Pub Date : 2024-10-11DOI: 10.1016/j.artd.2024.101518
Guillain-Barré syndrome (GBS) is an acute immune-mediated inflammatory demyelinating polyneuropathy characterized by symmetrical limb weakness and areflexia. GBS is typically monophasic but may recur in 1%-7% of patients. Many etiologies exist for GBS; one rare associated etiology is surgery, most notably orthopaedic, abdominal, and cardiac surgery. Here, we present a 76-year-old male who developed postsurgical GBS after a right total knee arthroplasty (TKA), 11 years after developing GBS following a left TKA. The patient developed worsening ascending paralysis and, ultimately, respiratory failure requiring tracheostomy. This study reports a rare case of recurrent postsurgical GBS after TKA, possibly triggered by general anesthesia or tourniquet use. Early recognition of postsurgical GBS is imperative to avoid patient mortality.
{"title":"Recurrent Guillain-Barré Syndrome After Subsequent Total Knee Arthroplasties","authors":"","doi":"10.1016/j.artd.2024.101518","DOIUrl":"10.1016/j.artd.2024.101518","url":null,"abstract":"<div><div>Guillain-Barré syndrome (GBS) is an acute immune-mediated inflammatory demyelinating polyneuropathy characterized by symmetrical limb weakness and areflexia. GBS is typically monophasic but may recur in 1%-7% of patients. Many etiologies exist for GBS; one rare associated etiology is surgery, most notably orthopaedic, abdominal, and cardiac surgery. Here, we present a 76-year-old male who developed postsurgical GBS after a right total knee arthroplasty (TKA), 11 years after developing GBS following a left TKA. The patient developed worsening ascending paralysis and, ultimately, respiratory failure requiring tracheostomy. This study reports a rare case of recurrent postsurgical GBS after TKA, possibly triggered by general anesthesia or tourniquet use. Early recognition of postsurgical GBS is imperative to avoid patient mortality.</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":"142427483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.artd.2024.101521
Hydatid disease is a zoonotic infestation caused by the Echinococcus, with extremely rare bone involvement. We present a case of acetabular hydatid cyst in a 16-year-old girl who initially underwent wide surgical excision, adjuvant ablation, and local administration of anthelminthic agent followed by systemic anthelmintic therapy. After 5 years, due to the development of degenerative joint disease and as infection was suspected intraoperatively, a 2-stage total hip arthroplasty was performed. The patient’s prosthesis remained stable and well fixed, and she is now fully functional at the 12-year follow-up. The consideration of hydatid disease in the differential diagnosis of destructive bone lesions, particularly in endemic areas, is crucial for timely detection and effective treatment. This case report highlights the challenges in the surgical treatment of periacetabular bone hydatidosis.
{"title":"Acetabular Hydatid Cyst in a Teenage Girl: A Rare Manifestation and Successful Long-Term Management With Combined Surgical and Anthelmintic Approaches","authors":"","doi":"10.1016/j.artd.2024.101521","DOIUrl":"10.1016/j.artd.2024.101521","url":null,"abstract":"<div><div>Hydatid disease is a zoonotic infestation caused by the <em>Echinococcus</em>, with extremely rare bone involvement. We present a case of acetabular hydatid cyst in a 16-year-old girl who initially underwent wide surgical excision, adjuvant ablation, and local administration of anthelminthic agent followed by systemic anthelmintic therapy. After 5 years, due to the development of degenerative joint disease and as infection was suspected intraoperatively, a 2-stage total hip arthroplasty was performed. The patient’s prosthesis remained stable and well fixed, and she is now fully functional at the 12-year follow-up. The consideration of hydatid disease in the differential diagnosis of destructive bone lesions, particularly in endemic areas, is crucial for timely detection and effective treatment. This case report highlights the challenges in the surgical treatment of periacetabular bone hydatidosis.</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":"142427481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.artd.2024.101505
Background
Dalbavancin (DAL) off-label use for treating bone and joint infections has increased especially as long-term intravenous access is not needed. Little is known about the effectiveness and safety of its use.
Methods
This retrospective, single-center, descriptive study included adults treated with DAL for bone or joint infections over a 4-year period (2019-2023). Patient demographics, infection type and location, pre-DAL antibiotic and surgical treatments, indication for DAL, and clinical outcomes were collected. Risk factor analysis for 1-year infection recurrence was performed.
Results
There were 58 patient encounters of bone and/or joint infections treated with DAL. The majority of patients were treated for osteomyelitis (81.0%) followed by native (8.6%) and peri-prosthetic (10.4%) joint infection. Fifty (86.2%) patients underwent surgical intervention, and 17 (68%) of the 25 patients with infected hardware had full hardware removal. The most common pathogen identified was Staphylococcus aureus (41; 70.7%), with methicillin-resistant Staphylococcus aureus isolated in 23 (40.0%) cases. Ten (17.2%) patients had recurrence within 1 year. Hardware removal was found to significantly decrease the risk of infection recurrence (P = .026). None of the peri-prosthetic joint infection patients had infection recurrence within 1 year.
Conclusions
Our findings support DAL as an effective treatment for bone and joint infection when combined with surgical debridement and hardware removal. Failure to remove infected hardware significantly increased the risk of infection recurrence within 1 year. Randomized controlled trials are needed to further support DAL as a novel treatment for orthopedic infections.
背景达巴万星（DAL）用于治疗骨和关节感染的标示外使用有所增加，尤其是在不需要长期静脉注射的情况下。这项回顾性、单中心、描述性研究纳入了在 4 年内（2019-2023 年）使用 DAL 治疗骨或关节感染的成人患者。研究收集了患者的人口统计学特征、感染类型和部位、DAL 前的抗生素和手术治疗、DAL 的适应症以及临床结果。结果共有58例患者接受了DAL治疗后发生骨和/或关节感染。大多数患者接受治疗的原因是骨髓炎（81.0%），其次是本关节感染（8.6%）和假体周围关节感染（10.4%）。50例（86.2%）患者接受了手术治疗，25例硬件感染患者中有17例（68%）完全切除了硬件。最常见的病原体是金黄色葡萄球菌（41；70.7%），其中 23 例（40.0%）分离出耐甲氧西林金黄色葡萄球菌。10例（17.2%）患者在一年内复发。研究发现，移除假体能明显降低感染复发的风险（P = .026）。结论：我们的研究结果表明，在结合手术清创和硬件移除的情况下，DAL是治疗骨关节感染的有效方法。未移除受感染的硬件会显著增加一年内感染复发的风险。需要进行随机对照试验，以进一步支持 DAL 作为骨科感染的新型治疗方法。
{"title":"Dalbavancin Use in Bone and Joint Infections","authors":"","doi":"10.1016/j.artd.2024.101505","DOIUrl":"10.1016/j.artd.2024.101505","url":null,"abstract":"<div><h3>Background</h3><div>Dalbavancin (DAL) off-label use for treating bone and joint infections has increased especially as long-term intravenous access is not needed. Little is known about the effectiveness and safety of its use.</div></div><div><h3>Methods</h3><div>This retrospective, single-center, descriptive study included adults treated with DAL for bone or joint infections over a 4-year period (2019-2023). Patient demographics, infection type and location, pre-DAL antibiotic and surgical treatments, indication for DAL, and clinical outcomes were collected. Risk factor analysis for 1-year infection recurrence was performed.</div></div><div><h3>Results</h3><div>There were 58 patient encounters of bone and/or joint infections treated with DAL. The majority of patients were treated for osteomyelitis (81.0%) followed by native (8.6%) and peri-prosthetic (10.4%) joint infection. Fifty (86.2%) patients underwent surgical intervention, and 17 (68%) of the 25 patients with infected hardware had full hardware removal. The most common pathogen identified was <em>Staphylococcus aureus</em> (41; 70.7%), with methicillin-resistant <em>Staphylococcus aureus</em> isolated in 23 (40.0%) cases. Ten (17.2%) patients had recurrence within 1 year. Hardware removal was found to significantly decrease the risk of infection recurrence (<em>P</em> = .026). None of the peri-prosthetic joint infection patients had infection recurrence within 1 year.</div></div><div><h3>Conclusions</h3><div>Our findings support DAL as an effective treatment for bone and joint infection when combined with surgical debridement and hardware removal. Failure to remove infected hardware significantly increased the risk of infection recurrence within 1 year. Randomized controlled trials are needed to further support DAL as a novel treatment for orthopedic infections.</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":"142427474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.artd.2024.101510
Accelerometer-based navigation (OrthAlign) is the first computer-assisted surgical navigation system approved for use in the setting of revision total knee arthroplasty (TKA) in the United States. The senior author has used this technology in the revision setting for several years and developed the individualized, reproducible technique. The 4 goals during revision TKA are to (1) gain adequate exposure for the safe explanation of prior implants, (2) address any resultant bone loss, (3) restore the joint line via distal femur metal augmentation, and (4) ensure adequate stability through gap-balancing techniques and increasing the constraint of the revision implants as needed. This technique guide illustrates how accelerometer-based navigation (OrthAlign) can achieve these goals in the revision TKA setting.
{"title":"Accelerometer-Navigated Revision Total Knee Arthroplasty: A Technique for Successful Gap Balancing","authors":"","doi":"10.1016/j.artd.2024.101510","DOIUrl":"10.1016/j.artd.2024.101510","url":null,"abstract":"<div><div>Accelerometer-based navigation (OrthAlign) is the first computer-assisted surgical navigation system approved for use in the setting of revision total knee arthroplasty (TKA) in the United States. The senior author has used this technology in the revision setting for several years and developed the individualized, reproducible technique. The 4 goals during revision TKA are to (1) gain adequate exposure for the safe explanation of prior implants, (2) address any resultant bone loss, (3) restore the joint line via distal femur metal augmentation, and (4) ensure adequate stability through gap-balancing techniques and increasing the constraint of the revision implants as needed. This technique guide illustrates how accelerometer-based navigation (OrthAlign) can achieve these goals in the revision TKA setting.</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":"142427043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.artd.2024.101514
In orthopaedic surgery, the advancement of surgical techniques aims to enhance patient outcomes and minimize postoperative complications. A notable innovation in this field is the anterior-based muscle-sparing (ABMS) approach to total hip arthroplasty, also known as ABLE or Rottinger approach. ABMS modifies the Watson-Jones approach, using the intermuscular plane between the tensor fascia lata and the gluteus medius to access the hip joint without detaching abductor muscles. This technique offers several benefits including muscle preservation, decreased pain, faster recovery, and lower dislocation rates, similar to the direct anterior approach. However, ABMS distinguishes itself by its lower infection rate, reduced nerve injury risk, easier femoral exposure, and compatibility with various implants. Large-scale studies have confirmed its safety and effectiveness. While mastering the ABMS technique requires some learning, this article provides a concise description of the technique, along with practical insights gained from surgical experience to support safe and effective execution.
{"title":"Surgical Tips and Tricks for the Anterior-Based Muscle-Sparing Approach During Total Hip Arthroplasty","authors":"","doi":"10.1016/j.artd.2024.101514","DOIUrl":"10.1016/j.artd.2024.101514","url":null,"abstract":"<div><div>In orthopaedic surgery, the advancement of surgical techniques aims to enhance patient outcomes and minimize postoperative complications. A notable innovation in this field is the anterior-based muscle-sparing (ABMS) approach to total hip arthroplasty, also known as ABLE or Rottinger approach. ABMS modifies the Watson-Jones approach, using the intermuscular plane between the tensor fascia lata and the gluteus medius to access the hip joint without detaching abductor muscles. This technique offers several benefits including muscle preservation, decreased pain, faster recovery, and lower dislocation rates, similar to the direct anterior approach. However, ABMS distinguishes itself by its lower infection rate, reduced nerve injury risk, easier femoral exposure, and compatibility with various implants. Large-scale studies have confirmed its safety and effectiveness. While mastering the ABMS technique requires some learning, this article provides a concise description of the technique, along with practical insights gained from surgical experience to support safe and effective execution.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.artd.2024.101414
Background
Robotic systems for total knee arthroplasty (TKA) may utilize computed tomography three-dimensional modeling and intraoperative ligamentous balancing data to assist surgeons with implant size and position. This study evaluated the effect of such robotic systems on implant selection.
Methods
We reviewed 645 TKAs performed with a single prosthetic design at 2 academic medical centers between 2016 and 2022. A robotic system was utilized in 304 TKAs, 341 were conventionally instrumented. Implant sizing was compared between cohorts. Multivariate analyses assessed for confounding and effect modification on the basis of demographics.
Results
The 2 cohorts exhibited no significant differences in age (P = .33), weight (P = .29), or race (P = .24). The robotic-arm cohort had fewer women (58.9% vs 66.7% P = .04) and was taller on average (66.3 in vs 65.0 in P < .001). Mean polyethylene liner thickness was larger in the manual cohort (10.3 robotic and 10.6 manual; P < .00). On multivariate analysis, robotic-arm TKAs had larger tibial components (P < .001) and smaller femoral components (P = .017).
Conclusions
Robotic-arm assisted TKA with computed tomography–based three-dimensional planning was associated with a larger mean tibial component size and a smaller mean femoral component size when compared to conventionally instrumented TKAs. Observed differences likely reflect differences in the data informing implant size selection; effects on clinical outcomes warrant further study.
背景用于全膝关节置换术（TKA）的机器人系统可利用计算机断层三维建模和术中韧带平衡数据来协助外科医生确定植入物的大小和位置。本研究评估了此类机器人系统对植入物选择的影响。方法我们回顾了2016年至2022年期间在两家学术医疗中心使用单一假体设计进行的645例TKA手术。304例TKAs使用了机器人系统，341例使用了传统器械。对不同组群的假体尺寸进行了比较。结果两个队列在年龄（P = .33）、体重（P = .29）或种族（P = .24）方面无显著差异。机器人手臂队列中女性较少（58.9% vs 66.7% P = .04），平均身高较高（66.3 英寸 vs 65.0 英寸 P < .001）。手动组的平均聚乙烯衬垫厚度更大（机器人为 10.3 英寸，手动为 10.6 英寸；P < .00）。结论与传统的器械辅助 TKA 相比，基于计算机断层扫描三维规划的机器人臂辅助 TKA 的胫骨组件平均尺寸较大，股骨组件平均尺寸较小。观察到的差异可能反映了选择植入物尺寸的数据差异；对临床结果的影响值得进一步研究。
{"title":"Robotic Arm–Assisted Total Knee Arthroplasty Results in Smaller Femoral Components and Larger Tibial Baseplates Than the Manual Technique","authors":"","doi":"10.1016/j.artd.2024.101414","DOIUrl":"10.1016/j.artd.2024.101414","url":null,"abstract":"<div><h3>Background</h3><div>Robotic systems for total knee arthroplasty (TKA) may utilize computed tomography three-dimensional modeling and intraoperative ligamentous balancing data to assist surgeons with implant size and position. This study evaluated the effect of such robotic systems on implant selection.</div></div><div><h3>Methods</h3><div>We reviewed 645 TKAs performed with a single prosthetic design at 2 academic medical centers between 2016 and 2022. A robotic system was utilized in 304 TKAs, 341 were conventionally instrumented. Implant sizing was compared between cohorts. Multivariate analyses assessed for confounding and effect modification on the basis of demographics.</div></div><div><h3>Results</h3><div>The 2 cohorts exhibited no significant differences in age (<em>P</em> = .33), weight (<em>P</em> = .29), or race (<em>P</em> = .24). The robotic-arm cohort had fewer women (58.9% vs 66.7% <em>P</em> = .04) and was taller on average (66.3 in vs 65.0 in <em>P</em> < .001). Mean polyethylene liner thickness was larger in the manual cohort (10.3 robotic and 10.6 manual; <em>P</em> < .00). On multivariate analysis, robotic-arm TKAs had larger tibial components (<em>P</em> < .001) and smaller femoral components (<em>P</em> = .017).</div></div><div><h3>Conclusions</h3><div>Robotic-arm assisted TKA with computed tomography–based three-dimensional planning was associated with a larger mean tibial component size and a smaller mean femoral component size when compared to conventionally instrumented TKAs. Observed differences likely reflect differences in the data informing implant size selection; effects on clinical outcomes warrant further study.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.artd.2024.101570
{"title":"Total Hip Arthroplasty Outcomes are Improved When Cement is Used for Femoral Fixation in Elderly Patients?","authors":"","doi":"10.1016/j.artd.2024.101570","DOIUrl":"10.1016/j.artd.2024.101570","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1016/j.artd.2024.101408
Adverse local tissue reaction (ALTR) from the release of chromium and cobalt ions in metal-on-metal total hip arthroplasty (MoM THA) is a well-reported complication, but there is little evidence suggesting that this inflammatory reaction causes malignancy. We present a 69-year-old female with MoM THA who developed synovial sarcoma (SS). She underwent mass resection and revision THA. Postoperative pathologic analysis revealed the unanticipated diagnosis of SS. She subsequently underwent chemotherapy, sarcoma resection, and endoprosthetic reconstruction. We hypothesize that the SS developed from an ALTR in the setting of failed MoM THA. Given the paucity of data on possible malignant transformation of an ALTR to SS, we advise surgeons to consider potential malignancies when diagnosing ALTR in the setting of failed MoM THA bearings.
{"title":"Possible Transformation of Pseudotumor to Synovial Sarcoma in a Failed Metal-on-Metal Total Hip Arthroplasty","authors":"","doi":"10.1016/j.artd.2024.101408","DOIUrl":"10.1016/j.artd.2024.101408","url":null,"abstract":"<div><div>Adverse local tissue reaction (ALTR) from the release of chromium and cobalt ions in metal-on-metal total hip arthroplasty (MoM THA) is a well-reported complication, but there is little evidence suggesting that this inflammatory reaction causes malignancy. We present a 69-year-old female with MoM THA who developed synovial sarcoma (SS). She underwent mass resection and revision THA. Postoperative pathologic analysis revealed the unanticipated diagnosis of SS. She subsequently underwent chemotherapy, sarcoma resection, and endoprosthetic reconstruction. We hypothesize that the SS developed from an ALTR in the setting of failed MoM THA. Given the paucity of data on possible malignant transformation of an ALTR to SS, we advise surgeons to consider potential malignancies when diagnosing ALTR in the setting of failed MoM THA bearings.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1016/j.artd.2024.101499
Background
Cemented total knee arthroplasty (TKA) is the gold standard treatment for osteoarthritis, but uncemented TKA offers benefits like improved osseointegration and reduced complications from cement debris. This study aimed to investigate (1) if there has been a rise in uncemented TKA from 2017 to 2021 and (2) if there are differences in early complications between cemented and uncemented TKA.
Methods
A retrospective data review was performed on the Michigan Arthroplasty Registry Collaborative Quality Initiative database of TKA patients from 2017 to 2021 at 6 hospitals. Patients with revision or partial knee arthroplasty were excluded. Patients were divided into 2 groups: uncemented and cemented. Hybrid and reverse hybrid fixation data were collected for incidence, but not for demographics or complications. All patient demographics and 90-day postoperative events were collected and analyzed.
Results
A retrospective study of 18,749 primary TKAs found that 89.7% were cemented, 9.7% uncemented, and 0.7% hybrid or reverse hybrid. Uncemented patients were younger, men, heavier, current smokers, and diabetics than cemented patients (P < .0001, P = .03). They also had a shorter length of stay (P ≤ .0001) and were on fewer preoperative medications: anticoagulants (P = .0059), antiplatelets (P ≤ .0001), opioids (P = .0091), and steroids (P = .0039). The rate of uncemented TKA increased from 3.3% to 17.1%, while the rate of cemented TKA fell from 96.2% to 81.9% (P = .0048). The readmission rate was higher in cemented TKAs (4.0%) than in uncemented TKAs (2.6%) (P = .0048).
Conclusions
The use of uncemented TKA increased from 3.3% in 2017 to 17.1% in 2021, while cemented fixation decreased from 96.7% to 81.9%. There were no significant differences in short-term complications between groups. Uncemented patients were younger, men, took fewer medications, had a shorter length of stay, and were less likely to be readmitted. However, they were more likely to have comorbidities than the cemented group.
{"title":"Uncemented Total Knee Arthroplasty is on the Rise. A Report of Patient Demographics and Short-Term Outcomes From the Michigan Arthroplasty Registry Collaborative Quality Initiative","authors":"","doi":"10.1016/j.artd.2024.101499","DOIUrl":"10.1016/j.artd.2024.101499","url":null,"abstract":"<div><h3>Background</h3><div>Cemented total knee arthroplasty (TKA) is the gold standard treatment for osteoarthritis, but uncemented TKA offers benefits like improved osseointegration and reduced complications from cement debris. This study aimed to investigate (1) if there has been a rise in uncemented TKA from 2017 to 2021 and (2) if there are differences in early complications between cemented and uncemented TKA.</div></div><div><h3>Methods</h3><div>A retrospective data review was performed on the Michigan Arthroplasty Registry Collaborative Quality Initiative database of TKA patients from 2017 to 2021 at 6 hospitals. Patients with revision or partial knee arthroplasty were excluded. Patients were divided into 2 groups: uncemented and cemented. Hybrid and reverse hybrid fixation data were collected for incidence, but not for demographics or complications. All patient demographics and 90-day postoperative events were collected and analyzed.</div></div><div><h3>Results</h3><div>A retrospective study of 18,749 primary TKAs found that 89.7% were cemented, 9.7% uncemented, and 0.7% hybrid or reverse hybrid. Uncemented patients were younger, men, heavier, current smokers, and diabetics than cemented patients (<em>P</em> < .0001, <em>P</em> = .03). They also had a shorter length of stay (<em>P</em> ≤ .0001) and were on fewer preoperative medications: anticoagulants (<em>P</em> = .0059), antiplatelets (<em>P</em> ≤ .0001), opioids (<em>P</em> = .0091), and steroids (<em>P</em> = .0039). The rate of uncemented TKA increased from 3.3% to 17.1%, while the rate of cemented TKA fell from 96.2% to 81.9% (<em>P</em> = .0048). The readmission rate was higher in cemented TKAs (4.0%) than in uncemented TKAs (2.6%) (<em>P</em> = .0048).</div></div><div><h3>Conclusions</h3><div>The use of uncemented TKA increased from 3.3% in 2017 to 17.1% in 2021, while cemented fixation decreased from 96.7% to 81.9%. There were no significant differences in short-term complications between groups. Uncemented patients were younger, men, took fewer medications, had a shorter length of stay, and were less likely to be readmitted. However, they were more likely to have comorbidities than the cemented group.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124001845/pdfft?md5=df0d6b4454caa6103351f7457dd5f36d&pid=1-s2.0-S2352344124001845-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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