Arthroplasty Today最新文献

{"title":"Effect of Anatomic Joint-Line Obliquity Prostheses on Coronal Plane Alignment of the Knee Alignment in a Chinese Population","authors":"Poon Jerome Chi Wang MBBS, HKU,&nbsp;Qunn-jid Lee MB-ChB, CUHK,&nbsp;Kenneth Wing-kin Law MB-ChB, CUHK,&nbsp;Daniel Wai-yip Wong MBBS, HKU,&nbsp;Cho Pong Lo MB-ChB, CUHK","doi":"10.1016/j.artd.2025.101888","DOIUrl":"10.1016/j.artd.2025.101888","url":null,"abstract":"<div><h3>Background</h3><div>The Coronal Plane Alignment of the Knee (CPAK) classification describes knee phenotypes based on limb alignment and joint-line obliquity (JLO). This study evaluates CPAK distribution in the Hong Kong population and assesses how prosthesis design affects CPAK reproducibility and clinical outcomes.</div></div><div><h3>Methods</h3><div>This retrospective study included patients who underwent navigated total knee arthroplasty (TKA) with adjusted mechanical alignment in a single institution in 2021. First, we analyzed the epidemiology of CPAK phenotypes in our population. Second, patients were divided into 2 propensity score-matched groups based on implant design: Journey II BCS TKA (JLO prothesis) vs Persona PS TKA (joint line neutral prothesis). Radiological outcomes (mechanical hip–knee–ankle angle, lateral distal femoral angle, medial proximal tibial angle) and clinical outcomes (range of motion, Knee Society Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index score, Forgotten Joint Score) assessed preoperatively and at 6 and 12 months postoperatively.</div></div><div><h3>Results</h3><div>Our CPAK distribution was comparable to that of other East Asian populations. The Journey II BCS TKA more effectively restored JLO and CPAK phenotypes compared to the Persona PS TKA. However, there was no statistically significant clinical correlation between the restoration of JLO, arithmetic HKA, and CPAK.</div></div><div><h3>Conclusions</h3><div>Although radiological restoration improves with JLO prostheses, short-term clinical outcomes remain unaffected.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101888"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466855","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}

{"title":"Evaluating the Impact of a Preoperative Risk Management Program on Outcomes Following Total Joint Arthroplasty: A Retrospective Cohort Study","authors":"Chloe Dlott MD ,&nbsp;Sebastian Romero BS ,&nbsp;Claire A. Donnelley MD ,&nbsp;Stephanie Kaszuba MD ,&nbsp;Daniel Wiznia MD","doi":"10.1016/j.artd.2025.101880","DOIUrl":"10.1016/j.artd.2025.101880","url":null,"abstract":"<div><h3>Background</h3><div>Total joint arthroplasty is an effective intervention for end-stage joint disease, but carries elevated risks for patients with comorbidities and those from historically marginalized populations. Preoperative risk management programs are designed to mitigate these risks by optimizing patient health prior to surgery. This study evaluated the impact of such a program on postoperative outcomes at a single academic institution, with attention to racial and ethnic minorities and patients with public insurance.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 2748 patients who underwent total hip or knee arthroplasty between 2019 and 2021 at a single academic institution. Of these, 1548 patients received preoperative optimization targeting modifiable risk factors such as diabetes, obesity, and anemia, while 1200 followed standard preoperative protocols. Outcomes assessed included length of stay, prosthetic joint infection, 30- and 90-day readmissions, and emergency department (ED) visits. Patients were stratified by race/ethnicity, insurance type, and American Society of Anesthesiology physical classification.</div></div><div><h3>Results</h3><div>The optimized cohort had a higher average Charlson Comorbidity Index (1.1 vs 0.9; <em>P</em> = .01). There were no significant differences between groups in length of stay, readmissions, or overall ED visit rates. Black patients experienced higher ED utilization within 90 days postoperatively, regardless of optimization status. Medicaid patients with severe systemic disease had the highest rates of prosthetic joint infection (3.8%), and optimization was not associated with improved outcomes in this group. Patients with American Society of Anesthesiology physical classification ≥3 had increased ED visits postoperatively despite optimization.</div></div><div><h3>Conclusions</h3><div>Preoperative risk management did not consistently improve outcomes, particularly among patients with greater comorbidity burdens or those facing socioeconomic disadvantage. These findings support the need for tailored optimization strategies that address both clinical risk and social determinants of health.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101880"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418298","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}

{"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,&nbsp;Colin C. Neitzke MD,&nbsp;Yu-Fen Chiu MS,&nbsp;Sonia K. Chandi MD,&nbsp;Pravjit Bhatti MD,&nbsp;Alejandro Gonzalez Della Valle MD,&nbsp;Geoffrey H. Westrich MD,&nbsp;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> &lt; .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> &lt; .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":"2025-12-01","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}

{"title":"Use of a Novel Surgical Irrigant Significantly Reduces Rate of Infection in Primary Hip and Knee Arthroplasty at 1 year","authors":"Ravi K. Bashyal MD ,&nbsp;Avinash Inabathula MD ,&nbsp;Samantha Lariosa BS ,&nbsp;S. David Stulberg MD","doi":"10.1016/j.artd.2025.101907","DOIUrl":"10.1016/j.artd.2025.101907","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infection (PJI) prevention in primary hip and knee arthroplasty remains an important challenge in arthroplasty. Dilute topical povidone–iodine followed by a sterile saline rinse is widely used for intraoperative irrigation and infection prophylaxis in surgery. The Food and Drug Administration recently issued a reminder about the nonsterility of topical iodine preparations used in deep surgical wounds. Thus, our institution sought a terminally sterilized alternative. We investigated a terminally sterile irrigant with minimal cytotoxicity, efficacy against biofilm, and no required secondary rinse.</div></div><div><h3>Methods</h3><div>This was a single-surgeon retrospective cohort study of 2087 consecutive primary total hip and knee arthroplasties with minimum 1-year follow-up in a major metropolitan community hospital. The control group of 1045 patients received a dilute povidone-iodine soak followed by saline rinse. The experimental group of 1042 patients received the new irrigant (XPerience (XP)) without secondary rinse. The International Consensus Meeting 2018 recommended algorithm and criteria were used to diagnose PJI.</div></div><div><h3>Results</h3><div>Overall, the PJI rate was 0% (0 of 1042) in the XP group and 0.6% (6/1045) in the povidone-iodine group (<em>P</em> = .017). The overall return to operating room rate was 0.5% (5 of 1042) in the XP group and 1.1% (12 of 1045) in the control group (<em>P</em> = .11).</div></div><div><h3>Conclusions</h3><div>The novel solution had a lower infection rate in our cohort. We conclude that it is a comparable alternative to povidone–iodine. An ongoing prospective randomized control trial and a cost-benefit analysis may provide stronger guidance for surgeons.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101907"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erythrocyte Exchange Transfusion Enabling Simultaneous Bilateral Total Hip Arthroplasty by a direct anterior approach in a Young Patient with Sickle Cell Disease","authors":"Enrique Alberto Vargas Meouchi MD ,&nbsp;Ricard Llovera González-Adrio MD ,&nbsp;David Beneitez Pastor MD ,&nbsp;Veronica Pons MD ,&nbsp;Marta Garcia Bernal MD ,&nbsp;Victor Manuel Barro Ojeda MD","doi":"10.1016/j.artd.2025.101909","DOIUrl":"10.1016/j.artd.2025.101909","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101909"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579119","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}

{"title":"Avoiding Orthostatic Intolerance During Early Ambulation After Total Knee Arthroplasty: The Impact of Lying-to-Standing Time","authors":"Nonn Jaruthien MD ,&nbsp;Supparurk Suksumran MD ,&nbsp;Chotetawan Tanavalee MD ,&nbsp;Chavarin Amarase MD ,&nbsp;Aree Tanavalee MD ,&nbsp;Wirinaree Kampitak MD ,&nbsp;Srihatach Ngarmukos MD","doi":"10.1016/j.artd.2025.101905","DOIUrl":"10.1016/j.artd.2025.101905","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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 &gt;20 mmHg, or decrease in diastolic blood pressure &gt;10 mmHg.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>This study demonstrates that a 60-second sitting interval between lying and standing effectively prevents OI during early ambulation after TKA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101905"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526310","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}

{"title":"Presence of Metallosis Can Interfere With Culture Positivity in Prosthetic Joint Infection of the Hip","authors":"Ayesha Abdeen MD ,&nbsp;Nelson Merchan MD ,&nbsp;Marcos R. Gonzalez MD ,&nbsp;Joshua B. Davis BS ,&nbsp;Jacob Drew MD ,&nbsp;Rubén Monárrez MD ,&nbsp;Antonia F. Chen MD, MBA ,&nbsp;Edward K. Rodriguez MD","doi":"10.1016/j.artd.2025.101910","DOIUrl":"10.1016/j.artd.2025.101910","url":null,"abstract":"<div><h3>Background</h3><div>Metallosis is a well-described complication of total hip arthroplasty (THA); however, its impact on periprosthetic joint infection (PJI) diagnosis and treatment remains unknown. We assessed whether coexisting metallosis at the time of revision THA is associated with delayed diagnosis and poorer PJI treatment outcomes.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients undergoing revision THA due to chronic and acute hematogenous PJI with coexisting metallosis (metallosis and PJI group). A matched cohort of patients with chronic and acute hematogenous PJI without metallosis was established (control group). The 2018 International Consensus Meeting criteria were used to define PJI. Metallosis was diagnosed based on the intraoperative findings or serum chromium/cobalt levels. The primary outcomes were culture positivity and survival free of reoperation or revision. Thirteen and 42 patients were included in the metallosis and PJI and the control groups, respectively.</div></div><div><h3>Results</h3><div>The initial set of cultures was negative in 38% of patients in the metallosis and PJI group, compared to only 12% in the control group (<em>P</em> = .03). Time elapsed between presentation of symptoms and first positive culture was significantly longer in the metallosis and PJI group compared to the control (14.5 vs 0 days, <em>P</em> &lt; .001). The revision rate was 46% in the metallosis and PJI group and 24% in the control group (<em>P</em> = .12). Revision-free survival in patients treated with debridement, antibiotics, and implant retention was 28% in the metallosis and PJI group and 79.7% in the control group, (<em>P</em> = .21).</div></div><div><h3>Conclusions</h3><div>Metallosis may increase the likelihood of initial false negative culture results and delay PJI diagnosis in patients undergoing revision THA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101910"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of an Anteromedial Cortical Window for Tibial Component Removal During Revision Total Knee Arthroplasty","authors":"Bailey J. Ross MD ,&nbsp;Jacob Glassman BS ,&nbsp;Grayson Nour BS ,&nbsp;Jacob M. Wilson MD ,&nbsp;Jose A. Rodriguez MD ,&nbsp;Ajay Premkumar MD, MPH","doi":"10.1016/j.artd.2025.101890","DOIUrl":"10.1016/j.artd.2025.101890","url":null,"abstract":"<div><div>Revision total knee arthroplasty often entails removal of well-fixed components. Tibial component removal is particularly challenging due to (I) mechanical barriers that limit circumferential disruption when pegs, keels, or stems are present; (II) restricted access to implant-cement and cement-bone interfaces within the proximal canal; and (III) the proximity of critical structures, including the collateral ligaments, patellar tendon, popliteal artery, and distal femur. We present a novel anteromedial cortical window technique that facilitates removal of well-fixed tibial components by improving access to the implant-cement, burr-cement, and cement-bone interfaces within the proximal tibial metaphysis. This technique is suited for cases not requiring posterolateral exposure, offering a less morbid alternative to tibial tubercle osteotomy with the option for conversion if greater exposure is needed.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101890"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Malnutrition Is Associated With Increased Rates of Periprosthetic Fractures in Total Knee Arthroplasty","authors":"Andrew Ni MD,&nbsp;Shawn Dripchak MD,&nbsp;Coltin Gerhart MD,&nbsp;Victor Martinez DO,&nbsp;Zachary Jodoin MD,&nbsp;Chance Moore MD,&nbsp;Frank Buttacavoli MD","doi":"10.1016/j.artd.2025.101914","DOIUrl":"10.1016/j.artd.2025.101914","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic fractures (PPFx) after total knee arthroplasty (TKA) are associated with high morbidity and mortality. While previous studies have shown the potential role of malnutrition as a predictor of PPFx in total hip arthroplasty, no studies have evaluated malnutrition as a risk factor for PPFx in TKA patients. This study aims to evaluate the relationship between preoperative nutrition status and PPFx after TKA.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from the TriNetX Registry to identify patients who underwent primary TKA or revision TKA (rTKA) from 2005 to 2025. Preoperative nutrition status was assessed using albumin levels within 3 months prior to TKA based on prior arthroplasty and nutrition literature. Hypoalbuminemia was defined as &lt; 3.5 g/dl. The primary outcome was PPFx occurring at least 1 day after TKA surgery, thereby excluding intraoperative PPFx. Cox proportional hazard models were used to determine hazard ratios (HRs) for each cohort.</div></div><div><h3>Results</h3><div>There were 176,662 TKA patients and 1301 (0.74%) patients with subsequent PPFx during this study period. Preoperative malnutrition was identified in 19,500 patients (11.5%) in the primary TKA group and 1138 patients (17.9%) in the rTKA group. Both primary TKA (hazard ratio [HR] = 1.37, 95% confidence interval [CI], 1.23-1.52, <em>P</em> ≤ 0.001) and rTKA patients (HR = 1.20, 95% CI, 1.03-1.41, <em>P</em> = .022) with preoperative hypoalbuminemia were at an increased risk of PPFx while albumin levels of greater than 3.5 g/dl were protective against PPFx ((HR = 0.73, 95% CI, 0.58-0.93, <em>P</em> = .009) and (HR = 0.72, 95% CI, 0.53-0.97, <em>P</em> = .029) for primary TKA and rTKA respectively). Other nutritional labs including increased prealbumin and higher lymphocyte percentage were statistically significantly associated with a decreased risk for PPFx. Independent risk factors for PPFx following TKA included diabetes, obesity, female sex, and increased age.</div></div><div><h3>Conclusions</h3><div>Our study shows that poor preoperative nutrition status is associated with statistically significant increased risks of PPFx following TKA in both primary TKA and rTKA. Optimization of nutrition may help prevent PPFx following TKA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101914"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to Achieve a Minimal Clinically Important Difference After Total Hip Arthroplasty: A Retrospective Cohort Comparison of Robotic-Assisted, Navigation-Assisted, and Conventional Techniques","authors":"Kareem Omran MD, MPhil (Cantab) ,&nbsp;Colleen Wixted MD, MBA ,&nbsp;Daniel Waren MSPH, CCRP ,&nbsp;Joshua C. Rozell MD ,&nbsp;Ran Schwarzkopf MD, MSc","doi":"10.1016/j.artd.2025.101902","DOIUrl":"10.1016/j.artd.2025.101902","url":null,"abstract":"<div><h3>Background</h3><div>Technological advancements in total hip arthroplasty (THA), including robotic-assisted (RA-THA) and navigation-assisted (NA-THA) techniques, aim to improve outcomes. However, impact on recovery timing remains unclear. This study examined whether these technologies reduce the time to reach the minimal clinically important difference (MCID) on the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement compared with conventional THA.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed osteoarthritic THA patients (01/2020-04/2023) who completed preoperative and postoperative Hip Disability and Osteoarthritis Outcome Score for Joint Replacement questionnaires. The exclusion criteria included bilateral procedures or revision within 1 year. MCID was defined using anchor-based (23 points) and distribution-based thresholds (7.6 points). Multivariable interval-censored accelerated failure time models assessed time to MCID.</div></div><div><h3>Results</h3><div>Among the 1395 patients, 181 (12.9%) underwent RA-THA, 754 (54.1%) underwent NA-THA, and 460 (33.0%) underwent conventional THA. Anchor-based MCID rates were 65.2%, 63.4%, and 66.5%, respectively (<em>P</em> &gt; .05), with median times of 38.9, 48.4, and 45.1 days. Neither RA-THA (time ratio [TR] = 0.86, 95% confidence interval [CI]: 0.63-1.18, <em>P</em> = .347) nor NA-THA (TR = 1.07, 95% CI: 0.87-1.32, <em>P</em> = .502) significantly affected time to MCID vs conventional distribution-based thresholds yielded higher MCID rates (93.9%, 88.9%, 89.8%; <em>P</em> &gt; .05) with median times of 8.6, 11.4, and 12.9 days, respectively. RA-THA reached MCID 33.5% faster than conventional THA (TR = 0.66, 95% 26 CI: 0.52-0.86, <em>P</em> = .002) and 24.3% faster than NA-THA (TR = 0.76, 95% CI: 0.60-0.95, <em>P</em> = .019), while NA-THA showed no significant difference vs conventional THA (TR = 0.88, 95% CI: 0.74-1.04, <em>P</em> = .140).</div></div><div><h3>Conclusions</h3><div>Anchor-based MCID demonstrated comparable recovery times across RA, NA, and conventional THA, suggesting no patient-perceived advantage with technology. Distribution-based thresholds indicated RA-THA achieved faster statistically significant improvement, though the relevance remains uncertain.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101902"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466853","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}