Arthroplasty Today最新文献_第5页

Intravenous Dexamethasone Administered Perioperatively vs 8 Hours Prior to Incision to Control Pain after Total Knee Arthroplasty. A Prospective Randomized Clinical Trial 围手术期静脉注射地塞米松与切口前8小时控制全膝关节置换术后疼痛的比较。一项前瞻性随机临床试验

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-11-22 DOI: 10.1016/j.artd.2025.101912

Burin Sutthapakti MD , Kritsanat Lertussavavivat MD , Kritsada Sukha MD , Wiboon Wanitcharoenporn MD , Artit Laoruengthana MD

Background

Theoretically, intravenous dexamethasone administered 6-8 hours prior to surgical trauma may inhibit the transcription of genes via the genomic pathway and optimize their anti-inflammatory effects. Thus, the purpose of the study was to compare the efficacy of intravenous dexamethasone administered preoperatively and more common use, perioperative injection for controlling pain after total knee arthroplasty (TKA).

Method

One-hundred fifty TKAs were randomized to receive 10 mg of intravenous dexamethasone 8 hours prior to incision (preoperative group) or to receive before incision (perioperative group). The outcomes included a visual analog scale (VAS) for pain, morphine consumption, frequency of postoperative nausea and vomiting, knee circumference, C-reactive protein levels, and blood glucose levels.

Results

No differences in VAS at rest and during movement were observed between groups at any time point, except the perioperative group had 0.45 lower VAS during movement at 4 hours postoperatively (P = .038). The preoperative group had 0.75 mg lower morphine consumption at 12 hours postoperatively (P = .020). However, both differences did not reach the minimal clinically important difference. There were no significant differences between groups regarding postoperative nausea and vomiting, knee circumference, and C-reactive protein. Over 50% of patients in both groups experienced high blood glucose level (>137 mg/dl) during the first 48 hours postoperatively, however, no infection was observed during 3 months of follow-up.

Conclusions

Perioperative dexamethasone injection provides comparable clinical outcomes and inflammation level after TKA to those administered 8 hours prior to incision. Thus, both intravenous dexamethasone approach can be an option for current clinical pathways of TKA.

从理论上讲，手术创伤前6-8小时静脉给予地塞米松可能通过基因组途径抑制基因转录并优化其抗炎作用。因此，本研究的目的是比较术前静脉注射地塞米松和更常用的围手术期注射地塞米松控制全膝关节置换术（TKA）后疼痛的疗效。方法150例tka患者随机分为两组，术前8小时静脉注射地塞米松10 mg（术前组），围手术期组（术前组）。结果包括疼痛、吗啡用量、术后恶心和呕吐频率、膝关节围度、c反应蛋白水平和血糖水平的视觉模拟评分（VAS）。结果除围手术期患者术后4 h运动时VAS降低0.45分（P = 0.038）外，各组间各时间点静止和运动时VAS均无差异。术前组术后12 h吗啡用量降低0.75 mg （P = 0.020）。然而，这两种差异都没有达到最小的临床重要差异。两组术后恶心呕吐、膝围、c反应蛋白无显著差异。两组均有超过50%的患者在术后48小时内出现高血糖（137 mg/dl），但在3个月的随访中未观察到感染。结论术中注射地塞米松与术前8 h注射地塞米松的临床疗效和炎症水平相当。因此，静脉注射地塞米松方法可以作为目前TKA临床途径的一种选择。

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引用次数: 0

Patients With Lymphedema are at Increased Risk of Complication After Total Knee Arthroplasty: A Population Level Study 全膝关节置换术后淋巴水肿患者并发症风险增加：一项人群水平的研究

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-11-21 DOI: 10.1016/j.artd.2025.101900

Bryce T. Hrudka MD, Evan Bailey MD, Alyssa Woltemath MD, Grayson Nour BS, Ajay Premkumar MD, MPH, Jacob M. Wilson MD

Background

Lymphedema, a chronic disorder characterized by abnormal lymphatic fluid buildup, most commonly affects the lower extremities. Limited literature exists regarding the impact of lymphedema on outcomes following primary total knee arthroplasty (TKA). This study examined the effect of lymphedema’s impact on complications and early revision-free survivorship following primary TKA using population-level data. We hypothesized that patients with preoperative lymphedema would have higher complication and revision rates.

Methods

Patients undergoing TKA for osteoarthritis between 2009 and 2020 were identified from a national claims database. Those with preoperative lymphedema were matched 1:1 to contemporaries without lymphedema using propensity score matching. Comparisons between matched and unmatched cohorts were performed using Chi-square and independent t-tests, while Cox proportional hazards models assessed revision risk.

Results

Of the 530,938 TKA patients, 1.05% (n = 5602) had preoperative lymphedema. Matched analysis showed lymphedema had higher 90-day rates of periprosthetic joint infection (2.9% vs 1.4%, P < .001), superficial surgical site infection (2.3% vs 1.6%, P = .007), wound complications (2.4% vs 1.7%, P = .013), and pulmonary embolism (6.6% vs 4.6%, P < .001). At 2 years, lymphedema was associated with increased risk of all-cause (hazard ratio (HR) = 1.42, P < .001) and septic revisions (HR = 1.88, P < .001) but not aseptic revisions (HR = 0.99, P = .929).

Conclusions

Preoperative lymphedema is associated with increased 90-day rates of periprosthetic joint infection and superficial surgical site infection, wound complications, and pulmonary embolism after primary TKA. Although aseptic revision risk was not increased, the association with higher all-cause and septic revisions warrants attention. These findings emphasize the need for aggressive counseling and preoperative optimization before TKA in lymphedema patients.

背景：淋巴水肿是一种以淋巴液异常积聚为特征的慢性疾病，最常见于下肢。关于原发性全膝关节置换术（TKA）后淋巴水肿对预后影响的文献有限。本研究使用人群水平的数据考察了淋巴水肿对原发性TKA术后并发症和早期无修复生存率的影响。我们假设术前淋巴水肿患者会有更高的并发症和翻修率。方法从国家索赔数据库中确定2009年至2020年期间接受骨关节炎TKA的患者。术前淋巴水肿患者与同期无淋巴水肿患者进行倾向评分匹配，比例为1:1。使用卡方检验和独立t检验对匹配和不匹配队列进行比较，Cox比例风险模型评估修订风险。结果530,938例TKA患者中，1.05% （n = 5602）患者术前有淋巴水肿。匹配分析显示，淋巴水肿患者在90天内的假体周围关节感染（2.9%对1.4%,P < 0.001）、浅表手术部位感染（2.3%对1.6%,P = 0.007）、伤口并发症（2.4%对1.7%,P = 0.013）和肺栓塞（6.6%对4.6%,P < 0.001）发生率较高。2年后，淋巴水肿与全因风险增加（风险比(HR) = 1.42, P < 0.001）和脓毒症治疗（HR = 1.88, P < 0.001）相关，但与无菌治疗无关（HR = 0.99, P = 0.929）。结论术后淋巴水肿与原发性TKA术后90天假体周围关节感染、浅表手术部位感染、伤口并发症和肺栓塞发生率增加有关。尽管无菌翻修风险没有增加，但与全因翻修和脓毒性翻修的关系值得注意。这些发现强调了淋巴水肿患者TKA前积极咨询和术前优化的必要性。

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引用次数: 0

Response to letter to the Editor Regarding “Utility of Frailty Index in Predicting Discharge Disposition and Prolonged Length of Stay Following Enhanced Recovery After Surgery Protocol Total Hip and Knee Arthroplasty” 关于“虚弱指数在预测全髋关节置换术后增强恢复后出院处置和延长住院时间中的效用”致编辑的回复

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-11-19 DOI: 10.1016/j.artd.2025.101894

Christoper Reynolds MD, Tariq Z. Issa MD, Jennings Dooley MD, Isaac Sontag-Milobsky BS, W. Christian Thomas MD, Kevin D. Hardt MD, David W. Manning MD

引用次数: 0

Erythrocyte Exchange Transfusion Enabling Simultaneous Bilateral Total Hip Arthroplasty by a direct anterior approach in a Young Patient with Sickle Cell Disease 年轻镰状细胞病患者经直接前路同时行双侧全髋关节置换术的红细胞交换输血

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-11-17 DOI: 10.1016/j.artd.2025.101909

Enrique Alberto Vargas Meouchi MD , Ricard Llovera González-Adrio MD , David Beneitez Pastor MD , Veronica Pons MD , Marta Garcia Bernal MD , Victor Manuel Barro Ojeda MD

Sickle cell disease (SCD) is a known risk factor for femoral head osteonecrosis, often leading to early joint degeneration. We report a 17-year-old male with homozygous SCD and bilateral femoral head collapse who underwent simultaneous bilateral total hip arthroplasty through a direct anterior approach. Preoperative optimization included erythrocyte exchange transfusion effectively reducing hemoglobin S from 76% to 26%. The procedure was completed without complications, and the patient recovered uneventfully, with no sickling crises or acute chest syndrome. Cemented implants were used due to poor bone quality. The patient regained full, pain-free ambulation by three months. This case supports the safety and feasibility of simultaneous bilateral total hip arthroplasty in selected SCD patients when preceded by targeted erythrocyte exchange transfusion and managed by a multidisciplinary team.

镰状细胞病（SCD）是已知的股骨头骨坏死的危险因素，通常导致早期关节变性。我们报告了一位17岁男性纯合子SCD和双侧股骨头塌陷患者，他同时通过直接前路行双侧全髋关节置换术。术前优化包括红细胞交换输血有效地将血红蛋白S从76%降低到26%。手术完成后无并发症，患者恢复平稳，无镰状危象或急性胸综合征。由于骨质量差，采用骨水泥种植体。3个月后，患者恢复了完全无痛的行走。本病例支持在选择的SCD患者中同时进行双侧全髋关节置换术的安全性和可行性，在此之前进行靶向红细胞交换输血并由多学科团队管理。

引用次数: 0

Demographic and Clinical Determinants of Unicondylar Vs Total Knee Arthroplasty Selection 单髁与全膝关节置换术选择的人口学和临床决定因素

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-11-15 DOI: 10.1016/j.artd.2025.101904

Nikita Golovachev MD, Kassem Ghayyad MD, Ramakanth Yakkanti MD, Obinna Adigweme MD

Background

Knee osteoarthritis is the most common degenerative joint disease in the elderly. Depending on affected compartments, treatment options include unicondylar knee arthroplasty (UKA) or total knee arthroplasty (TKA). Studies show higher osteoarthritis incidence and disparities in arthroplasty use and outcomes among minority groups. This study aimed to compare demographic and clinical differences in UKA and TKA procedures.

Methods

Patients who underwent primary UKA or TKA at 2 different institutions between 2014 and 2024 were identified. Variables compared between UKA and TKA groups included patient sex, age, body mass index (BMI), ethnicity, smoking status, comorbidities, assistance in activities of daily living (ADL), number of falls, and the American Society of Anesthesiologists (ASA) class.

Results

Of the 58,794 patients identified, 2421 received a UKA, and 56,373 received a TKA. The UKA group had a higher proportion of men and a lower average BMI. UKA patients had a higher percentage of White patients and a lower percentage of African American patients. Fewer UKA patients required assistance in ADL, and fewer had experienced falls in the past year. TKA patients had higher percentages of diabetes, heart disease, and hypertension. A higher percentage of UKA patients were ASA class II, and a lower percentage were ASA class III.

Conclusions

Patients who underwent primary UKA vs TKA showed significant differences in sex, BMI, race, ADL, comorbidities, falls in the past year, and ASA class. The results suggest that UKA patients are generally younger, have lower BMI, fewer comorbidities, and better functional status compared to TKA patients.

膝关节骨性关节炎是老年人最常见的退行性关节疾病。根据受影响的腔室，治疗方案包括单髁膝关节置换术（UKA）或全膝关节置换术（TKA）。研究表明，在少数群体中，骨关节炎的发病率更高，关节置换术的使用和结果也存在差异。本研究旨在比较UKA和TKA手术的人口学和临床差异。方法选取2014年至2024年间在2家不同机构接受原发性UKA或TKA的患者。UKA组和TKA组之间比较的变量包括患者性别、年龄、体重指数（BMI）、种族、吸烟状况、合并症、辅助日常生活活动（ADL）、跌倒次数和美国麻醉医师协会（ASA）等级。结果在58,794例患者中，2421例接受了UKA， 56,373例接受了TKA。UKA组的男性比例较高，平均体重指数较低。UKA患者中白人患者的比例较高，非裔美国人患者的比例较低。更少的UKA患者在ADL中需要帮助，更少的患者在过去一年中经历过跌倒。TKA患者患糖尿病、心脏病和高血压的比例更高。UKA患者ASA II级的比例较高，ASA III级的比例较低。结论原发性UKA与TKA患者在性别、BMI、种族、ADL、合并症、过去一年跌倒、ASA分级等方面存在显著差异。结果表明，与TKA患者相比，UKA患者通常更年轻，BMI更低，合并症更少，功能状态更好。

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引用次数: 0

Self-Reducible Neglected Recurrent Posterior Hip Dislocation Treated With Cemented Total Hip Arthroplasty 骨水泥全髋关节置换术治疗复发性复发性髋后脱位

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-11-15 DOI: 10.1016/j.artd.2025.101908

Subhan Shahid MBBS, FCPS , Waqas Ahmad MBBS , Abdul Rafeh Awan MBBS , Meher Ayyazuddin MBBS, MD , Faisal Masood MBBS, FCPS, CMT

Hip dislocations in adults are uncommon and usually follow high-energy trauma, with neglected cases being rarer but still encountered in low-resource settings. This report describes a 67-year-old man with 6 months of recurrent posterior hip dislocations after an initial injury. He first sought traditional treatment and eventually learned self-reduction techniques. Examination showed limb shortening, muscle wasting, and a neglected posterior acetabular wall fracture with major bone loss. He underwent cemented total hip arthroplasty via a posterior approach, with reconstruction of the posterior wall using an autologous femoral head-neck graft secured by cannulated screws. The case underscores the need for early recognition and proper surgical planning to prevent avascular necrosis, joint degeneration, and long-term disability, especially in developing regions.

成人髋关节脱位不常见，通常发生在高能创伤之后，被忽视的病例很少，但在资源匮乏的环境中仍然会遇到。本报告描述了一位67岁的男性，在初次受伤后6个月复发性髋后脱位。他首先寻求传统疗法，最终学会了自我减法。检查显示肢体缩短，肌肉萎缩，以及被忽视的髋臼后壁骨折伴主要骨丢失。患者经后路行骨水泥全髋关节置换术，并使用空心螺钉固定的自体股骨头颈移植物重建后壁。该病例强调了早期识别和适当的手术计划的必要性，以防止缺血性坏死，关节变性和长期残疾，特别是在发展中地区。

引用次数: 0

Robotic-Assisted Primary Total Knee Arthroplasty is Associated With Decreased 90-Day Opioid Prescribing Patterns Compared to Manual Instrumentation 与人工器械相比，机器人辅助的初次全膝关节置换术与减少90天阿片类药物处方模式相关

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-11-12 DOI: 10.1016/j.artd.2025.101886

Nathaniel T. Ondeck MD, MHS, Colin C. Neitzke MD, Yu-Fen Chiu MS, Sonia K. Chandi MD, Pravjit Bhatti MD, Alejandro Gonzalez Della Valle MD, Geoffrey H. Westrich MD, Brian P. Chalmers MD

Background

Robotic assistance minimizes bony resection and surrounding soft tissue damage during total knee arthroplasty (TKA), potentially decreasing postoperative pain. The objective of this study was to evaluate in-hospital opioid consumption, 90-day opioid prescribing patterns, length of stay (LOS), and patient-reported outcome measures (PROMs) following robotic-assisted vs manual primary TKA.

Methods

Utilizing an institutional database, all patients undergoing primary unilateral TKA between 2019 and 2022 with 90-day minimum follow-up were retrospectively queried. Patients were excluded if they had another surgery within 90 days of the index TKA, were discharged to a rehabilitation center, or were prescribed opioid or benzodiazepine medications preoperatively. One-to-one propensity score matching identified 1476 patients undergoing robotic-assisted (n = 738) or manual (n = 738) TKA. Multivariable regression analysis assessed in-hospital morphine milligram equivalents (MMEs) consumption, LOS, 90-day opioid prescribing patterns (not necessarily consumption), and PROMs (preoperative, 6 weeks, and 3 months).

Results

The robotic-assisted cohort consumed on average 12 fewer in-hospital MMEs (P = .026) and had an average LOS that was 8 hours shorter than the manual cohort (P < .001). There was no difference in MMEs prescribed at discharge (P = .12), but the robotic-assisted cohort had on average 113 fewer 90-day postdischarge MMEs prescribed (P = .001) and 145 fewer total 90-day MMEs (consumed in-hospital plus prescribed) (P < .001). There was no difference in PROMs at 6 weeks or 3 months.

Conclusions

Robotic-assisted TKA may confer shorter LOS with decreased 90-day opioid use patterns. This information is important given the increased scrutiny on opioid usage and recent focus on rapid recovery and ambulatory TKA pathways.

背景：在全膝关节置换术（TKA）中，机器人辅助最大限度地减少了骨切除和周围软组织损伤，潜在地减少了术后疼痛。本研究的目的是评估院内阿片类药物消耗、90天阿片类药物处方模式、住院时间（LOS）和患者报告的结果测量（PROMs），机器人辅助与手动原发性TKA。方法利用机构数据库，回顾性查询2019年至2022年期间所有接受原发性单侧TKA的患者，随访时间至少为90天。如果患者在TKA指数90天内进行了另一次手术，出院到康复中心，或术前开了阿片类药物或苯二氮卓类药物，则排除患者。一对一倾向评分匹配确定了1476例接受机器人辅助（n = 738）或人工（n = 738） TKA的患者。多变量回归分析评估了院内吗啡毫克当量（MMEs）消耗、LOS、90天阿片类药物处方模式（不一定是消耗）和PROMs（术前、6周和3个月）。结果与人工组相比，机器人辅助组平均少使用12个住院MMEs (P = 0.026)，平均LOS缩短8小时（P < .001）。出院时处方的MMEs没有差异（P = .12），但机器人辅助队列在出院后90天的MMEs处方平均减少113个（P = .001），总90天MMEs减少145个（院内消耗加上处方）（P < .001）。6周和3个月时的PROMs无差异。结论机器人辅助TKA可缩短LOS，减少90天阿片类药物使用模式。鉴于对阿片类药物使用的审查越来越严格，以及最近对快速恢复和动态TKA途径的关注，这一信息很重要。

{"title":"Robotic-Assisted Primary Total Knee Arthroplasty is Associated With Decreased 90-Day Opioid Prescribing Patterns Compared to Manual Instrumentation","authors":"Nathaniel T. Ondeck MD, MHS, Colin C. Neitzke MD, Yu-Fen Chiu MS, Sonia K. Chandi MD, Pravjit Bhatti MD, Alejandro Gonzalez Della Valle MD, Geoffrey H. Westrich MD, Brian P. Chalmers MD","doi":"10.1016/j.artd.2025.101886","DOIUrl":"10.1016/j.artd.2025.101886","url":null,"abstract":"<div><h3>Background</h3><div>Robotic assistance minimizes bony resection and surrounding soft tissue damage during total knee arthroplasty (TKA), potentially decreasing postoperative pain. The objective of this study was to evaluate in-hospital opioid consumption, 90-day opioid prescribing patterns, length of stay (LOS), and patient-reported outcome measures (PROMs) following robotic-assisted vs manual primary TKA.</div></div><div><h3>Methods</h3><div>Utilizing an institutional database, all patients undergoing primary unilateral TKA between 2019 and 2022 with 90-day minimum follow-up were retrospectively queried. Patients were excluded if they had another surgery within 90 days of the index TKA, were discharged to a rehabilitation center, or were prescribed opioid or benzodiazepine medications preoperatively. One-to-one propensity score matching identified 1476 patients undergoing robotic-assisted (n = 738) or manual (n = 738) TKA. Multivariable regression analysis assessed in-hospital morphine milligram equivalents (MMEs) consumption, LOS, 90-day opioid prescribing patterns (not necessarily consumption), and PROMs (preoperative, 6 weeks, and 3 months).</div></div><div><h3>Results</h3><div>The robotic-assisted cohort consumed on average 12 fewer in-hospital MMEs (<em>P</em> = .026) and had an average LOS that was 8 hours shorter than the manual cohort (<em>P</em> < .001). There was no difference in MMEs prescribed at discharge (<em>P</em> = .12), but the robotic-assisted cohort had on average 113 fewer 90-day postdischarge MMEs prescribed (<em>P</em> = .001) and 145 fewer total 90-day MMEs (consumed in-hospital plus prescribed) (<em>P</em> < .001). There was no difference in PROMs at 6 weeks or 3 months.</div></div><div><h3>Conclusions</h3><div>Robotic-assisted TKA may confer shorter LOS with decreased 90-day opioid use patterns. This information is important given the increased scrutiny on opioid usage and recent focus on rapid recovery and ambulatory TKA pathways.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101886"},"PeriodicalIF":2.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526309","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}

引用次数: 0

Design of Surgical Impaction Instruments Matters 手术嵌套器械的设计很重要

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-11-12 DOI: 10.1016/j.artd.2025.101898

Peter J. Schlieker MSc , Frank Lampe MD , Johann Zwirner MD , Benjamin Ondruschka MD , Michael M. Morlock PhD , Gerd Huber PhD

Background

Femoral stem impaction in total hip arthroplasty is commonly performed by mallet blows on a metal impactor attached to the stem. Factors including the surgeon, the impactor, and the patient can influence the impaction. A wide range of impactors, varying in design and thus in mass and stiffness, are available. However, little is known about their influence on the force transmission and, consequently, about the proportion of the mallet force that ultimately reaches the implant. This study aimed to investigate the force transmission through the impactor for different impactor designs, while investigating different patient-specific femur-tissue systems in situ and in silico.

Methods

The mallet and impactor forces of 9 consecutive blows on seated femoral stems were measured for 2 different approaches on each of 4 cadavers. The mallet-implant force transmission was calculated using a phenomenological model for 2 different impactor designs.

Results

The attenuated force in the impactor achieved approximately 65% to 75% of the corresponding mallet peak force, regardless of cadaver or surgical approach. Measuring the force distant from the tip resulted in an overestimation of the transferred forces. Depending on impactor design just 24% to 47% of the applied mallet peak force reached the implant itself.

Conclusions

The force transmission for overcritical mallet blows can be regarded as independent from patient- and approach-specific boundary conditions and primarily dependent on the impactor design. Surgeons must be aware of this relationship and exercise caution when using other or novel instruments to prevent intraoperative complications.

背景：在全髋关节置换术中，股骨柄内嵌通常是通过锤击附着在股骨柄上的金属撞击器来实现的。影响嵌塞的因素包括外科医生、嵌塞者和患者。有各种各样的冲击器，设计不同，质量和刚度也不同。然而，对于它们对力传递的影响知之甚少，因此，对于最终到达植入物的槌状力的比例知之甚少。本研究旨在研究不同设计的冲击器的力传递，同时在原位和计算机上研究不同的患者特异性股骨组织系统。方法对4具尸体分别采用2种不同入路对固定股骨干进行连续9次锤击和冲击力测定。采用现象学模型对2种不同的冲击器设计进行了锤体-种植体力传递计算。结果无论尸体入路还是手术入路，冲击器的衰减力都达到了相应木槌峰值力的65%至75%。测量距离尖端的力会导致对传递力的高估。根据冲击器的设计，只有24%到47%的锤头峰值力到达植入物本身。结论：过临界锤击的力传递可以被认为与患者和入路特定的边界条件无关，主要取决于冲击器的设计。外科医生必须意识到这种关系，并在使用其他或新型器械时谨慎行事，以防止术中并发症。

{"title":"Design of Surgical Impaction Instruments Matters","authors":"Peter J. Schlieker MSc , Frank Lampe MD , Johann Zwirner MD , Benjamin Ondruschka MD , Michael M. Morlock PhD , Gerd Huber PhD","doi":"10.1016/j.artd.2025.101898","DOIUrl":"10.1016/j.artd.2025.101898","url":null,"abstract":"<div><h3>Background</h3><div>Femoral stem impaction in total hip arthroplasty is commonly performed by mallet blows on a metal impactor attached to the stem. Factors including the surgeon, the impactor, and the patient can influence the impaction. A wide range of impactors, varying in design and thus in mass and stiffness, are available. However, little is known about their influence on the force transmission and, consequently, about the proportion of the mallet force that ultimately reaches the implant. This study aimed to investigate the force transmission through the impactor for different impactor designs, while investigating different patient-specific femur-tissue systems in situ and in silico.</div></div><div><h3>Methods</h3><div>The mallet and impactor forces of 9 consecutive blows on seated femoral stems were measured for 2 different approaches on each of 4 cadavers. The mallet-implant force transmission was calculated using a phenomenological model for 2 different impactor designs.</div></div><div><h3>Results</h3><div>The attenuated force in the impactor achieved approximately 65% to 75% of the corresponding mallet peak force, regardless of cadaver or surgical approach. Measuring the force distant from the tip resulted in an overestimation of the transferred forces. Depending on impactor design just 24% to 47% of the applied mallet peak force reached the implant itself.</div></div><div><h3>Conclusions</h3><div>The force transmission for overcritical mallet blows can be regarded as independent from patient- and approach-specific boundary conditions and primarily dependent on the impactor design. Surgeons must be aware of this relationship and exercise caution when using other or novel instruments to prevent intraoperative complications.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101898"},"PeriodicalIF":2.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526242","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}

引用次数: 0

Response to: “Reconsidering Patellofemoral Outcomes in Medially Stabilized Total Knee Arthroplasty: The Role of Implant Design and Rotational Strategy in Kinematic Alignment” 回复：“重新考虑内侧稳定全膝关节置换术的髌骨结果：假体设计和旋转策略在运动学对齐中的作用”

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-11-11 DOI: 10.1016/j.artd.2025.101896

Samuel W. King BM, BCh, MRCSEd, Nicolas Silvestrini PhD, Anne Lübbeke MD, DSc, Hemant Pandit DPhil, FRCS, Hermes H. Miozzari MD, PD

引用次数: 0

Avoiding Orthostatic Intolerance During Early Ambulation After Total Knee Arthroplasty: The Impact of Lying-to-Standing Time 全膝关节置换术后早期活动中避免直立性不耐受：躺到站立时间的影响

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-11-10 DOI: 10.1016/j.artd.2025.101905

Nonn Jaruthien MD , Supparurk Suksumran MD , Chotetawan Tanavalee MD , Chavarin Amarase MD , Aree Tanavalee MD , Wirinaree Kampitak MD , Srihatach Ngarmukos MD

Background

Orthostatic intolerance (OI), characterized by dizziness, blurred vision, syncope, can occur during ambulation after total knee arthroplasty (TKA) causing delayed rehabilitation and hospital discharge. Standardized guidelines to prevent OI during early ambulation are lacking. This study aimed to provide evidence regarding the impact of postural transition timing or lying-to-standing time (LTST) on OI during early postoperative ambulation following TKA.

Methods

We evaluated 120 patients undergoing unilateral primary TKA for OI with varying LTST. Patients with significant comorbidities, body mass index ≥40 kg/m², or presence of preoperative OI or orthostatic hypotension were excluded. Preoperatively and at 12 hours postoperatively, patients performed three protocols with varying LTST: after changing position from lying to sitting, wait 60 seconds before standing (protocol A), wait 30 seconds before standing (protocol B), and immediate standing (protocol C). Systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation were measured at sitting and standing positions for each protocol. OI was defined if signs of cerebral hypoperfusion were detected, or decrease in systolic blood pressure >20 mmHg, or decrease in diastolic blood pressure >10 mmHg.

Results

From 120 TKAs, 98 patients were included (mean age 74 years, mean body mass index 26.46 kg/m²). The incidences of postoperative OI were 0% for protocol A, 16.3% for protocol B, and 44.9% for protocol C. All protocol B patients with OI also experienced it in protocol C.

Conclusions

This study demonstrates that a 60-second sitting interval between lying and standing effectively prevents OI during early ambulation after TKA.

背景：全膝关节置换术（TKA）后活动时，可发生以头晕、视力模糊、晕厥为特征的坐姿不耐受（OI），导致康复和出院延迟。缺乏预防早期活动时成骨不全的标准化指南。本研究旨在为TKA术后早期活动中姿势转换时间或躺-站时间（LTST）对成骨不全的影响提供证据。方法我们评估了120例单侧原发性全髋关节置换术治疗不同LTST的成骨不全患者。排除有明显合并症、体重指数≥40 kg/m2、术前存在成骨不全或体位性低血压的患者。术前和术后12小时，患者采用三种不同的LTST方案：从躺姿改为坐姿后，等待60秒后站立（方案A），等待30秒后站立（方案B），立即站立（方案C）。分别在坐姿和站立位置测量收缩压、舒张压、心率和血氧饱和度。如果检测到脑灌注不足的迹象，或收缩压下降20mmhg，或舒张压下降10mmhg，则定义为成骨不全。结果共纳入120例tka患者98例，平均年龄74岁，平均体重指数26.46 kg/m2。方案A术后成骨不全发生率为0%，方案B为16.3%，方案c为44.9%。所有方案B的成骨不全患者在方案c中也发生了成骨不全。结论本研究表明，在TKA术后早期活动中，躺着和站立之间60秒的坐姿间隔可有效预防成骨不全。

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引用次数: 0