Arthroplasty Today最新文献

{"title":"Global Hip Offset is an Important Factor in the Success of Abductor Mechanism Insufficiency Repair After Total Hip Arthroplasty: A Case Series","authors":"Samo Roškar MD ,&nbsp;Neža Trebše MD ,&nbsp;René Mihalič MD, PhD ,&nbsp;Nejc Kurinčič MD ,&nbsp;Mateja Blas MSc ,&nbsp;Rihard Trebše MD, PhD","doi":"10.1016/j.artd.2025.101861","DOIUrl":"10.1016/j.artd.2025.101861","url":null,"abstract":"<div><h3>Background</h3><div>Hip abductor mechanism deficiency due to abductor tendon degeneration, tear, or intraoperative damage during total hip arthroplasty (THA) may cause severe walking disability. For severe abductor weakness in native hip joints, Whiteside muscle transfer is a good solution. However, the literature on the results of abductor mechanism reconstruction (AMR) after THA remains limited. Our study aimed to assess the outcome of AMR in patients with THA suffering from Milwaukee III and IV hip abductor deficiency.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective cohort study of THA with hip abductor mechanism deficiency treated surgically with AMR. Data were collected between January 2011 and December 2019 and included the following parameters: patient’s data, subjective level of pain, Harris Hip Score (HHS), gait pattern, extent of hip abductor tear, and offset measurements.</div></div><div><h3>Results</h3><div>The cohort included 16 THAs with AMR in 16 patients. The whole group median HHS improved from 37.1 interquartile range (IQR) (31.0-38.7) to 73.9 IQR (63.5-83.7) (<em>P</em> &lt; .001). In a subgroup of 9 hips, the global offset was preserved after THA while it was reduced in remaining 7 hips. All patients with preserved global offset had significantly better clinical outcome compared to the group with reduced global offset (median HHS improvement was 48 IQR [46-53] compared to 22 IQR [18-25], <em>P</em> = .001).</div></div><div><h3>Conclusions</h3><div>Our study showed favorable outcome of the AMR for chronic, Milwaukee III and IV hip abductor deficiency after THA. It is the first study to show that restoration of global offset after THA is of utmost importance to avoid chronic abductor mechanism deficiency.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101861"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247879","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":"Clarifying Potential Candidates for Extended Oral Antibiotic Prophylaxis: A Retrospective Analysis of Risk Factors for Infection Following Revision Hip and Knee Arthroplasty","authors":"Mia J. Fowler BS ,&nbsp;Allina A. Nocon PhD, MPH ,&nbsp;Yu-fen Chiu MS ,&nbsp;Kathleen Tam MPH ,&nbsp;Alberto V. Carli MD, MSc","doi":"10.1016/j.artd.2025.101866","DOIUrl":"10.1016/j.artd.2025.101866","url":null,"abstract":"<div><h3>Background</h3><div>Extended oral antibiotic prophylaxis (EOAP) has gained popularity after a study showed an 81% reduction in periprosthetic joint infection (PJI) among “high-risk” patients undergoing total joint arthroplasty (TJA). However, subsequent studies report inconsistent efficacy, particularly in revision TJA (rTJA) where PJI risk is higher. EOAP also conflicts with antibiotic stewardship principles. To optimize EOAP use, consensus on “high-risk” patients is needed. This study determined which preoperative comorbidities from the Inabathula comorbidities (IC) actually increase PJI risk in aseptic rTJA patients.</div></div><div><h3>Methods</h3><div>1995 consecutive aseptic rTJAs (1014 hips, 981 knees) met criteria for retrospective analysis. International Classification of Diseases-10 codes identified IC comorbidities, including autoimmune diseases, smoking, among others. Reoperations for PJI at 90 days and 1 year were recorded. Chi-squared/Fisher’s exact tests analyzed associations between IC and PJI. Multivariable logistic regressions evaluated specific comorbidities’ contributions to PJI risk.</div></div><div><h3>Results</h3><div>502 (50%) revision hips and 580 (60%) revision knees had at least 1 IC. Having at least 1 IC did not significantly increase the risk of developing PJI for revision hips. Only body mass index &gt;35 kg/m² (90-day RR = 3.5; <em>P</em> = .011; 1-year RR = 3.0; <em>P</em> = .014) and chronic kidney disease (90-day RR = 4.1; <em>P</em> = .016; 1-year RR = 4.0; <em>P</em> = .006) were the comorbidities significantly associated with developing PJI for revision hip cases. Meanwhile for knees, having at least 1 IC produced a 3.6x-fold increased relative risk for developing PJI at 1 year (<em>P</em> = .010). However, on multivariate analysis, diabetes mellitus was the only comorbidity significantly associated (90-day odds ratio = 3.5; 95% confidence interval [1.3-9.4]; 1-year odds ratio = 3.3; 95% confidence interval [1.4-7.7]) with developing PJI for revision knee cases. In hips and knees, having &gt;3 IC comorbidities conferred the highest odds of PJI.</div></div><div><h3>Conclusions</h3><div>Although over half of rTJA patients meet IC and could be eligible for EOAP, very few comorbidities significantly confer increased PJI risk. Prospective EOAP studies should consider using indications that are stricter than the IC to avoid unnecessary antibiotic use.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101866"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736294","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":"Design of Surgical Impaction Instruments Matters","authors":"Peter J. Schlieker MSc ,&nbsp;Frank Lampe MD ,&nbsp;Johann Zwirner MD ,&nbsp;Benjamin Ondruschka MD ,&nbsp;Michael M. Morlock PhD ,&nbsp;Gerd Huber PhD","doi":"10.1016/j.artd.2025.101898","DOIUrl":"10.1016/j.artd.2025.101898","url":null,"abstract":"<div><h3>Background</h3><div>Femoral stem impaction in total hip arthroplasty is commonly performed by mallet blows on a metal impactor attached to the stem. Factors including the surgeon, the impactor, and the patient can influence the impaction. A wide range of impactors, varying in design and thus in mass and stiffness, are available. However, little is known about their influence on the force transmission and, consequently, about the proportion of the mallet force that ultimately reaches the implant. This study aimed to investigate the force transmission through the impactor for different impactor designs, while investigating different patient-specific femur-tissue systems in situ and in silico.</div></div><div><h3>Methods</h3><div>The mallet and impactor forces of 9 consecutive blows on seated femoral stems were measured for 2 different approaches on each of 4 cadavers. The mallet-implant force transmission was calculated using a phenomenological model for 2 different impactor designs.</div></div><div><h3>Results</h3><div>The attenuated force in the impactor achieved approximately 65% to 75% of the corresponding mallet peak force, regardless of cadaver or surgical approach. Measuring the force distant from the tip resulted in an overestimation of the transferred forces. Depending on impactor design just 24% to 47% of the applied mallet peak force reached the implant itself.</div></div><div><h3>Conclusions</h3><div>The force transmission for overcritical mallet blows can be regarded as independent from patient- and approach-specific boundary conditions and primarily dependent on the impactor design. Surgeons must be aware of this relationship and exercise caution when using other or novel instruments to prevent intraoperative complications.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101898"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Reducible Neglected Recurrent Posterior Hip Dislocation Treated With Cemented Total Hip Arthroplasty","authors":"Subhan Shahid MBBS, FCPS ,&nbsp;Waqas Ahmad MBBS ,&nbsp;Abdul Rafeh Awan MBBS ,&nbsp;Meher Ayyazuddin MBBS, MD ,&nbsp;Faisal Masood MBBS, FCPS, CMT","doi":"10.1016/j.artd.2025.101908","DOIUrl":"10.1016/j.artd.2025.101908","url":null,"abstract":"<div><div>Hip dislocations in adults are uncommon and usually follow high-energy trauma, with neglected cases being rarer but still encountered in low-resource settings. This report describes a 67-year-old man with 6 months of recurrent posterior hip dislocations after an initial injury. He first sought traditional treatment and eventually learned self-reduction techniques. Examination showed limb shortening, muscle wasting, and a neglected posterior acetabular wall fracture with major bone loss. He underwent cemented total hip arthroplasty via a posterior approach, with reconstruction of the posterior wall using an autologous femoral head-neck graft secured by cannulated screws. The case underscores the need for early recognition and proper surgical planning to prevent avascular necrosis, joint degeneration, and long-term disability, especially in developing regions.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101908"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526307","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":"Primary Total Hip Arthroplasty With Concomitant Gluteus Medius Repair: Mid-term Outcomes With Nested Propensity-Matched Benchmark Control","authors":"Roger Quesada-Jimenez MD ,&nbsp;Yasemin E. Kingham BA ,&nbsp;Tyler R. McCarroll MD ,&nbsp;Jessica C. Keane BS ,&nbsp;Ady H. Kahana-Rojkind MD ,&nbsp;Benjamin G. Domb MD","doi":"10.1016/j.artd.2025.101775","DOIUrl":"10.1016/j.artd.2025.101775","url":null,"abstract":"<div><h3>Background</h3><div>Patients who undergo total hip arthroplasty (THA) without addressing gluteus medius (GM) pathology tend to experience inferior outcomes. The study aims to evaluate mid-term outcomes in patients who underwent a primary THA with concomitant GM tear repair, as compared to a benchmark control group of primary THA patients that did not have GM pathology.</div></div><div><h3>Methods</h3><div>Data were retrospectively analyzed from patients who underwent a primary THA with a concomitant GM repair between 2015 and 2018. Included patients completed preoperative and minimum 5-year questionnaires for Harris Hip Score, visual analog scale, Veteran's Rand 12-item (VR-12) health survey, 12-item Short Form (SF-12) heath surveys, Forgotten Joint Score, and the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement. The GM cohort was matched in a 1:3 ratio based on age at surgery, body mass index, sex, approach, and robotic-assisted surgery to a control group of primary THAs without GM pathology. Thresholds for functional outcomes were included.</div></div><div><h3>Results</h3><div>Forty patients who underwent primary THA with GM repair were included successfully match to 120 control patients. There were significant improvements in the reported Harris Hip Score, visual analog scale, VR-12 Physical, VR-12 Mental, SF-12 Physical, and SF-12 Mental scores in the study group. Despite their gluteus medius pathology, with concomitant repair, the study group achieved patient-reported outcomes improvements and rates of minimal clinically important difference and patient acceptable symptom state that were comparable to the control group.</div></div><div><h3>Conclusions</h3><div>THA with concomitant GM repair yielded significant improvement in functional status and clinical outcomes, which compared favorably to a benchmark control group without GM tears. Surgeons may consider addressing GM tears during a primary THA.</div></div><div><h3>Level of Evidence</h3><div>Level III.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101775"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145322866","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":"Medial Collateral Ligament Repair With Internal Suture Brace Augmentation in Total Knee Arthroplasty","authors":"Sergio F. Guarin Perez MD ,&nbsp;Diego Alarcon Perico MD ,&nbsp;Katherine E. Mallet MD ,&nbsp;Rafael J. Sierra MD ,&nbsp;Robert A. Cates DO","doi":"10.1016/j.artd.2025.101836","DOIUrl":"10.1016/j.artd.2025.101836","url":null,"abstract":"<div><div>Medial collateral ligament (MCL) insufficiency during or after total knee arthroplasty (TKA) is a challenging scenario that often necessitates constrained implants or allograft reconstruction. This series describes 3 patients who underwent MCL repair with internal suture brace augmentation (ISBA). Two patients (ages 54 and 51) had chronic valgus instability after primary TKA and were treated with revision surgery using a more constrained implant or liner plus ISBA. A third patient (age 77) sustained an intraoperative MCL disruption during primary TKA and was managed acutely with ISBA. At 12–34.5 months of follow-up, all patients achieved full motion and medial stability. ISBA provided soft-tissue reinforcement and may represent a useful adjunct for medial instability, though its long-term effectiveness remains uncertain.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101836"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466858","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":"Extensive Femoral Bone Loss Following Two-Stage Periprosthetic Joint Infection Treatment: Persistent Challenges in Proximal Femoral Replacement","authors":"Nelo J.Z. Chihal Lima MD,&nbsp;Vasfi Karatosun MD","doi":"10.1016/j.artd.2025.101906","DOIUrl":"10.1016/j.artd.2025.101906","url":null,"abstract":"<div><h3>Background</h3><div>Proximal femoral replacement (PFR) has gained popularity in nononcological reconstruction surgeries over recent decades. However, there is sparse literature on its application in extensive bone defects following 2-stage revision treatment for periprosthetic joint infection (PJI). This study retrospectively evaluates the clinical and functional outcomes, complication rates, and prosthesis survivorship in patients undergoing PFR surgery for severe bone defects due to 2-stage PJI treatment.</div></div><div><h3>Method</h3><div>This single-center retrospective study analyzed patients who underwent PFR as part of a 2-stage treatment for hip arthroplasty-related PJI between 2010 and 2020. All patients had extensive proximal femoral bone loss (Paprosky type 3B and 4) before the PFR surgery. Inclusion required a minimum follow-up period of 24 months. Functional outcomes were evaluated using the Musculoskeletal Tumor Society Score (MSTS), while PFR prosthesis failure was classified according to Henderson's Classification. Combined PFR and acetabular prosthesis survival was determined using Kaplan–Meier survival curves.</div></div><div><h3>Results</h3><div>Thirty-four patients (21 women and 13 men, average age 72.9) were included in the study. The mean follow-up was 75 months (range: 24-132). Pre-PFR surgeries averaged 3.88 per patient (range: 2-13). Mechanical complications were present in 7 patients (20.6%), nonmechanical complications in 8 (23.5%), and 2 patients (5.9%) had both. The mean MSTS score was 66.74%. The all-cause complication-free survival rate was 80% in the second year and decreased to 52% by the fifth year. The all-cause revision-free rate was 73 % in the second year and decreased to 47% by the fifth year.</div></div><div><h3>Conclusions</h3><div>PFR is effective for limb salvage in complex cases but comes with high mechanical and non-mechanical complications and moderate to poor survival rates. While larger femoral heads and constrained liners help reduce dislocation, infection remains a significant issue. The gap between high MSTS scores and difficulties in daily activities signals a need for improved functional assessment tools. These findings highlight the persistent challenges in managing PJIs.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101906"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736315","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":"Intravenous Dexamethasone Administered Perioperatively vs 8 Hours Prior to Incision to Control Pain after Total Knee Arthroplasty. A Prospective Randomized Clinical Trial","authors":"Burin Sutthapakti MD ,&nbsp;Kritsanat Lertussavavivat MD ,&nbsp;Kritsada Sukha MD ,&nbsp;Wiboon Wanitcharoenporn MD ,&nbsp;Artit Laoruengthana MD","doi":"10.1016/j.artd.2025.101912","DOIUrl":"10.1016/j.artd.2025.101912","url":null,"abstract":"<div><h3>Background</h3><div>Theoretically, intravenous dexamethasone administered 6-8 hours prior to surgical trauma may inhibit the transcription of genes via the genomic pathway and optimize their anti-inflammatory effects. Thus, the purpose of the study was to compare the efficacy of intravenous dexamethasone administered preoperatively and more common use, perioperative injection for controlling pain after total knee arthroplasty (TKA).</div></div><div><h3>Method</h3><div>One-hundred fifty TKAs were randomized to receive 10 mg of intravenous dexamethasone 8 hours prior to incision (preoperative group) or to receive before incision (perioperative group). The outcomes included a visual analog scale (VAS) for pain, morphine consumption, frequency of postoperative nausea and vomiting, knee circumference, C-reactive protein levels, and blood glucose levels.</div></div><div><h3>Results</h3><div>No differences in VAS at rest and during movement were observed between groups at any time point, except the perioperative group had 0.45 lower VAS during movement at 4 hours postoperatively (<em>P</em> = .038). The preoperative group had 0.75 mg lower morphine consumption at 12 hours postoperatively (<em>P</em> = .020). However, both differences did not reach the minimal clinically important difference. There were no significant differences between groups regarding postoperative nausea and vomiting, knee circumference, and C-reactive protein. Over 50% of patients in both groups experienced high blood glucose level (&gt;137 mg/dl) during the first 48 hours postoperatively, however, no infection was observed during 3 months of follow-up.</div></div><div><h3>Conclusions</h3><div>Perioperative dexamethasone injection provides comparable clinical outcomes and inflammation level after TKA to those administered 8 hours prior to incision. Thus, both intravenous dexamethasone approach can be an option for current clinical pathways of TKA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101912"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579121","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":"Patients With Lymphedema are at Increased Risk of Complication After Total Knee Arthroplasty: A Population Level Study","authors":"Bryce T. Hrudka MD,&nbsp;Evan Bailey MD,&nbsp;Alyssa Woltemath MD,&nbsp;Grayson Nour BS,&nbsp;Ajay Premkumar MD, MPH,&nbsp;Jacob M. Wilson MD","doi":"10.1016/j.artd.2025.101900","DOIUrl":"10.1016/j.artd.2025.101900","url":null,"abstract":"<div><h3>Background</h3><div>Lymphedema, a chronic disorder characterized by abnormal lymphatic fluid buildup, most commonly affects the lower extremities. Limited literature exists regarding the impact of lymphedema on outcomes following primary total knee arthroplasty (TKA). This study examined the effect of lymphedema’s impact on complications and early revision-free survivorship following primary TKA using population-level data. We hypothesized that patients with preoperative lymphedema would have higher complication and revision rates.</div></div><div><h3>Methods</h3><div>Patients undergoing TKA for osteoarthritis between 2009 and 2020 were identified from a national claims database. Those with preoperative lymphedema were matched 1:1 to contemporaries without lymphedema using propensity score matching. Comparisons between matched and unmatched cohorts were performed using Chi-square and independent t-tests, while Cox proportional hazards models assessed revision risk.</div></div><div><h3>Results</h3><div>Of the 530,938 TKA patients, 1.05% (n = 5602) had preoperative lymphedema. Matched analysis showed lymphedema had higher 90-day rates of periprosthetic joint infection (2.9% vs 1.4%, <em>P</em> &lt; .001), superficial surgical site infection (2.3% vs 1.6%, <em>P</em> = .007), wound complications (2.4% vs 1.7%, <em>P</em> = .013), and pulmonary embolism (6.6% vs 4.6%, <em>P</em> &lt; .001). At 2 years, lymphedema was associated with increased risk of all-cause (hazard ratio (HR) = 1.42, <em>P</em> &lt; .001) and septic revisions (HR = 1.88, <em>P</em> &lt; .001) but not aseptic revisions (HR = 0.99, <em>P</em> = .929).</div></div><div><h3>Conclusions</h3><div>Preoperative lymphedema is associated with increased 90-day rates of periprosthetic joint infection and superficial surgical site infection, wound complications, and pulmonary embolism after primary TKA. Although aseptic revision risk was not increased, the association with higher all-cause and septic revisions warrants attention. These findings emphasize the need for aggressive counseling and preoperative optimization before TKA in lymphedema patients.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101900"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579120","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":"Association Between Lithium Use and Periprosthetic Fracture After Total Hip Arthroplasty","authors":"Rafa Rahman MD, MPH,&nbsp;Billy Kim MD,&nbsp;Benjamin Basseri MD,&nbsp;Michael Mazzucco BS,&nbsp;Alexander McLawhorn MD, MBA","doi":"10.1016/j.artd.2025.101851","DOIUrl":"10.1016/j.artd.2025.101851","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic fracture (PPFx) is a devastating complication following total hip arthroplasty (THA), with concern for higher risk in osteoporotic patients. Lithium is associated with higher bone mineral density, and has emerged as a potential low-cost, widely available method for preventing fractures, promoting fracture healing, and improving implant osseointegration. This study investigated the association between lithium use and risk of PPFx following THA.</div></div><div><h3>Methods</h3><div>Retrospective review of the PearlDiver Mariner Patient Claims Database was performed, querying all patients who underwent THA for osteoarthritis from 2010 to 2022. Lithium-use patients were those who filled lithium prescriptions for at least 90 days before and 90 days after THA. These patients were propensity-score matched to controls not on lithium in a 1:4 ratio, matching for age, diagnosis of bipolar disorder, gender, body mass index, Charlson Comorbidity Index, and insurance. PPFx rate was compared between groups at 90 days and 2 years postoperatively. Secondarily, rate of aseptic loosening, revision, and prosthetic joint infection were compared between groups.</div></div><div><h3>Results</h3><div>Four thousand six hundred seventy patients were included, with 934 patients on lithium and 3736 controls. There was no difference in PPFx rate (90 day: lithium 1.3% vs no lithium 1.2%, <em>P</em> = .97; 2 year: lithium 1.7% vs no lithium 1.9%, <em>P</em> = .93), aseptic loosening, revision, or prosthetic joint infection.</div></div><div><h3>Conclusions</h3><div>Despite the theoretical benefit of lithium on bone density, it was not associated with a difference in the rate of PPFx or other surgical complication following THA. Further work is needed to address treatment of osteoporosis and prevention of periprosthetic fracture in the arthroplasty population.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101851"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157954","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}