surgery. Among the 118 patients who had an MRI, abductor tendon tears were diagnosed in 33 patients (28.0%), and tendinosis was noted in 106 patients (89.8%).

Conclusions

There is a high prevalence of hip abductor pathology in patients presenting for THA. Clinicians should evaluate patients for signs of abductor tendon pathology when presenting for consideration of THA. Careful examination and MRI may be helpful to further evaluate the status of the gluteus minimus and gluteus medius musculotendinous units.

背景：全髋关节置换术（THA）通常被认为是晚期髋关节关节炎患者的成功手术。髋关节外展肌病理可导致预后降低。髋关节外展肌病理在THA患者中的患病率尚未得到很好的描述。方法：查询本机构的关节置换术登记，以确定术前有髋关节或骨盆磁共振成像（MRI）的THA患者。mri检查是否有外展肌（臀中肌或臀小肌）肌腱损伤。外展肌腱单位的功能障碍是通过使用Goutallier/Fuchs分类对肌肉腹部脂肪浸润进行分级来评估的。结果：在研究期间共进行了1090例原发性tha手术，118例（10.8%）患者在手术前≤12个月进行了髋关节或骨盆MRI检查。在118例接受MRI检查的患者中，33例（28.0%）被诊断为外展肌腱撕裂，106例（89.8%）被诊断为肌腱萎缩。结论：髋关节外展肌病变在THA患者中有很高的患病率。临床医生在考虑THA时应评估患者的外展肌腱病理征象。仔细的检查和MRI可能有助于进一步评估臀小肌和臀中肌腱单位的状态。

{"title":"What Is the Prevalence of Hip Abductor Pathology in Patients Undergoing Total Hip Arthroplasty?","authors":"David A. Brethouwer DO , Matthew L. Brown MD , Julie C. McCauley MPH , William D. Bugbee MD , Eric Y. Chang MD , Alecio F. Lombardi MD , Brian J. Rebolledo MD","doi":"10.1016/j.artd.2024.101601","DOIUrl":"10.1016/j.artd.2024.101601","url":null,"abstract":"<div><h3>Background</h3><div>Total hip arthroplasty (THA) is generally considered a successful operation for patients with advanced hip arthritis. Hip abductor pathology can lead to diminished outcomes. The prevalence of hip abductor pathology in patients undergoing THA is not well described.</div></div><div><h3>Methods</h3><div>Our institution’s arthroplasty registry was queried to identify patients undergoing THA who had preoperative magnetic resonance imaging (MRI) of the hip or pelvis. MRIs were reviewed for presence of abductor (gluteus medius or gluteus minimus) tendon injury. Dysfunction of the abductor musculotendinous units was assessed by grading fatty infiltration of the muscle bellies using the Goutallier/Fuchs classification.</div></div><div><h3>Results</h3><div>A total of 1090 primary THAs were performed during the study period, and 118 (10.8%) patients had a preoperative MRI of the hip or pelvis ≤12 months prior to surgery. Among the 118 patients who had an MRI, abductor tendon tears were diagnosed in 33 patients (28.0%), and tendinosis was noted in 106 patients (89.8%).</div></div><div><h3>Conclusions</h3><div>There is a high prevalence of hip abductor pathology in patients presenting for THA. Clinicians should evaluate patients for signs of abductor tendon pathology when presenting for consideration of THA. Careful examination and MRI may be helpful to further evaluate the status of the gluteus minimus and gluteus medius musculotendinous units.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"31 ","pages":"Article 101601"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984783","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