Arthroplasty Today最新文献

{"title":"Perioperative Outcomes of Intramedullary Nail vs Hemiarthroplasty vs Total Hip Arthroplasty for Intertrochanteric Fracture: An Analysis of 31,519 Cases","authors":"Natalia Czerwonka MD,&nbsp;Sohil S. Desai MD,&nbsp;Puneet Gupta MD,&nbsp;Roshan P. Shah MD, JD,&nbsp;Jeffrey A. Geller MD,&nbsp;H. John Cooper MD,&nbsp;Alexander L. Neuwirth MD","doi":"10.1016/j.artd.2024.101513","DOIUrl":"10.1016/j.artd.2024.101513","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study is to compare 30-day perioperative outcomes following treatment of intertrochanteric (IT) fractures with intramedullary nail (IMN), total hip arthroplasty (THA), or hemiarthroplasty (HA).</div></div><div><h3>Methods</h3><div>Using the National Surgical Quality Improvement Program database, we conducted a retrospective cohort study of patients who had sustained an IT fracture treated with primary IMN, THA, or HA between 2017 and 2020. International Classification of Diseases, 10th Revision codes S72.141-S72.146, subtypes A through C, were used to identify eligible patients and were cross-referenced to primary Current Procedural Terminology codes, used to identify the following procedure types: 27245: IMN; 27130: THA; and 27236: HA. Revision cases and patients who underwent arthroplasty for osteoarthritis were excluded. Outcomes of interest included reoperation, readmission, operative time, length of stay, and major and minor complications. Multivariate regression was used to evaluate differences in postoperative outcomes between groups.</div></div><div><h3>Results</h3><div>There were 29,809 IT fractures treated with IMN (94.6%), 1493 treated with HA (4.7%), and 217 treated with THA (0.70%). There was a statistically significant increase in 30-day reoperation rates (adjusted odds ratio [aOR] = 1.99 [95% confidence interval = 1.51, 2.63], <em>P</em> &lt; .001) when combining all arthroplasty patients compared to IMN. There was no statistically significant difference in the overall complication rate between IMN (13.58%) and HA (14.60%, aOR = 1.09, <em>P</em> = .315) or THA (11.98%, aOR = 1.00, <em>P</em> = .998). When compared to IMN (0.12%), there was a statistically significantly decreased need for transfusion in the HA group (aOR = 0.71 [95% confidence interval = 0.61, 0.80], <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Primary HA is associated with an increased 30-day reoperation rate and decreased need for blood transfusion, but there were no other significant differences in postoperative morbidity identified among IMN, THA, and HA in the treatment of IT fractures. Given the challenges and inferior outcomes associated with conversion arthroplasty, the lack of significant difference in morbidity between the 3 groups suggests that primary arthroplasty may be a safe and viable treatment option in selected patients with IT fractures. Comparative studies with longer clinical follow-up will be necessary to establish the appropriate indications and further evaluate the clinical outcomes of primary arthroplasty in the treatment of IT fractures.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101513"},"PeriodicalIF":1.5,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446378","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}

{"title":"Cement Viscosity and Application Time Lead to Significant Changes in Cement Penetration and Contact Surface Area","authors":"Christian Fölsch Prof Dr med ,&nbsp;Julia Schirmer ,&nbsp;Cosmin Glameanu ,&nbsp;Bernd Ishaque Prof Dr med ,&nbsp;Carlos Alfonso Fonseca Ulloa Dr biol hom ,&nbsp;Torben Harz ,&nbsp;Markus Rickert Prof Dr med ,&nbsp;John Ryan Martin MD ,&nbsp;Jan Scherberich Dr rer nat ,&nbsp;Jessica Steinbart ,&nbsp;Gabriele Krombach Prof Dr med ,&nbsp;Christian Paul ,&nbsp;Klaus-Dieter Kühn Prof Dr ,&nbsp;Alexander Jahnke Dr biol hom","doi":"10.1016/j.artd.2024.101476","DOIUrl":"10.1016/j.artd.2024.101476","url":null,"abstract":"<div><h3>Background</h3><div>Application time and viscosity are factors that can significantly affect the properties of bone cement and implant fixation. The aim of this study was to investigate the influence of different application times of 2 different cements on mechanical parameters, cement interdigitation, and cement distribution.</div></div><div><h3>Methods</h3><div>P.F.C. Sigma tibial trays were cemented with high-viscous Palacos R and medium- to low-viscous Simplex P in an open-cell model. The application was performed at different times within the manufacturer’s specifications. Cement interdigitation and micromotion were measured with computed tomography scan using a novel method.</div></div><div><h3>Results</h3><div>Significant differences of insertion forces were found at all times of cement application. Cement penetration decreased with increasing pressure and viscosity. No significant differences were shown for micromotion between Palacos R and Simplex P except for an increase for Simplex P from 3 to 7 minutes at the bone-cement interface. Simplex P appeared to trap air at the implant-cement interface at 3 minutes and increased at 7 minutes.</div></div><div><h3>Conclusions</h3><div>Cement distribution and intrusion of Palacos R and Simplex P decreased with time. Simplex P trapped air at the implant-cement interface, decreasing the amount of contact at the implant-cement interface, which is worrisome for long-term implant fixation. Given the significant changes in cement properties after mixing, it is necessary for surgeons to understand the viscosity and timing of cement application to achieve optimal cement penetration and surface contact area to potentially decrease implant loosening. High-viscous Palacos R should be applicated immediately with doughing time and medium-viscous Simplex P for about 4 minutes considering a threshold of minimum pressure.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101476"},"PeriodicalIF":1.5,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446377","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}

{"title":"Robotic-Assisted Total Knee Arthroplasty Improves Accuracy and Reproducibility of the Polyethylene Insert Thickness Compared to Manual Instrumentation or Navigation: A Retrospective Cohort Study","authors":"Yoan Bourgeault-Gagnon FRCSC ,&nbsp;Lucy J. Salmon BAppSci (Physio), PhD ,&nbsp;Matthew C. Lyons MBBS, FRACS","doi":"10.1016/j.artd.2024.101489","DOIUrl":"10.1016/j.artd.2024.101489","url":null,"abstract":"<div><h3>Background</h3><div>Increased accuracy and lower rates of component positioning outliers have been associated with better long-term survival and functional outcomes of total knee arthroplasty (TKA). This study investigates the accuracy of robotic-assisted TKA compared to navigation-assisted and manual instrumentation techniques, using polyethylene tibial insert thickness as a surrogate.</div></div><div><h3>Methods</h3><div>Consecutive primary TKA by a single surgeon were retrospectively reviewed and divided in 3 groups: manual instrumentation, navigation-assisted, and robotic-assisted (RA-TKA). Polyethylene insert thickness, deviation from planned thickness, and rate of outliers were compared between the 3 groups using nonparametric analysis of variance, Kruskal-Wallis tests, and Bonferroni corrections. Logistic regression analysis was performed to identify predictors of polyethylene thickness ≥9 mm. The learning curve for RA-TKA was evaluated with a box plot graph of groups of 10 consecutive cases.</div></div><div><h3>Results</h3><div>There were 474 patients in manual instrumentation TKA, 257 in navigation-assisted TKA and 225 in RA-TKA, with median polyethylene thicknesses of 6.0 (interquartile range 5.0-7.0), 6.0 (interquartile range 5.0-7.0), and 5.0 (interquartile range 5.0-6.0) millimeters, respectively (P˂0.001 RA-TKA compared to both other groups). Polyethylene inserts with a thickness ≥9 mm were used in 28 (5.9%) manual instrumentation TKA, 13 (5.1%) navigation-assisted TKA, and 1 (0.4%) RA-TKA (<em>P</em> = .004). Independent predictors for polyethylene thickness ≥9 mm included surgical technique, left side, and male sex. A learning curve of &lt;30 cases was observed before consistent polyethylene thickness was achieved in RA-TKA.</div></div><div><h3>Conclusions</h3><div>Tibial polyethylene insert thickness, as a surrogate of surgical accuracy, is more reproducible in robotic-assisted than in navigation-assisted or manual-instrumentation TKA. The learning curve to reach high levels of reproducibility with this technique is relatively short.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101489"},"PeriodicalIF":1.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441239","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}

{"title":"Retaining a Well-fixed Cone During Revision Total Knee Arthroplasty: Surgical Technique and Outcomes","authors":"Xiao T. Chen MD,&nbsp;Michael W. Seward MD,&nbsp;Robert T. Trousdale MD,&nbsp;David G. Lewallen MD,&nbsp;Matthew P. Abdel MD,&nbsp;Nicholas A. Bedard MD","doi":"10.1016/j.artd.2024.101477","DOIUrl":"10.1016/j.artd.2024.101477","url":null,"abstract":"<div><div>Metaphyseal cones are frequently used in revision total knee arthroplasties (TKAs). However, during subsequent aseptic re-revisions, removing a well-fixed cone can be difficult. One innovative option is to retain the well-fixed cone and cement a new, stemmed revision component through the retained cone, yet minimal data exist on this technique. We describe a technique for retaining a well-fixed cone during re-revision TKA and report outcomes in 6 patients with 6 well-fixed metaphyseal cones. At a mean of 4 years follow-up, no retained cones with a new femoral or tibial component with stems were revised and there was no radiographic evidence of aseptic loosening. These early data suggest that retaining a well-fixed cone can be safe in re-revision TKA to minimize morbidity associated with cone removal.</div></div><div><h3>Level of evidence</h3><div>IV (retrospective study).</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101477"},"PeriodicalIF":1.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441237","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}

{"title":"Patient-Specific Acetabular Safe Zones in Total Hip Arthroplasty: External Validation of a Quantitative Approach to Preoperatively Templating Spinopelvic Parameters","authors":"Michael Pang BS ,&nbsp;Jonathan M. Vigdorchik MD ,&nbsp;Ran Schwarzkopf MD ,&nbsp;Antonia F. Chen MD, MBA ,&nbsp;Richard Iorio MD ,&nbsp;Jeffrey K. Lange MD ,&nbsp;Prem N. Ramkumar MD, MBA","doi":"10.1016/j.artd.2024.101508","DOIUrl":"10.1016/j.artd.2024.101508","url":null,"abstract":"<div><h3>Background</h3><div>Spinopelvic mechanics are critical in total hip arthroplasty; however, there is no established consensus for adjusting acetabular component positioning based on spinopelvic parameters. This study aimed to (1) validate a recently developed Patient-Specific acetabular safe-zone calculator that factors in spinopelvic parameters and (2) compare differences with hip-spine classification targets.</div></div><div><h3>Methods</h3><div>A total of 3750 patients underwent primary total hip arthroplasty across 3 academic referral centers, with 33 (0.88%) requiring revision for instability. Spinopelvic parameters were measured before initial total hip arthroplasty, and acetabular component position was measured following the index and revision procedures. Most operations employed either computer navigation or robotic assistance (94%). Surgical approaches included both anterior and posterior techniques. Utilizing our recently developed patient-specific safe-zone calculator, theoretical intraoperative positions were calculated and compared to true component positions before and after revision.</div></div><div><h3>Results</h3><div>Among 33 patients who underwent revision, none dislocated at an average follow-up of 5.1 years. In the external validation cohort, the average absolute differences between the patient-specific safe-zone and the median hip-spine classification recommendation were 3.8° ± 2.1° inclination and 5.0° ± 3.2° version. For the pooled cohort, the absolute differences between the patient-specific safe-zone targets and the prerevision component positions were 7.9° ± 5.1° inclination and 11.4° ± 6.9° version. After revision, the mean absolute differences decreased to 3.6° ± 3.1° inclination and 5.8° ± 3.5° version (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>A patient-specific approach improved acetabular component positioning accuracy within 6° of version and 4° of inclination of stable, revised hips. Patient-specific safe zones provide quantitative targets for nuanced spinopelvic preoperative planning that may mitigate risk of instability and may indicate use of assisted technologies.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101508"},"PeriodicalIF":1.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441238","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}

{"title":"Mechanical Failure of Modular Rotating Hinge Femoral Component","authors":"Justin Leal BS,&nbsp;Rahul K. Goel MD,&nbsp;Michael P. Bolognesi MD,&nbsp;Samuel S. Wellman MD,&nbsp;Thorsten M. Seyler MD, PhD,&nbsp;Sean P. Ryan MD","doi":"10.1016/j.artd.2024.101495","DOIUrl":"10.1016/j.artd.2024.101495","url":null,"abstract":"<div><div>Hinge constructs can be used in revision total knee arthroplasty in cases of major collateral ligament deficiency, global knee instability, repeated failure of constrained implants, or large bone defects. Although the success of this construct in revision total knee arthroplasty varies depending on the type of surgery and bone quality, hinged implants can solve a wide array of complex problems while preserving stable flexion-extension motion for ambulation. The most common reasons for re-revision include patellofemoral complications, aseptic loosening, and infection. Most cases of mechanical failure for these hinged constructs occur at the hinge component. Here, we report the first instance of catastrophic femoral component failure in a modular rotating hinge via a low-energy mechanism.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101495"},"PeriodicalIF":1.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441240","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}

{"title":"Predicting 30-Day Venous Thromboembolism Following Total Joint Arthroplasty: Adjusting for Trends in Annual Length of Stay","authors":"Johnathan R. Lex MBChB, MASc ,&nbsp;Robert Koucheki MD, MEng ,&nbsp;Aazad Abbas MD ,&nbsp;Jesse I. Wolfstadt MD, MSc, FRCSC, FAAOS ,&nbsp;Alexander S. McLawhorn MD, MBA ,&nbsp;Bheeshma Ravi MD, PhD, FRCSC","doi":"10.1016/j.artd.2024.101491","DOIUrl":"10.1016/j.artd.2024.101491","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE) following total hip arthroplasty and total knee arthroplasty (TKA) is linked to immobility, and preoperative prediction remains difficult. We aimed to evaluate whether annual mean length of stay (LOS) is associated with the incidence of VTE and develop a generalizable machine learning model to preoperatively predict the incidence of symptomatic VTE following total hip and TKA using National Surgical Quality Improvement Program.</div></div><div><h3>Methods</h3><div>Annual incidence of 30-day postoperative VTE, deep vein thrombosis, and pulmonary embolism was calculated over 6 years and tested for trend. Correlation between annual VTE rates and mean LOS was calculated. Predictive models (logistic regression, random forest, and XGBoost) were trained and tested based on year of surgery with different oversampling algorithms used to address data imbalance.</div></div><div><h3>Results</h3><div>A total of 498,314 patients were included, with 0.88% developing a VTE within 30 days. VTE rates decreased from 1.11% in 2014 to 0.76% in 2019 (<em>P</em> &lt; .001). There was a strong correlation between the yearly incidence of VTE, pulmonary embolism, and deep vein thrombosis and mean LOS (r = 0.96, 0.87, and 0.98, respectively). Univariate analysis demonstrated that TKA, inpatient setting, American Society of Anesthesiologists classification, and various patient comorbidities were significantly associated with VTE. The logistic regression model trained on all data with a balanced loss scoring function performed the best (area under the curve = 0.600).</div></div><div><h3>Conclusions</h3><div>This study revealed declining VTE rates strongly correlated to decreasing postoperative LOS and identified patient and surgery-specific factors associated with VTE risk. Development of more accurate machine learning models for VTE prediction may improve risk stratification, prevention, and monitoring for arthroplasty patients.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101491"},"PeriodicalIF":1.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437928","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}

{"title":"Conversational Engagement Using a Short Message Service Chatbot After Total Joint Arthroplasty","authors":"Joshua P. Rainey MD ,&nbsp;Emily A. Treu MD ,&nbsp;Kevin J. Campbell MD ,&nbsp;Brenna E. Blackburn PhD ,&nbsp;Christopher E. Pelt MD ,&nbsp;Michael J. Archibeck MD ,&nbsp;Jeremy M. Gililland MD ,&nbsp;Lucas A. Anderson MD","doi":"10.1016/j.artd.2024.101484","DOIUrl":"10.1016/j.artd.2024.101484","url":null,"abstract":"<div><h3>Background</h3><div>Utilizing conversational analytics in orthopaedic surgery may provide insights into patients’ experiences and outcomes. This study retrospectively assessed how patients interacted with a perioperative chatbot and whether the topic of patients’ queries could offer insight on their outcomes after total knee or hip arthroplasty.</div></div><div><h3>Methods</h3><div>We identified 1338 patients (746 knees and 592 hips) who enrolled in a short message service chatbot from 2020-2022 with greater than 3 months of follow-up. The total number and topics of patient-generated text responses to the chatbot were recorded. Independent <em>t</em>-tests, chi-squared tests, and linear regressions were performed to determine if specific patient-generated responses to the chatbot or overall chatbot engagement were associated with demographics or outcomes.</div></div><div><h3>Results</h3><div>Readmitted patients interacted less with the perioperative chatbot than those who were not readmitted (3.9 messages vs 12.7 messages, <em>P</em> &lt; .0001). Return to emergency department (ED) and reoperation rates were not associated with engagement. Patients who visited the ED within 90 days of their surgery were most commonly seeking advice about walking after surgery (<em>P</em> = .0046) and weaning off their opiate pain medications (<em>P</em> = .0281). Patients who were readmitted to the hospital were similarly seeking advice about walking (<em>P</em> = .0188) and weaning off pain medications (<em>P</em> = .0218). Replying “exercise” was associated with no ED visits or readmissions (<em>P</em> = .0009). Patients with a mental health diagnosis were more likely to reply with high-acuity topics (<em>P</em> = .0052).</div></div><div><h3>Conclusions</h3><div>The topic of chatbot queries and chatbot engagement were associated with patient outcomes after total knee arthroplasty or total hip arthroplasty and may provide insight to patients’ perioperative courses.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101484"},"PeriodicalIF":1.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437929","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}

{"title":"Higher Comorbidities are Correlated With Readmission Following Arthroplasty for Femoral Neck Fracture","authors":"Anastasia Gazgalis MD,&nbsp;Shawn Simmons BA,&nbsp;Mary Doucet LCSW,&nbsp;Prakash Gorroochurn PhD,&nbsp;H. John Cooper MD,&nbsp;Carl L. Herndon MD","doi":"10.1016/j.artd.2024.101494","DOIUrl":"10.1016/j.artd.2024.101494","url":null,"abstract":"<div><h3>Background</h3><div>A desire to control cost and improve patient outcomes following arthroplasty led to the introduction of the Center for Medicare and Medicaid Service Comprehensive Care for Joint Replacement Program. Hemi and total hip arthroplasty for femoral neck fracture has been shown to have worse outcomes than those for osteoarthritis. However, little has been studied about the effect of comorbidities on costs associated with arthroplasty for femoral neck fracture. This study investigates how the number of comorbidities influence 90-day outcomes and cost following hemi or total hip arthroplasty for displaced femoral neck fracture in patients covered by the Comprehensive Care for Joint Replacement bundle.</div></div><div><h3>Methods</h3><div>We reviewed all Medicare hip fracture patients undergoing hemi or total hip arthroplasty at our institution between April 2016 and November 2020. Basic demographic and perioperative information was collected. The primary outcome was hospital readmission within 90 days. The data set captured 90-day readmission to any institution, not just within our system. Secondary outcomes included 90-day reoperation and outpatient complications. Multiple logistic regression was used to examine the influence of number of comorbidities on the primary and secondary outcomes while controlling for other variables.</div></div><div><h3>Results</h3><div>The cohort comprised 378 patients (72% female), mean age 82 (±9) years, mean body mass index 23.4 (±4.7) kg/m². For every additional comorbidity, the odds of related readmission without reoperation increased by 1.261 (95% confidence interval [1.055-1.507], <em>P</em> = .011). Odds of reoperation and odds of outpatient complication did not show statistical significance with the available numbers.</div></div><div><h3>Conclusions</h3><div>Increasing preoperative comorbidities results in a higher odd of readmission within 90 days following arthroplasty for femoral neck fracture in this Medicare population.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101494"},"PeriodicalIF":1.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437926","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}

{"title":"Role of the Conjoined Tendon in Hip Stability Post-Total Hip Arthroplasty: Insights From a Direct Anterior Approach Cadaver Study","authors":"Gongyin Zhao MD, PhD ,&nbsp;Chenyu Zhao MBBS ,&nbsp;Hongwei Bao MD ,&nbsp;Junting Liu MD ,&nbsp;Baojun Zhou MD ,&nbsp;Yuji Wang MD, PhD","doi":"10.1016/j.artd.2024.101487","DOIUrl":"10.1016/j.artd.2024.101487","url":null,"abstract":"<div><h3>Background</h3><div>Hip dislocation represents a significant complication encountered following hip arthroplasty procedures. In this investigation, we conducted a comparative analysis of the biomechanical characteristics exhibited by the piriformis and the conjoined tendon after total hip arthroplasty (THA) via the direct anterior approach (DAA), utilizing cadaveric specimens. The objective is to ascertain the relative significance of the piriformis muscle and the conjoined tendon in mitigating hip dislocation.</div></div><div><h3>Methods</h3><div>A total of 16 hip joints from 8 freshly frozen cadavers were selected and stratified into 2 groups: the piriformis tendon (PT) group and the conjoined tendon (CT) group. Following THA via the DAA, measurements were taken to record the torque required to induce hip dislocation under various conditions. Torque readings were obtained with the tendon in its intact state (intact group) and after preservation or reconstruction of either the PT or the CT.</div></div><div><h3>Results</h3><div>The torques of anterior and posterior dislocation in PT group were 22.24 ± 4.53 N.m and 30.7 ± 15.5 N.m following tendon severed, and 20.04 ± 2.67 N.m and 17.5 ± 6.7 N.m following reconstruction. There were no differences compared to the intact group. The torque decreased in the CT group after CT was severed with the torques dropping from 31.2 ± 7.6 N.m to 8.18 ± 2.6 N.m (<em>P</em> &lt; .0001) for anterior dislocation, and from 34.9 ± 8.3 N.m to 9.8 ± 2.8 N.m (<em>P</em> &lt; .0001) for posterior dislocation. Following reconstruction, the torque required for dislocation significantly increased (<em>P</em> &lt; .0001).</div></div><div><h3>Conclusions</h3><div>This study underscores the preeminent role of the CT in ensuring hip stability following THA via DAA, highlighting the cruciality of its preservation and reconstruction during surgical interventions.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101487"},"PeriodicalIF":1.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437927","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}