Pub Date : 2025-02-15DOI: 10.1016/j.artd.2025.101630
Katherine Mistretta MD, Caroline Granger MD, Joseph Kromka MD, Andrew M. Schneider MD
A 2-stage protocol is standard of care treatment in the United States for chronic periprosthetic joint infection of the knee. While many patients benefit from insertion of an articulating spacer, there are instances in which this is not feasible, and a static spacer is indicated. However, many static spacer techniques risk instability and lack durability. The ideal static spacer construct should provide immediate brace-free weight-bearing to maximize function during the spacer stage and, if needed, permit delayed reimplantation in the case of medically high-risk patients. Here, we describe our surgical technique for a femoral nail and cement static spacer in the treatment of chronic knee periprosthetic joint infection, a reproducible, stable, and durable construct essential to the armamentarium of the arthroplasty surgeon.
{"title":"Femoral Nail and Cement Static Spacer Technique for the Treatment of Chronic Periprosthetic Knee Infection","authors":"Katherine Mistretta MD, Caroline Granger MD, Joseph Kromka MD, Andrew M. Schneider MD","doi":"10.1016/j.artd.2025.101630","DOIUrl":"10.1016/j.artd.2025.101630","url":null,"abstract":"<div><div>A 2-stage protocol is standard of care treatment in the United States for chronic periprosthetic joint infection of the knee. While many patients benefit from insertion of an articulating spacer, there are instances in which this is not feasible, and a static spacer is indicated. However, many static spacer techniques risk instability and lack durability. The ideal static spacer construct should provide immediate brace-free weight-bearing to maximize function during the spacer stage and, if needed, permit delayed reimplantation in the case of medically high-risk patients. Here, we describe our surgical technique for a femoral nail and cement static spacer in the treatment of chronic knee periprosthetic joint infection, a reproducible, stable, and durable construct essential to the armamentarium of the arthroplasty surgeon.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101630"},"PeriodicalIF":1.5,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-14DOI: 10.1016/j.artd.2025.101620
Insa Mannstadt BS, BA , J. Alex B. Gibbons BA , Troy B. Amen MD, MBA , Mangala Rajan PhD , Sarah R. Young PhD , Henry Tischler MD , Michael L. Parks MD , Mark Figgie MD , Anne Bass MD , Linda Russell MD , Bella Mehta MD, MS , Iris Navarro-Millán MD , Susan M. Goodman MD
Background
Orthopaedic consultations' influence on perceived barriers to total joint arthroplasty (TJA) remains unclear. This study explores how orthopedic consultations are associated with patient perceptions of barriers to TJA.
Methods
We performed a post-hoc analysis of questionnaire responses based on data from a previous study that used semi-structured interviews with patients with advanced osteoarthritis. This earlier study identified 5 key barriers to TJA—trust in surgeon, cost/insurance, recovery, surgical outcome, and timing of surgery—and highlighted significant racial differences in these barriers. Our analysis focused specifically on the role of orthopaedic consultations. Using multiple logistic regression models, we compared responses from patients who had an orthopaedic consultation to those who did not, while adjusting for race, age, Hip Disability and Osteoarthritis Outcome Score, Joint Replacement/Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, insurance status, education level, and prior discussions about TJA.
Results
Of the 696 participants, 88% were female, 77% White, 11% Black, and 9% Hispanic. Nearly half (49%) had an orthopaedic consultation. Participants who had consulted with an orthopaedist were older, more likely to be college graduates, Medicare beneficiaries, have consulted a primary care physician, attempted conservative management including joint injections, braces, and physical therapy. After adjusting for participant factors, orthopaedic consultation was a predictor of fewer perceived cost/insurance and timing barriers. However, no differences were observed in other barriers.
Conclusions
Orthopaedic consultation is associated with fewer reported cost/insurance and timing barriers to TJA. Addressing barriers of concern to patients in the context of orthopaedic consultations could further improve TJA utilization.
{"title":"Orthopaedic Consultation is Associated With Fewer Patient-Perceived Barriers to Total Joint Arthroplasty","authors":"Insa Mannstadt BS, BA , J. Alex B. Gibbons BA , Troy B. Amen MD, MBA , Mangala Rajan PhD , Sarah R. Young PhD , Henry Tischler MD , Michael L. Parks MD , Mark Figgie MD , Anne Bass MD , Linda Russell MD , Bella Mehta MD, MS , Iris Navarro-Millán MD , Susan M. Goodman MD","doi":"10.1016/j.artd.2025.101620","DOIUrl":"10.1016/j.artd.2025.101620","url":null,"abstract":"<div><h3>Background</h3><div>Orthopaedic consultations' influence on perceived barriers to total joint arthroplasty (TJA) remains unclear. This study explores how orthopedic consultations are associated with patient perceptions of barriers to TJA.</div></div><div><h3>Methods</h3><div>We performed a post-hoc analysis of questionnaire responses based on data from a previous study that used semi-structured interviews with patients with advanced osteoarthritis. This earlier study identified 5 key barriers to TJA—trust in surgeon, cost/insurance, recovery, surgical outcome, and timing of surgery<em>—</em>and highlighted significant racial differences in these barriers. Our analysis focused specifically on the role of orthopaedic consultations. Using multiple logistic regression models, we compared responses from patients who had an orthopaedic consultation to those who did not, while adjusting for race, age, Hip Disability and Osteoarthritis Outcome Score, Joint Replacement/Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, insurance status, education level, and prior discussions about TJA.</div></div><div><h3>Results</h3><div>Of the 696 participants, 88% were female, 77% White, 11% Black, and 9% Hispanic. Nearly half (49%) had an orthopaedic consultation. Participants who had consulted with an orthopaedist were older, more likely to be college graduates, Medicare beneficiaries, have consulted a primary care physician, attempted conservative management including joint injections, braces, and physical therapy. After adjusting for participant factors, orthopaedic consultation was a predictor of fewer perceived cost/insurance and timing barriers. However, no differences were observed in other barriers.</div></div><div><h3>Conclusions</h3><div>Orthopaedic consultation is associated with fewer reported cost/insurance and timing barriers to TJA. Addressing barriers of concern to patients in the context of orthopaedic consultations could further improve TJA utilization.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101620"},"PeriodicalIF":1.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-13DOI: 10.1016/j.artd.2025.101627
Kristen I. Barton MD, PhD , Daniel N. Bracey MD, PhD , Vishal Hegde MD , Aviva Pollet MS , Roseann Johnson BSc , Douglas A. Dennis MD , Jason M. Jennings MD, DPT
Background
Complications following total hip arthroplasty (THA) may necessitate a revision and patients who go on to a revision THA may experience depressive symptoms. The objective of this study was to investigate the prevalence of depressive symptoms before and after revision THA for six different failure modes.
Methods
Patients who underwent a THA revision with minimum 1-year follow-up at a single institution from 2008 to 2022 were retrospectively reviewed. Patients were grouped by failure modes: aseptic loosening, impingement, infection, instability, metallosis, polyethylene wear, and femoral stem pain. Preoperative and postoperative Veterans RAND 12-Item Health Scores and Harris Hip Score were compared.
Results
Twenty-four percent of patients in the retrospective cohort review had a previous existing mental health diagnosis, with depression being the most common (18% of all patients). The prevalence of depressive symptoms differed significantly by failure mode both preoperatively (P = .002) and postoperatively (P = .019). Veterans RAND 12 mental component score was significant between mode of failure groups both preoperatively (P < .001) and postoperatively (P = .005). Function significantly improved in all groups from preoperatively to postoperatively. Patients with depressive symptoms had significantly lower physical component score with instability, aseptic loosening, stem pain, and metallosis preoperatively (P < .001) and with instability, aseptic loosening, stem pain, and polyethylene wear postoperatively (P = .002).
Conclusions
Nearly 25% of patients with failed THA had a pre-existing mental health diagnosis and depressive symptoms were the most common. Unfortunately, depressive symptoms only improve modestly with revision surgery and can adversely affect a patient’s functional outcome.
{"title":"Prevalence of Depressive Symptoms in Patients Undergoing Aseptic Revision Total Hip Arthroplasty Differs Based on Mode of Failure","authors":"Kristen I. Barton MD, PhD , Daniel N. Bracey MD, PhD , Vishal Hegde MD , Aviva Pollet MS , Roseann Johnson BSc , Douglas A. Dennis MD , Jason M. Jennings MD, DPT","doi":"10.1016/j.artd.2025.101627","DOIUrl":"10.1016/j.artd.2025.101627","url":null,"abstract":"<div><h3>Background</h3><div>Complications following total hip arthroplasty (THA) may necessitate a revision and patients who go on to a revision THA may experience depressive symptoms. The objective of this study was to investigate the prevalence of depressive symptoms before and after revision THA for six different failure modes.</div></div><div><h3>Methods</h3><div>Patients who underwent a THA revision with minimum 1-year follow-up at a single institution from 2008 to 2022 were retrospectively reviewed. Patients were grouped by failure modes: aseptic loosening, impingement, infection, instability, metallosis, polyethylene wear, and femoral stem pain. Preoperative and postoperative Veterans RAND 12-Item Health Scores and Harris Hip Score were compared.</div></div><div><h3>Results</h3><div>Twenty-four percent of patients in the retrospective cohort review had a previous existing mental health diagnosis, with depression being the most common (18% of all patients). The prevalence of depressive symptoms differed significantly by failure mode both preoperatively (<em>P</em> = .002) and postoperatively (<em>P</em> = .019). Veterans RAND 12 mental component score was significant between mode of failure groups both preoperatively (<em>P</em> < .001) and postoperatively (<em>P</em> = .005). Function significantly improved in all groups from preoperatively to postoperatively. Patients with depressive symptoms had significantly lower physical component score with instability, aseptic loosening, stem pain, and metallosis preoperatively (<em>P</em> < .001) and with instability, aseptic loosening, stem pain, and polyethylene wear postoperatively (<em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>Nearly 25% of patients with failed THA had a pre-existing mental health diagnosis and depressive symptoms were the most common. Unfortunately, depressive symptoms only improve modestly with revision surgery and can adversely affect a patient’s functional outcome.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101627"},"PeriodicalIF":1.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-11DOI: 10.1016/j.artd.2025.101614
Clark Yin MD , Lauren Eberhardt MD , Matthew Cederman BS , Henry Haley MD , Andrew Steffenmeier MD , Mark Karadsheh MD
Ceramics are used in total hip arthroplasty due to inherent wettability and low wear rates, but fracture risk is a known complication. Rates as high as 13.4% were reported in the past, yet as low as 0.02% in newer generations. Howard et al. reported a fracture rate of 0.009% for fourth-generation ceramic heads. We present a case report of a 69-year-old male with a BMI of 40.01 kg/m2 who suffered a fracture of a 36-mm ceramic femoral head with pseudoacetabular involvement of the polyethylene liner. This occurred 2 years and 3 months after his primary surgery after a 4-foot fall off of a ladder. The patient underwent revision of his total hip arthroplasty with arthroplasty of the polyethylene liner and femoral head component without stem explantation.
{"title":"Fourth-generation Ceramic Head Fracture in Total Hip Arthroplasty: A Case Report and Literature Review","authors":"Clark Yin MD , Lauren Eberhardt MD , Matthew Cederman BS , Henry Haley MD , Andrew Steffenmeier MD , Mark Karadsheh MD","doi":"10.1016/j.artd.2025.101614","DOIUrl":"10.1016/j.artd.2025.101614","url":null,"abstract":"<div><div>Ceramics are used in total hip arthroplasty due to inherent wettability and low wear rates, but fracture risk is a known complication. Rates as high as 13.4% were reported in the past, yet as low as 0.02% in newer generations. Howard et al. reported a fracture rate of 0.009% for fourth-generation ceramic heads. We present a case report of a 69-year-old male with a BMI of 40.01 kg/m<sup>2</sup> who suffered a fracture of a 36-mm ceramic femoral head with pseudoacetabular involvement of the polyethylene liner. This occurred 2 years and 3 months after his primary surgery after a 4-foot fall off of a ladder. The patient underwent revision of his total hip arthroplasty with arthroplasty of the polyethylene liner and femoral head component without stem explantation.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101614"},"PeriodicalIF":1.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143379062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-11DOI: 10.1016/j.artd.2025.101631
Justin Leal BS, Christine J. Wu MD, Niall H. Cochrane MD, Thorsten M. Seyler MD, PhD, William A. Jiranek MD, Samuel S. Wellman MD, Michael P. Bolognesi MD, Sean P. Ryan MD
Background
This study compared outcomes between patients undergoing outpatient total joint arthroplasty (TJA) at an ambulatory surgery center (ASC) versus a cohort of medically and socially complex patients undergoing TJA at a tertiary healthcare system.
Methods
An institutional database at a single academic center was retrospectively reviewed for patients who underwent primary TJA since the opening of an ASC from August 2021 to January 2024. A total of 716 (outpatient: 374; inpatient: 342) total knee arthroplasties and 458 (outpatient: 196; inpatient: 262) total hip arthroplasties met inclusion criteria.
Results
Patients in the inpatient total knee arthroplasty group had a higher proportion of patients requiring an emergency department visit (11.4% vs 4.5%; P = .008) and admission (6.7% vs 2.7%; P = .025) within the first 90 days after surgery than the outpatient group; however, 2-year revision-free (97.9% vs 97.9%; P = .75) survival was similar between groups. Patients in the inpatient total hip arthroplasty group had a higher proportion of patients requiring an emergency department visit (13.0% vs 4.6%; P = .035) and admission (7.3% vs 1.0%; P = .018) within the first 90 days after surgery compared to the outpatient group; however, there was no difference in 2-year revision-free survival (96.4% vs 99.5%; P = .059).
Conclusions
Medically and socially complex patients undergoing TJA required additional resources during the 90-day postoperative window; however, they achieved similar survivorship as patients who met criteria for outpatient surgery.
{"title":"Outpatient Versus Inpatient Total Joint Arthroplasty: Do Medically and Socially Complex Patients Require More Resources but Achieve Similar Outcomes?","authors":"Justin Leal BS, Christine J. Wu MD, Niall H. Cochrane MD, Thorsten M. Seyler MD, PhD, William A. Jiranek MD, Samuel S. Wellman MD, Michael P. Bolognesi MD, Sean P. Ryan MD","doi":"10.1016/j.artd.2025.101631","DOIUrl":"10.1016/j.artd.2025.101631","url":null,"abstract":"<div><h3>Background</h3><div>This study compared outcomes between patients undergoing outpatient total joint arthroplasty (TJA) at an ambulatory surgery center (ASC) versus a cohort of medically and socially complex patients undergoing TJA at a tertiary healthcare system.</div></div><div><h3>Methods</h3><div>An institutional database at a single academic center was retrospectively reviewed for patients who underwent primary TJA since the opening of an ASC from August 2021 to January 2024. A total of 716 (outpatient: 374; inpatient: 342) total knee arthroplasties and 458 (outpatient: 196; inpatient: 262) total hip arthroplasties met inclusion criteria.</div></div><div><h3>Results</h3><div>Patients in the inpatient total knee arthroplasty group had a higher proportion of patients requiring an emergency department visit (11.4% vs 4.5%; <em>P =</em> .008) and admission (6.7% vs 2.7%; <em>P =</em> .025) within the first 90 days after surgery than the outpatient group; however, 2-year revision-free (97.9% vs 97.9%; <em>P =</em> .75) survival was similar between groups. Patients in the inpatient total hip arthroplasty group had a higher proportion of patients requiring an emergency department visit (13.0% vs 4.6%; <em>P =</em> .035) and admission (7.3% vs 1.0%; <em>P =</em> .018) within the first 90 days after surgery compared to the outpatient group; however, there was no difference in 2-year revision-free survival (96.4% vs 99.5%; <em>P =</em> .059).</div></div><div><h3>Conclusions</h3><div>Medically and socially complex patients undergoing TJA required additional resources during the 90-day postoperative window; however, they achieved similar survivorship as patients who met criteria for outpatient surgery.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101631"},"PeriodicalIF":1.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143379060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-11DOI: 10.1016/j.artd.2025.101626
Siddhartha Dandamudi BBA , Kyleen Jan MD , Madelyn Malvitz BS , Anne DeBenedetti MSc , Omar Behery MD, MPH , Brett R. Levine MD, MS
Background
Patient satisfaction with total joint arthroplasty (TJA) remains a challenge, with up to 20% of patients expressing dissatisfaction despite good clinical outcomes. This study aims to assess patient expectations and experiences prior to and after undergoing a primary TJA.
Methods
A 13-question survey assessing patient expectations around surgical risks, logistics, physical therapy (PT), and pain was distributed in the clinics of multiple surgeons at an academic center. Each patient was categorized as either preoperative or postoperative, with similar questions for both groups. No identifying information was collected.
Results
One hundred eight preoperative and 344 postoperative responses were collected. Preoperatively, 91.3% of patients felt they had enough time to ask questions compared to 98.5% (P = .01) postoperatively. Preoperative patients named risks of TJA more accurately (P < .00001). Expectations of long-term pain differed: 48.3% of preoperative patients expected no pain and 1.7% expected to be unable to move; postoperatively, 7.3% (P < .0001) reported no pain and 10.3% (P = .03) were unable to move; 17.3% of patients finished PT within 2 weeks, compared to 1.7% who believed this was possible (P =.0027). A total of 73.1% of postoperative patients requested additional weeks of PT. Only 52.1% or patients had a long-term follow-up plan in place.
Conclusions
Expectations vary in patients undergoing TJA. Preoperative patients may have unrealistic expectations regarding postoperative pain and mobility. The need for more PT and the lack of a long-term follow-up plan highlight the importance of comprehensive perioperative communication to align expectations and potentially improve satisfaction and follow-up compliance.
{"title":"Preoperative vs Postoperative Patient Outcome and Recovery Expectations of Total Joint Arthroplasty","authors":"Siddhartha Dandamudi BBA , Kyleen Jan MD , Madelyn Malvitz BS , Anne DeBenedetti MSc , Omar Behery MD, MPH , Brett R. Levine MD, MS","doi":"10.1016/j.artd.2025.101626","DOIUrl":"10.1016/j.artd.2025.101626","url":null,"abstract":"<div><h3>Background</h3><div>Patient satisfaction with total joint arthroplasty (TJA) remains a challenge, with up to 20% of patients expressing dissatisfaction despite good clinical outcomes. This study aims to assess patient expectations and experiences prior to and after undergoing a primary TJA.</div></div><div><h3>Methods</h3><div>A 13-question survey assessing patient expectations around surgical risks, logistics, physical therapy (PT), and pain was distributed in the clinics of multiple surgeons at an academic center. Each patient was categorized as either preoperative or postoperative, with similar questions for both groups. No identifying information was collected.</div></div><div><h3>Results</h3><div>One hundred eight preoperative and 344 postoperative responses were collected. Preoperatively, 91.3% of patients felt they had enough time to ask questions compared to 98.5% (<em>P</em> = .01) postoperatively. Preoperative patients named risks of TJA more accurately (<em>P</em> < .00001). Expectations of long-term pain differed: 48.3% of preoperative patients expected no pain and 1.7% expected to be unable to move; postoperatively, 7.3% (<em>P</em> < .0001) reported no pain and 10.3% (<em>P</em> = .03) were unable to move; 17.3% of patients finished PT within 2 weeks, compared to 1.7% who believed this was possible (<em>P</em> =.0027). A total of 73.1% of postoperative patients requested additional weeks of PT. Only 52.1% or patients had a long-term follow-up plan in place.</div></div><div><h3>Conclusions</h3><div>Expectations vary in patients undergoing TJA. Preoperative patients may have unrealistic expectations regarding postoperative pain and mobility. The need for more PT and the lack of a long-term follow-up plan highlight the importance of comprehensive perioperative communication to align expectations and potentially improve satisfaction and follow-up compliance.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101626"},"PeriodicalIF":1.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143379061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-10DOI: 10.1016/j.artd.2025.101632
Alexander V. Strait MS , Eric J. Wilson MD , Henry Ho MS , Kevin B. Fricka MD , Robert A. Sershon MD
Background
Improving outcomes has driven advancements in total knee arthroplasty (TKA) bearing design. The aim of this study was to compare medial-congruent (MC), ultracongruent (UC), and cruciate-retaining (CR) TKA utilizing a single CR total knee system.
Methods
Six surgeons performed 2883 primary TKAs from 2012 to 2022 using the same implant design, comprised of 708 MC, 799 UC, and 1376 CR bearings. Prospectively collected data on clinical and patient-reported outcome measures were compared. Data analyses utilized analysis of variance tests for continuous data, chi-square tests for categorical data, and Mantel-Cox tests for survivorship analysis. MC subjects were older (MC = 67.5 vs UC = 65.3 vs CR = 66.7 years; P < .001), had lower body mass index (MC = 32.4 vs UC = 33.1 vs CR = 33.2 kg/m2; P = .04), and had shorter mean follow-up (MC = 1.2 vs UC = 2.4 vs CR = 2.9 years; P < .001).
Results
All groups experienced similar rates of 90-day complications (MC = 26/708, 3.7% vs UC = 39/799, 4.9% vs CR = 52/1376, 3.8%; P = .38) and revisions (MC = 1/708, 0.1% vs UC = 4/799, 0.5% vs CR = 5/1376, 0.4%; P = .49). Survivorship was similar at 2 years (P = .41) and above 98% at 5 years for all groups. At the 1-year follow-up, MC bearings had significantly greater Patient-Reported Outcomes Measurement Information System Global Health Physical (MC = 47.1 vs UC = 41.5 vs CR = 42.8; P < .001) and mental scores (MC = 48.9 vs UC = 41.3 vs CR = 43.7; P < .001).
Conclusions
No differences in all-cause complications or revisions were observed for MC, UC, and CR bearings using the same total knee system. Clinically important differences favoring MC bearings were found with Patient-Reported Outcomes Measurement Information System Global Health Physical scores at 1 year; however, longer follow-up is necessary to determine if this trend holds.
{"title":"A Comparison of Medial-congruent, Ultracongruent, and Cruciate-retaining Bearings Using a Single Cruciate-retaining Total Knee Design","authors":"Alexander V. Strait MS , Eric J. Wilson MD , Henry Ho MS , Kevin B. Fricka MD , Robert A. Sershon MD","doi":"10.1016/j.artd.2025.101632","DOIUrl":"10.1016/j.artd.2025.101632","url":null,"abstract":"<div><h3>Background</h3><div>Improving outcomes has driven advancements in total knee arthroplasty (TKA) bearing design. The aim of this study was to compare medial-congruent (MC), ultracongruent (UC), and cruciate-retaining (CR) TKA utilizing a single CR total knee system.</div></div><div><h3>Methods</h3><div>Six surgeons performed 2883 primary TKAs from 2012 to 2022 using the same implant design, comprised of 708 MC, 799 UC, and 1376 CR bearings. Prospectively collected data on clinical and patient-reported outcome measures were compared. Data analyses utilized analysis of variance tests for continuous data, <em>chi</em>-square tests for categorical data, and Mantel-Cox tests for survivorship analysis. MC subjects were older (MC = 67.5 vs UC = 65.3 vs CR = 66.7 years; <em>P</em> < .001), had lower body mass index (MC = 32.4 vs UC = 33.1 vs CR = 33.2 kg/m<sup>2</sup>; <em>P</em> = .04), and had shorter mean follow-up (MC = 1.2 vs UC = 2.4 vs CR = 2.9 years; <em>P</em> < .001).</div></div><div><h3>Results</h3><div>All groups experienced similar rates of 90-day complications (MC = 26/708, 3.7% vs UC = 39/799, 4.9% vs CR = 52/1376, 3.8%; <em>P</em> = .38) and revisions (MC = 1/708, 0.1% vs UC = 4/799, 0.5% vs CR = 5/1376, 0.4%; <em>P</em> = .49). Survivorship was similar at 2 years (<em>P</em> = .41) and above 98% at 5 years for all groups. At the 1-year follow-up, MC bearings had significantly greater Patient-Reported Outcomes Measurement Information System Global Health Physical (MC = 47.1 vs UC = 41.5 vs CR = 42.8; <em>P</em> < .001) and mental scores (MC = 48.9 vs UC = 41.3 vs CR = 43.7; <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>No differences in all-cause complications or revisions were observed for MC, UC, and CR bearings using the same total knee system. Clinically important differences favoring MC bearings were found with Patient-Reported Outcomes Measurement Information System Global Health Physical scores at 1 year; however, longer follow-up is necessary to determine if this trend holds.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101632"},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143376967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-10DOI: 10.1016/j.artd.2025.101635
Francesco Pegreffi MD, PhD (Prof), Gianluca Costa MD (Dr), Arcangelo Russo MD (Prof), Raoul Saggini MD (Prof)
{"title":"Comment on: A Contemporary Analysis of Discharge Disposition Following Total Joint Arthroplasty","authors":"Francesco Pegreffi MD, PhD (Prof), Gianluca Costa MD (Dr), Arcangelo Russo MD (Prof), Raoul Saggini MD (Prof)","doi":"10.1016/j.artd.2025.101635","DOIUrl":"10.1016/j.artd.2025.101635","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101635"},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143376968","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}
Total hip arthroplasty (THA) is increasingly performed in younger patients, necessitating long-term femoral bone preservation. Metaphyseal engaging short stems offer potential benefits by reducing stress shielding and preserving bone stock. However, lacking long-term data in large quantities and younger patients in the literature led this study to assess mid-term to long-term outcome of these short stems.
Methods
This retrospective study evaluated the long-term outcomes of 755 hips (667 patients) underwent THA using the Fitmore stem via a direct anterior approach. Clinical and radiographic assessments were conducted, and survival rates were determined using Kaplan-Meier analyses. Statistical analyses were performed to identify associations and predictors of stem revision.
Results
The overall survival rate for the Fitmore stem was 92.11% at an average follow-up of 10 years. No revisions were performed due to aseptic loosening of the femoral component. Stem revisions were performed in 20 hips, primarily due to periprosthetic fractures followed by periprosthetic joint infections and recurrent dislocations. The clinical outcomes showed significant improvements in HHS, WOMAC Index, and VAS pain scores. Radiographic analysis revealed acceptable rates of complications, with minimal stem subsidence, no severe bone loss, and a low incidence of radiolucent lines and cortical hypertrophy.
Conclusions
The Fitmore stem demonstrated favorable mid-term to long-term outcomes in terms of implant survival, functional scores, and radiographic assessments even in younger populations. The findings contribute to the existing body of knowledge on the Fitmore stem’s efficacy and safety in preserving bone and achieving satisfactory clinical outcomes in THA.
Level of evidence
IV.
{"title":"Mid-Term to Long-Term Outcomes of Total Hip Arthroplasty Using a Cementless Trochanteric Sparing Short Stem Through Direct Anterior Approach: A Single-Center Study","authors":"Seyed Mohammad Javad Mortazavi MD , Pouya Tabatabaei Irani MD , Mohammad Poursalehian MD , Mahsa Mahanrad MD, Peyman Mirghaderi MD, Mohammadreza Razzaghof MD, Sadegh Saberi MD","doi":"10.1016/j.artd.2025.101623","DOIUrl":"10.1016/j.artd.2025.101623","url":null,"abstract":"<div><h3>Background</h3><div>Total hip arthroplasty (THA) is increasingly performed in younger patients, necessitating long-term femoral bone preservation. Metaphyseal engaging short stems offer potential benefits by reducing stress shielding and preserving bone stock. However, lacking long-term data in large quantities and younger patients in the literature led this study to assess mid-term to long-term outcome of these short stems.</div></div><div><h3>Methods</h3><div>This retrospective study evaluated the long-term outcomes of 755 hips (667 patients) underwent THA using the Fitmore stem via a direct anterior approach. Clinical and radiographic assessments were conducted, and survival rates were determined using Kaplan-Meier analyses. Statistical analyses were performed to identify associations and predictors of stem revision.</div></div><div><h3>Results</h3><div>The overall survival rate for the Fitmore stem was 92.11% at an average follow-up of 10 years. No revisions were performed due to aseptic loosening of the femoral component. Stem revisions were performed in 20 hips, primarily due to periprosthetic fractures followed by periprosthetic joint infections and recurrent dislocations. The clinical outcomes showed significant improvements in HHS, WOMAC Index, and VAS pain scores. Radiographic analysis revealed acceptable rates of complications, with minimal stem subsidence, no severe bone loss, and a low incidence of radiolucent lines and cortical hypertrophy.</div></div><div><h3>Conclusions</h3><div>The Fitmore stem demonstrated favorable mid-term to long-term outcomes in terms of implant survival, functional scores, and radiographic assessments even in younger populations. The findings contribute to the existing body of knowledge on the Fitmore stem’s efficacy and safety in preserving bone and achieving satisfactory clinical outcomes in THA.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101623"},"PeriodicalIF":1.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-06DOI: 10.1016/j.artd.2025.101617
Sean Sequeira MD , Alan Brett PhD , Joseph Nessler MD , Benjamin Frye MD , Michael A. Mont MD
<div><h3>Background</h3><div>As more total hip arthroplasty (THA) procedures continue to be performed and concomitant intraoperative fluoroscopic utilization continues to increase, it is important for surgeons to critically analyze this practice during their procedures. The direct anterior approach (DAA) is a popular technique, but often requires the use of fluoroscopy for evaluation of component positioning and implantation. Computed tomography (CT)–based robotic-assisted THA (RA-THA) may represent an alternative to conventional procedures, which may allow the avoidance of the use of intraoperative fluoroscopy to be avoided and instead rely on a preoperative CT scan of the patient and intraoperative mapping. The purpose of this study was to evaluate the difference in radiation exposure from CT-based RA-THA DAA vs fluoroscopy-guided conventional THA DAA based on values from a cadaver study.</div></div><div><h3>Methods</h3><div>There were 2 surgeons who had previous extensive experience with the DAA, as well as conventional and RA-THA. They completed bilateral direct anterior THAs on 6 cadaver specimens. For each cadaver, a conventional THA with fluoroscopy was performed on the first hip, and a robotically assisted THA without fluoroscopy was performed on the contralateral hip. For all robotic-assisted cases, a preoperative 3-dimensional CT was performed. The radiation dosage from the preoperative scan was acquired through the radiation dose structured reports. Radiation exposure dosage for intraoperative fluoroscopy required tabulation of the number of fluoroscopy shots performed for each case as well as the length of time of exposure. This time was then converted to an effective radiation dose based on accepted standards, and this was multiplied by the average number of fluoroscopy shots per case to determine the average dosage per case.</div></div><div><h3>Results</h3><div>No fluoroscopic images were taken during the RA-THA using the DAA. There was a mean of 21 ± 8.9 fluoroscopic shots taken during each fluoroscopy-guided conventional THA using the DAA. The minimum number of fluoroscopic shots was 9, with a maximum of 31. Total radiation exposure ranged from 300 to 1033 mrem, with an average of 700 mrem. The average radiation exposure for a hip CT scan was 289 mrem.</div></div><div><h3>Conclusions</h3><div>In this cadaver-based study, the use of a CT-based RA-THA DAA eliminated the need for intraoperative fluoroscopy, removing the concern of radiation exposure to the surgeon and surgical staff. The CT-based RA-THA DAA does require a preoperative CT scan of the patient; however, the radiation dosage to the patient was equivalent to 8.7 intraoperative fluoroscopy shots. As more surgeons, patients, and surgical staff are exposed to an increasing number of orthopaedic procedures that require ionizing radiation to generate images, such as fluoroscopy and CT, it is important to consider the radiation dosage for all individuals and understand the posi
{"title":"Robotic Assistance is Associated With No Intraoperative Fluoroscopy or Radiation Exposure During Direct Anterior Total Hip Arthroplasty","authors":"Sean Sequeira MD , Alan Brett PhD , Joseph Nessler MD , Benjamin Frye MD , Michael A. Mont MD","doi":"10.1016/j.artd.2025.101617","DOIUrl":"10.1016/j.artd.2025.101617","url":null,"abstract":"<div><h3>Background</h3><div>As more total hip arthroplasty (THA) procedures continue to be performed and concomitant intraoperative fluoroscopic utilization continues to increase, it is important for surgeons to critically analyze this practice during their procedures. The direct anterior approach (DAA) is a popular technique, but often requires the use of fluoroscopy for evaluation of component positioning and implantation. Computed tomography (CT)–based robotic-assisted THA (RA-THA) may represent an alternative to conventional procedures, which may allow the avoidance of the use of intraoperative fluoroscopy to be avoided and instead rely on a preoperative CT scan of the patient and intraoperative mapping. The purpose of this study was to evaluate the difference in radiation exposure from CT-based RA-THA DAA vs fluoroscopy-guided conventional THA DAA based on values from a cadaver study.</div></div><div><h3>Methods</h3><div>There were 2 surgeons who had previous extensive experience with the DAA, as well as conventional and RA-THA. They completed bilateral direct anterior THAs on 6 cadaver specimens. For each cadaver, a conventional THA with fluoroscopy was performed on the first hip, and a robotically assisted THA without fluoroscopy was performed on the contralateral hip. For all robotic-assisted cases, a preoperative 3-dimensional CT was performed. The radiation dosage from the preoperative scan was acquired through the radiation dose structured reports. Radiation exposure dosage for intraoperative fluoroscopy required tabulation of the number of fluoroscopy shots performed for each case as well as the length of time of exposure. This time was then converted to an effective radiation dose based on accepted standards, and this was multiplied by the average number of fluoroscopy shots per case to determine the average dosage per case.</div></div><div><h3>Results</h3><div>No fluoroscopic images were taken during the RA-THA using the DAA. There was a mean of 21 ± 8.9 fluoroscopic shots taken during each fluoroscopy-guided conventional THA using the DAA. The minimum number of fluoroscopic shots was 9, with a maximum of 31. Total radiation exposure ranged from 300 to 1033 mrem, with an average of 700 mrem. The average radiation exposure for a hip CT scan was 289 mrem.</div></div><div><h3>Conclusions</h3><div>In this cadaver-based study, the use of a CT-based RA-THA DAA eliminated the need for intraoperative fluoroscopy, removing the concern of radiation exposure to the surgeon and surgical staff. The CT-based RA-THA DAA does require a preoperative CT scan of the patient; however, the radiation dosage to the patient was equivalent to 8.7 intraoperative fluoroscopy shots. As more surgeons, patients, and surgical staff are exposed to an increasing number of orthopaedic procedures that require ionizing radiation to generate images, such as fluoroscopy and CT, it is important to consider the radiation dosage for all individuals and understand the posi","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101617"},"PeriodicalIF":1.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143216125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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