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Robotic-Assistance in Total Hip Arthroplasty Is Associated With Decreased Dislocation Rates 机器人辅助全髋关节置换术可降低脱位率

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-12 DOI: 10.1016/j.artd.2024.101473

Background

As the use of robotics in total hip arthroplasty (THA) continues to gain popularity, differences in clinical outcomes when compared to manual techniques have remained unclear. This study aimed to compare postoperative complications between patients undergoing robotic-assisted techniques and manual THA for primary osteoarthritis at 90 days, 1 year, and 2 years.

Methods

Using an all-payer national database, we identified 405,048 patients who underwent either robotic-assisted or manual THA for primary osteoarthritis. A propensity match was performed for age, sex, a comorbidity index, chronic kidney disease, obesity, and diabetes, resulting in 7652 patients in each cohort. We assessed postoperative outcomes, including surgical site infections, pulmonary emboli, venous thromboemboli, wound complications, dislocations, aseptic revisions, periprosthetic joint infections, and periprosthetic fractures. We completed bivariate analyses via chi-square tests to assess categorical variables. We utilized student’s t-tests to compare continuous variables, including ages and comorbidities. Odds ratios (ORs) were calculated for complications using 95% confidence intervals (CIs).

Results

The robotic-assisted cohort had lower rates of dislocation at 90 days (0.93 vs 1.41%, OR 0.65, 95% CI 0.48-0.88, P = .007), 1 year (1.32 vs 1.92%, OR 0.68, 95% CI 0.53-0.88, P = .004), and 2 years (1.66 vs 2.1%, OR 0.79, 95% CI 0.62-0.99, P = .049). Total surgical complications were significantly lower in the robotic-assisted cohort at 1 year (5.29 vs 6.16%, OR 0.85, 95% CI 0.74-0.98, P = .0205), but were similar at 90 days and 2 years. At 90 days, the rates of medical complications, including surgical site infections, pulmonary emboli, venous thromboemboli, and wound complications, were similar (all P > .05). The rates of periprosthetic joint infections, aseptic revision, periprosthetic fractures, and aseptic loosening were similar at all time points (all P > .05).

Conclusions

Patients who underwent robotic-assisted THA had lower rates of dislocation at 90 days, 1 year, and 2 years. This finding supports the use of robotic assistance in THA, though further research is needed to confirm and strengthen these findings.

背景随着机器人技术在全髋关节置换术（THA）中的应用不断普及，与人工技术相比，临床结果的差异仍不明确。本研究旨在比较接受机器人辅助技术和人工全髋关节置换术治疗原发性骨关节炎的患者在 90 天、1 年和 2 年的术后并发症。根据年龄、性别、合并症指数、慢性肾病、肥胖症和糖尿病等因素进行倾向匹配，结果每个队列中有 7652 名患者。我们对术后结果进行了评估，包括手术部位感染、肺栓塞、静脉血栓栓塞、伤口并发症、脱位、无菌翻修、假体周围关节感染和假体周围骨折。我们通过卡方检验完成了双变量分析，以评估分类变量。我们使用学生 t 检验来比较连续变量，包括年龄和合并症。用95%置信区间（CI）计算并发症的比值比（OR）。93 vs 1.41%，OR 0.65，95% CI 0.48-0.88，P = .007）、1 年（1.32 vs 1.92%，OR 0.68，95% CI 0.53-0.88，P = .004）和 2 年（1.66 vs 2.1%，OR 0.79，95% CI 0.62-0.99，P = .049）。机器人辅助组的手术总并发症在1年时明显降低（5.29 vs 6.16%，OR 0.85，95% CI 0.74-0.98，P = .0205），但在90天和2年时相似。90天时，包括手术部位感染、肺栓塞、静脉血栓栓塞和伤口并发症在内的医疗并发症发生率相似（所有P均为0.05）。在所有时间点，假体周围关节感染、无菌性翻修、假体周围骨折和无菌性松动的发生率相似（所有P均为0.05）。这一发现支持在 THA 中使用机器人辅助，但还需要进一步的研究来证实和加强这些发现。

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引用次数: 0

Qualitative Comparison of Cultured Skin Microbiota From the Inguinal Region of Obese and Nonobese Patients Eligible for Hip Arthroplasty 符合髋关节置换术条件的肥胖患者和非肥胖患者腹股沟区皮肤微生物群培养的定性比较

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-12 DOI: 10.1016/j.artd.2024.101483

Background

With the rising prevalence of obesity, surgeons are frequently confronted with the problem of treating osteoarthritis of the hip via arthroplasty (total hip arthroplasty) in severely obese patients. To reduce the surgical impact, minimal-invasive approaches are often chosen. For this reason, the direct anterior approach has gained popularity but is suspected of leading to more wound complications in obese patients, especially by Gram-negative pathogens. Causative differences of the skin microbiome have been suspected but not yet proven.

Methods

Patients scheduled for total hip arthroplasty via direct anterior approach were screened for inclusion. The study group was defined as patients with a body mass index ≥35 and an abdominal pannus hanging over the incision site, whereas nonobese patients served as the control group. Samples of the microbiome were taken 2-3 cm distal and lateral to the superior anterior iliac spine using plates and swabs. Species identification was carried out by mass spectrometric analysis.

Results

The study group consisted of 28 patients, the control group of 36 patients. The most frequent potential pathogen on the skin was Staphylococcus epidermidis in both the groups. Microbiota found in obese patients showed significantly higher prevalence of Gram-negative bacteria from the order Enterobacterales. Wound complications were more frequent in the study group, but this was not statistically significant.

Conclusions

Obese patients with abdominal pannus present higher rates of colonization with Enterobacterales at the incision site of the direct anterior approach. Modifications of the antibiotic regime and the incision should be considered in this special patient population.

背景随着肥胖症发病率的上升，外科医生经常面临通过关节成形术（全髋关节成形术）治疗严重肥胖患者髋关节骨性关节炎的问题。为了减少手术影响，通常会选择微创方法。因此，直接前路方法越来越受欢迎，但被怀疑会导致肥胖患者出现更多伤口并发症，尤其是革兰氏阴性病原体。方法对计划通过直接前路进行全髋关节置换术的患者进行筛选。研究组定义为体重指数≥35 且切口部位有腹部肿块的患者，而非肥胖患者为对照组。使用平板和棉签在髂前上棘远端和外侧 2-3 厘米处采集微生物组样本。研究组有 28 名患者，对照组有 36 名患者。两组患者皮肤上最常见的潜在病原体均为表皮葡萄球菌。肥胖患者的微生物群显示，肠杆菌科革兰氏阴性菌的感染率明显更高。研究组的伤口并发症发生率更高，但无统计学意义。对于这类特殊患者，应考虑对抗生素使用方法和切口进行调整。

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引用次数: 0

Factors Affecting Successful Restricted Kinematic Alignment With Robotic Assisted Total Knee Arthroplasty in Patients With Severe Varus Preoperative Alignment 影响机器人辅助全膝关节置换术成功实现术前严重外翻患者限制性运动对位的因素

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101490

Background

Total knee arthroplasty (TKA) remains challenging in severe varus knees. We evaluated the impact of hip-knee-ankle varus deformity and osteophyte size on achieving restricted kinematic alignment (rKA) in robotic-arm-assisted TKA.

Methods

This retrospective study included 244 knees (194 patients) that underwent robotic-arm-assisted TKA for varus primary knee osteoarthritis at an academic institution. Intraoperative hip-knee-ankle angle (HKA) and soft tissue balance were monitored to assess the success of rKA with osteophyte resection alone. For those that failed, medial collateral ligament needle pie-crusting was performed.

Results

Mean age was 65.3 years (range, 48-83). Mean preoperative HKA was 11.9° varus (range, 1.0°-32.0°), and HKA after osteophyte resection was 5.1° varus (range, 0°-19.0°). Mean HKA correction was 6.8° (range, 0°-18.0°). rKA was achieved in 36.9% at a boundary of ≤3° varus and up to 72.1% at ≤6° varus. Preoperative varus HKA was lower in successful cases across all target alignments (P < .05). Medial tibial osteophyte size was 6.1% ± 2.9% and was smaller in all groups that achieved rKA (P < .05). Both were positively correlated with degree of deformity correction, r = 0.718 (P < .01) and r = 0.281 (P < .01), respectively.

Conclusions

This study highlighted the importance of varus deformity and medial tibial osteophytes when adopting rKA. They were associated with increased failure to achieve rKA. rKA was reliably achieved in minimal varus deformities (HKA ≤ 5°), we recommend an expanded protocol of HKA ≤ 6° varus for mild deformities (HKA 6°-10°), and consider medial soft tissue release for moderate (HKA 11°-15°) and severe deformities (HKA ≥ 16°).

背景全膝关节置换术（TKA）对于严重屈曲的膝关节仍然具有挑战性。我们评估了髋-膝-踝关节屈曲畸形和骨赘大小对机器人手臂辅助全膝关节置换术（TKA）中实现受限运动学对位（rKA）的影响。对术中髋-膝-踝角度（HKA）和软组织平衡进行监测，以评估单纯骨质增生切除术（rKA）的成功率。结果平均年龄为 65.3 岁（48-83 岁）。术前 HKA 平均曲度为 11.9°（范围为 1.0°-32.0°），骨质增生切除术后 HKA 平均曲度为 5.1°（范围为 0°-19.0°）。36.9%的患者在髋关节屈曲≤3°时获得了rKA，72.1%的患者在髋关节屈曲≤6°时获得了rKA。在所有目标对齐的成功病例中，术前曲度 HKA 均较低（P < .05）。胫骨内侧骨质增生的大小为 6.1% ± 2.9%，在所有达到 rKA 的组别中均较小（P < .05）。两者与畸形矫正程度呈正相关，分别为 r = 0.718 (P < .01) 和 r = 0.281 (P < .01)。我们建议对轻度畸形（HKA 6°-10°）采用HKA≤6°的扩大方案，对中度畸形（HKA 11°-15°）和重度畸形（HKA≥16°）考虑内侧软组织松解。

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引用次数: 0

Failure of the Femoral and Tibial Components Following Anterior Cruciate Ligament Injury After Robotic-Assisted Bicruciate-Retaining Total Knee Arthroplasty 机器人辅助双叉韧带保留全膝关节置换术后，前交叉韧带损伤导致股骨和胫骨组件失效

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101523

We report a case of failure of the femoral and tibial components due to anterior cruciate ligament (ACL) injury after robotic-assisted bicruciate-retaining total knee arthroplasty. A 70-year-old woman with osteoarthritis underwent robotic-assisted bicruciate-retaining total knee arthroplasty. At 8 months after surgery, persistent knee pain and swelling of the knee joint were noted after fall in knee. We diagnosed a failure between the femoral and tibial components following an ACL injury. Proximal ACL injury and spin out of ultra-high molecular weight polyethylene were confirmed. We selected a constrained condylar knee prosthesis due to large bone attribution after femoral and tibial component removal. Postoperative three-dimensional computed tomography images suggested that excessive internal rotational alignment of the tibial component caused stress on the ACL.

我们报告了一例机器人辅助双叉韧带固定全膝关节置换术后因前交叉韧带（ACL）损伤导致股骨和胫骨组件失败的病例。一名患有骨关节炎的70岁女性接受了机器人辅助双叉韧带固定全膝关节置换术。术后 8 个月，膝关节出现持续性疼痛和肿胀。我们诊断为前交叉韧带损伤后股骨和胫骨组件之间出现故障。前交叉韧带近端损伤和超高分子量聚乙烯旋出得到证实。由于股骨和胫骨组件移除后骨归属较大，我们选择了约束髁膝关节假体。术后三维计算机断层扫描图像显示，胫骨组件的过度内旋对齐对前十字韧带造成了压力。

引用次数: 0

AI-Generated Graduate Medical Education Content for Total Joint Arthroplasty: Comment 人工智能生成的全关节置换术毕业医学教育内容：评论

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101500

引用次数: 0

Conversion of Unicompartmental Knee Arthroplasty to Total Knee Arthroplasty for Cement Allergy 因水泥过敏而将单隔间膝关节置换术改为全膝关节置换术

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101496

Despite the success of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA), complications leading to loosening and eventual failure can arise. While infection, instability, and aseptic loosening are some of most common causes of UKA and TKA failure, one of the less common reasons is delayed hypersensitivity reactions. While most allergic reactions are hypersensitivity reactions to metal, hypersensitivity reactions to other materials used in the procedure, such as polymethylmethacrylate bone cement, have begun to gain more attention in recent years. In this case report, we explore the unique instance of a patient who required a revision of a cemented UKA to TKA due to severe pain likely caused by a confirmed polymethylmethacrylate allergy.

尽管单间室膝关节置换术（UKA）和全膝关节置换术（TKA）取得了成功，但仍可能出现导致松动和最终失败的并发症。感染、不稳定性和无菌性松动是导致单关节膝关节置换术（UKA）和全膝关节置换术（TKA）失败的最常见原因，而迟发性超敏反应则是较少见的原因之一。虽然大多数过敏反应是对金属的超敏反应，但近年来，对手术中使用的其他材料（如聚甲基丙烯酸甲酯骨水泥）的超敏反应也开始受到越来越多的关注。在本病例报告中，我们探讨了一位患者的独特病例，该患者因剧烈疼痛而需要将粘接UKA翻修为TKA，其原因很可能是对聚甲基丙烯酸甲酯过敏。

引用次数: 0

A Handheld, Portable Image-Based System May Outperform Computer Navigation or Robotic Platforms in Providing Accurate Acetabular Component Positioning 基于图像的手持便携式系统在提供准确的髋臼组件定位方面可能优于计算机导航或机器人平台

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101511

Background

Malposition of the acetabular component during total hip arthroplasty (THA) is a leading cause of complications and need for revision. Robotic-assisted THA purports to improve accuracy of component positioning with many reports demonstrating over 92% of components within 10° of inclination and anteversion compared to intraoperative system output. This study aimed to evaluate the intraoperative accuracy output of acetabular cup position values using a handheld miniaturized portable navigation system (Naviswiss, AG) compared to postoperative computed tomography (CT) scans.

Methods

A total of 108 direct anterior approach THA surgeries using the intraoperative navigation device were performed over a 6-month period. Intraoperative device output for measured acetabular component inclination and anteversion were recorded and compared with values derived from postoperative CT scans.

Results

Postoperative CT analysis of acetabular component positioning demonstrated 97.22% and 94.44% were within 5° of intraoperative inclination and anteversion, respectively, compared to intraoperative values from the navigation unit. No CT demonstrated an absolute inclination or anteversion measurement difference more than 8° from the intraoperative navigation unit value. Overall, 92.59% of components were within 5° and 100% were within 8° for both inclination and anteversion compared to postoperative CT measurements.

Conclusions

This handheld portable navigation system yielded highly accurate intraoperative component positioning values confirmed by postoperative CT scans during direct anterior THA, possibly superior to reported robotic-assisted THA values. These smaller, portable, and more accessible intraoperative units may provide surgeons improved accuracy and availability in a number of surgical settings for use in THA.

背景在全髋关节置换术（THA）中，髋臼组件定位错误是导致并发症和翻修需求的主要原因。机器人辅助全髋关节置换术（Robotic-assisted THA）可提高组件定位的准确性，许多报告显示，与术中系统输出相比，92%以上的组件倾斜度和前倾角在10°以内。本研究旨在评估使用手持式微型便携导航系统（Naviswiss，AG）与术后计算机断层扫描（CT）相比，术中输出的髋臼杯位置值的准确性。方法在6个月的时间内，共进行了108例使用术中导航设备的直接前路THA手术。结果术后CT对髋臼组件定位的分析表明，与导航装置的术中值相比，97.22%和94.44%的髋臼组件的术中倾斜度和前倾角分别在5°以内。CT 显示的绝对倾斜度或前倾角与术中导航仪测量值的差异均未超过 8°。总体而言，与术后 CT 测量值相比，92.59% 的组件倾斜度和前倾角都在 5° 以内，100% 的组件倾斜度和前倾角都在 8° 以内。结论在直接前路 THA 手术中，这种手持便携式导航系统获得了经术后 CT 扫描确认的高度准确的术中组件定位值，可能优于已报道的机器人辅助 THA 值。这些更小、更便携、更易获得的术中设备可为外科医生提供更高的准确性，并可在多种手术环境中用于 THA。

{"title":"A Handheld, Portable Image-Based System May Outperform Computer Navigation or Robotic Platforms in Providing Accurate Acetabular Component Positioning","authors":"","doi":"10.1016/j.artd.2024.101511","DOIUrl":"10.1016/j.artd.2024.101511","url":null,"abstract":"<div><h3>Background</h3><div>Malposition of the acetabular component during total hip arthroplasty (THA) is a leading cause of complications and need for revision. Robotic-assisted THA purports to improve accuracy of component positioning with many reports demonstrating over 92% of components within 10° of inclination and anteversion compared to intraoperative system output. This study aimed to evaluate the intraoperative accuracy output of acetabular cup position values using a handheld miniaturized portable navigation system (Naviswiss, AG) compared to postoperative computed tomography (CT) scans.</div></div><div><h3>Methods</h3><div>A total of 108 direct anterior approach THA surgeries using the intraoperative navigation device were performed over a 6-month period. Intraoperative device output for measured acetabular component inclination and anteversion were recorded and compared with values derived from postoperative CT scans.</div></div><div><h3>Results</h3><div>Postoperative CT analysis of acetabular component positioning demonstrated 97.22% and 94.44% were within 5° of intraoperative inclination and anteversion, respectively, compared to intraoperative values from the navigation unit. No CT demonstrated an absolute inclination or anteversion measurement difference more than 8° from the intraoperative navigation unit value. Overall, 92.59% of components were within 5° and 100% were within 8° for both inclination and anteversion compared to postoperative CT measurements.</div></div><div><h3>Conclusions</h3><div>This handheld portable navigation system yielded highly accurate intraoperative component positioning values confirmed by postoperative CT scans during direct anterior THA, possibly superior to reported robotic-assisted THA values. These smaller, portable, and more accessible intraoperative units may provide surgeons improved accuracy and availability in a number of surgical settings for use in THA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medial Patellar Instability Following Total Knee Arthroplasty 全膝关节置换术后的髌骨内侧不稳定性

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101522

Although lateral patellar instability has been discussed as a complication following total knee arthroplasty (TKA), there are no published reports of medial patellar instability. We present a case of a 72-year-old female patient with a remote history of medializing tibial tubercle osteotomy who underwent TKA complicated by a medial dislocation of the patella. Management consisted of lateral retinaculum imbrication, revision of the patellar component, and lateralizing tibial tubercle osteotomy in the setting of appropriate rotation of the tibial and femoral components. It is important to be aware of medial patellar instability as well as potential treatment options as this is a rare complication that can occur following TKA.

虽然外侧髌骨不稳作为全膝关节置换术（TKA）后的并发症已有讨论，但目前还没有关于内侧髌骨不稳的公开报道。我们报告了一例 72 岁女性患者的病例，她曾接受过胫骨结节内侧截骨术，但因髌骨内侧脱位而并发了 TKA。治疗包括外侧韧带嵌顿、髌骨组件翻修以及胫骨和股骨组件适当旋转情况下的胫骨结节外侧截骨术。了解髌骨内侧不稳以及潜在的治疗方案非常重要，因为这是一种在TKA术后可能发生的罕见并发症。

引用次数: 0

Routine Postoperative Hemoglobin and Hematocrit Tests Are Unnecessary Following Primary Total Hip and Knee Arthroplasty 初次全髋关节和膝关节置换术后无需进行常规的术后血红蛋白和血细胞比容检测

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101502

Background

Acute blood loss and transfusion are recognized risks factors of total hip (THA) and total knee arthroplasty (TKA). This study aimed to investigate the clinical value of immediate postoperative hemoglobin and hematocrit (H&H) tests following primary elective THA and TKA.

Methods

This retrospective observational study was undertaken at a single academic hospital. Medical records were reviewed for a consecutive series of patients undergoing primary elective THA and TKA over a 12-month period. Patient demographic data; the use of preoperative anticoagulants; preoperative and postoperative blood test results; and the incidence of postoperative allogenic blood transfusion (ABT) were collected. The primary outcome measure was the incidence of postoperative ABT prescribed in response to the immediate postoperative H&H result.

Results

Overall, 367 eligible patients were included, with 167 THA (46%) and 200 TKA (54%) cases. Only 3 patients (0.8%) received a postoperative ABT; none on the day of surgery or on postoperative day 1. Immediate postoperative H&H tests were drawn in 246 patients (67%), but it did not influence clinical decision-making with regards to transfusion. No significant differences in ABT were observed in relation to patient age, sex, body mass index, operation (THA or TKA), or the use of preoperative anticoagulation medication. The incidence of ABT was significantly higher in patients with a combined preoperative hemoglobin <12.5 g/dL and hematocrit <40.0% (P = .003).

Conclusions

The incidence of postoperative blood transfusion following primary elective THA and TKA was low at 0.8%. Postoperative H&H tests were drawn in most patients but did not influence clinical management. Immediate postoperative hematological monitoring is unnecessary for most low-risk patients following uncomplicated primary elective THA and TKA.

背景急性失血和输血是公认的全髋关节（THA）和全膝关节置换术（TKA）的危险因素。本研究旨在探讨初诊择期全髋关节置换术（THA）和全膝关节置换术（TKA）术后立即检测血红蛋白和血细胞比容（H&H）的临床价值。研究人员查阅了一系列在 12 个月内接受初次择期 THA 和 TKA 手术的患者的病历。研究收集了患者的人口统计学数据、术前抗凝药物的使用情况、术前和术后血液检测结果以及术后异体输血（ABT）的发生率。主要结果指标是术后立即使用H&H结果所导致的术后ABT发生率。结果总共纳入了367例符合条件的患者，其中167例THA（46%），200例TKA（54%）。仅有 3 例患者（0.8%）在术后接受了 ABT，其中没有一例是在手术当天或术后第 1 天接受的。有 246 名患者（67%）在术后立即进行了 H&H 检测，但这并不影响输血方面的临床决策。ABT与患者的年龄、性别、体重指数、手术（THA或TKA）或术前抗凝药物的使用无明显差异。术前合并血红蛋白为 12.5 g/dL 和血细胞比容为 40.0% 的患者 ABT 发生率明显更高（P = .003）。结论初选 THA 和 TKA 术后输血发生率较低，仅为 0.8%。大多数患者术后都进行了 H&H 检测，但这并不影响临床治疗。对于大多数无并发症的初诊择期 THA 和 TKA 低风险患者来说，术后无需立即进行血液监测。

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引用次数: 0

Glucagon-Like Peptide-1 Receptor Agonist Use is Not Associated With Increased Complications After Total Knee Arthroplasty in Patients With Type-2 Diabetes 2 型糖尿病患者使用胰高血糖素样肽-1 受体激动剂与全膝关节置换术后并发症增加无关

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101506

Background

Glucagon-like peptide-1 (GLP-1) agonists have emerged as a powerful diabetic treatment adjunct; however, its effects on outcomes following total knee arthroplasty (TKA) are not well known. The purpose of this study was to compare the risk of complications after TKA in patients with type-2 diabetes who were on GLP-1 agonists with those who were not.

Methods

In total, 34,696 type 2 diabetes patients undergoing primary TKA between 2016 and 2021 were retrospectively reviewed utilizing a large national database. Propensity score matching was employed to match patients on GLP-1 agonists to controls at a 1:1 ratio (n = 2388 each). Multivariable logistic regression was utilized to examine 90-day and 1-year TKA outcomes between cohorts.

Results

Controls had higher odds of extended hospital stays (≥3 days) (odds ratio 1.29, P < .001). However, surgical complication rates at 90-days including surgical site infection and prosthetic joint infection were not significantly different. Similarly, no differences were seen in medical complications. There were also no significant differences in rates of all-cause revision TKA and aseptic revision TKA at 1 year postoperatively.

Conclusions

This study found that GLP-1 agonist use was not associated with increased medical or surgical complication rates in patients with diabetes undergoing TKA and was associated with lower rates of extended hospital stays after surgery. Given the potential for increased glycemic control and weight loss in patients using GLP-1 agonists, more data are needed to delineate the potential role of GLP-1 agonists in preoperative optimization of patients with diabetes prior to joint arthroplasty to minimize postoperative complications.

背景胰高血糖素样肽-1（GLP-1）激动剂已成为一种强有力的糖尿病辅助治疗药物；然而，它对全膝关节置换术（TKA）术后效果的影响却不甚了解。本研究旨在比较服用 GLP-1 激动剂和未服用 GLP-1 激动剂的 2 型糖尿病患者在 TKA 术后出现并发症的风险。方法利用大型国家数据库对 2016 年至 2021 年间接受初级 TKA 手术的 34,696 名 2 型糖尿病患者进行了回顾性研究。采用倾向得分匹配法，将使用 GLP-1 激动剂的患者与对照组按 1:1 的比例进行匹配（各为 2388 人）。结果对照组延长住院时间（≥3 天）的几率更高（几率比 1.29，P < .001）。然而，90 天后的手术并发症发生率（包括手术部位感染和假体关节感染）并无显著差异。同样，内科并发症也无差异。结论这项研究发现，在接受 TKA 手术的糖尿病患者中，GLP-1 促效剂的使用与内科或外科并发症发生率的增加无关，而且与术后住院时间延长率的降低有关。鉴于使用 GLP-1 激动剂的患者有可能增加血糖控制和减轻体重，因此需要更多的数据来界定 GLP-1 激动剂在糖尿病患者关节置换术前的术前优化中的潜在作用，以最大限度地减少术后并发症。

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引用次数: 0