Arthroplasty Today最新文献_第7页

Evaluating the Impact of a Preoperative Risk Management Program on Outcomes Following Total Joint Arthroplasty: A Retrospective Cohort Study 评估术前风险管理程序对全关节置换术后预后的影响：一项回顾性队列研究

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-27 DOI: 10.1016/j.artd.2025.101880

Chloe Dlott MD , Sebastian Romero BS , Claire A. Donnelley MD , Stephanie Kaszuba MD , Daniel Wiznia MD

Background

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.

Methods

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.

Results

The optimized cohort had a higher average Charlson Comorbidity Index (1.1 vs 0.9; P = .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.

Conclusions

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.

背景：全关节置换术是治疗终末期关节疾病的有效干预手段，但对于有合并症的患者和历史上处于边缘地位的人群，风险较高。术前风险管理程序旨在通过在手术前优化患者健康来减轻这些风险。本研究在单一学术机构评估了此类项目对术后结果的影响，并关注了种族和少数民族以及有公共保险的患者。方法：我们对2019年至2021年在单一学术机构接受全髋关节或膝关节置换术的2748例患者进行了回顾性队列研究。其中，1548例患者接受了针对糖尿病、肥胖和贫血等可改变危险因素的术前优化，1200例患者遵循标准术前方案。评估的结果包括住院时间、假体关节感染、30天和90天再入院以及急诊（ED）就诊。患者按种族/民族、保险类型和美国麻醉学会物理分类进行分层。结果优化后的队列平均Charlson合并症指数较高（1.1 vs 0.9; P = 0.01）。两组患者在住院时间、再入院率或总体急诊科就诊率方面没有显著差异。无论优化状态如何，黑人患者在术后90天内ED使用率较高。患有严重全身性疾病的医疗补助患者的假体关节感染率最高（3.8%），优化与该组预后改善无关。尽管进行了优化，但美国麻醉学会物理分类≥3的患者术后急诊次数增加。结论：术前风险管理并不能持续改善预后，特别是在合并症负担更重或面临社会经济劣势的患者中。这些发现支持需要量身定制的优化策略，以解决临床风险和健康的社会决定因素。

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引用次数: 0

Utilization of Jumbo-Sized Cups in Conjunction With Dual-Mobility Constructs Does Not Increase Risk of Re-Revision in Revision Hip Arthroplasty 在翻修髋关节置换术中，使用超大杯和双活动装置不会增加再次翻修的风险

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-23 DOI: 10.1016/j.artd.2025.101879

Ramesh B. Ghanta MD, Jeffrey Barry MD, Jeffrey Kwong MD, Hunter Warwick MD, Erik Hansen MD, Claudio Diaz-Ledezma MD

Background

Dual-mobility (DM) articulations are increasingly used in revision total hip arthroplasty (THA) to reduce instability, but their effectiveness in conjunction with jumbo cups is unclear. This study evaluated the risk of all-cause and instability-related re-revision when DM articulations were used with jumbo vs standard cups in revision THA.

Methods

A retrospective review included 199 revision THA patients with DM articulations: 156 with regular cups and 43 with jumbo cups (≥62 mm for females, ≥66 mm for males). Exclusion criteria were cup-cage constructs, cemented DM liners in pre-existing cups, and tumor cases. The primary outcome was re-revision, with focus on instability. Student's t-test compared revision rates, and multivariable logistic regression with backward selection was used to assess the relationship between cup size and re-revision risk.

Results

At a mean 4.6-year follow-up, re-revision rates were similar between groups (10.3% regular vs 11.6% jumbo, P = .79). Instability-related re-revisions were also comparable (5.1% regular vs 7% jumbo; P = .64). Logistic regression demonstrated that jumbo cup utilization was not associated with risk of all-cause revision (P = .99) or instability-related re-revision (P = .77). However, the number of prior surgeries increased risk for both all-cause (OR: 1.32 [1.07, 1.63], P = .009) and instability-related (OR: 1.46 [1.13, 1.87], P = .003) re-revisions.

Conclusions

Our results demonstrate satisfactory midterm outcomes in both jumbo and regular cup patients implanted with DM systems. These findings demonstrate that the use of DM liners in jumbo cups does not portend increased risk of re-revision compared to use of DM in regular sized cups.

背景双活动关节（DM）越来越多地用于翻修全髋关节置换术（THA）以减少不稳定性，但其与大杯联合使用的有效性尚不清楚。本研究评估了DM关节在翻修THA中使用大杯与标准杯时的全因和不稳定性相关的重新翻修风险。方法回顾性分析199例DM关节翻修THA患者：常规杯156例，特大杯43例（女性≥62 mm，男性≥66 mm）。排除标准是杯笼结构、预先存在的杯中胶结DM衬垫和肿瘤病例。主要结局是重新修订，重点是不稳定性。学生t检验比较复习率，多变量logistic回归与逆向选择评估罩杯大小与复习风险的关系。结果平均随访4.6年，两组患者的再修订率相似（普通组10.3% vs大组11.6%,P = 0.79）。与不稳定性相关的再修订也具有可比性（5.1%常规vs 7%巨型；P = 0.64）。逻辑回归表明，大杯的使用与全因修正（P = 0.99）或不稳定性相关的再修正（P = 0.77）的风险无关。然而，既往手术次数增加了全因（OR: 1.32 [1.07, 1.63], P = 0.009）和不稳定相关（OR: 1.46 [1.13, 1.87], P = 0.003）再次翻修的风险。结论大杯和普通杯患者植入DM系统的中期结果均令人满意。这些发现表明，在大杯中使用DM衬垫与在常规杯中使用DM衬垫相比，并不预示着再次翻修的风险增加。

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引用次数: 0

Comparative Analysis and Accuracy of Surgeon- and Prosthesis Manufacturer–Generated Radiographic Templates in Total Hip Arthroplasty 全髋关节置换术中外科医生和假体制造商生成的x线片模板的比较分析和准确性

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-23 DOI: 10.1016/j.artd.2025.101881

Brandon K. Couch MD, Allyson N. Pfeil BS, Corey F. Hryc PhD, Robin Goytia MD, Vasilios Mathews MD

Background

Preoperative templating in total hip arthroplasty (THA) improves surgical accuracy and predictability. Recently, prosthesis manufacturers (PMs) have introduced industry-generated templating systems, but their accuracy compared to surgeon-generated templates has yet to be evaluated.

Methods

A retrospective review was conducted on THAs performed by 2 surgeons between October 2023 and September 2024. Surgeon-generated and PM-generated templates were compared to actual implanted components. Accuracy of acetabular and femoral component sizing, as well as femoral offset prediction, was assessed using χ² analysis (P < .05). Subgroup analyses examined the influence of patient sex and body mass index on accuracy.

Results

A total of 306 surgeon templates and 240 PM templates were analyzed. Surgeons correctly predicted acetabular and femoral component sizes in 45.1% and 28.4% of cases, respectively, while PM templates achieved 33.8% and 35.0%. No significant difference was found between groups in component size accuracy (acetabular: P = .09; femoral: P = .08). However, surgeons demonstrated significantly greater accuracy in offset prediction (83.7% vs 73.3%, P = .003). Additionally, surgeon-generated femoral component accuracy was significantly associated with patient body mass index (P < .001).

Conclusions

PM templating demonstrated a reasonable ability to predict implant sizes in THA, with comparable performance to high-volume, fellowship-trained arthroplasty surgeons. While surgeon-generated templates outperformed PM templates in offset prediction, these findings suggest that industry-generated templates could be a valuable tool for surgical planning and inventory management in hospitals.

背景全髋关节置换术（THA）的术前模板可提高手术的准确性和可预测性。最近，假体制造商（pm）已经引入了工业生成的模板系统，但与外科医生生成的模板相比，它们的准确性尚未得到评估。方法回顾性分析2023年10月至2024年9月间2例外科医生行tha手术的资料。将外科医生生成的和pm生成的模板与实际植入的组件进行比较。采用χ2分析评估髋臼和股骨假体尺寸以及股骨偏移预测的准确性（P < 0.05）。亚组分析检验了患者性别和体重指数对准确性的影响。结果共分析外科医生模板306份，PM模板240份。外科医生正确预测髋臼和股骨假体大小的比例分别为45.1%和28.4%，而PM模板分别为33.8%和35.0%。各组间假体尺寸准确性无显著差异（髋臼：P = 0.09；股骨：P = 0.08）。然而，外科医生在偏移预测方面的准确性明显更高（83.7% vs 73.3%, P = 0.003）。此外，手术生成的股骨成分准确性与患者体重指数显著相关（P < .001）。结论spm模板在THA中具有合理的预测假体大小的能力，其性能可与大容量、培训过的关节置换外科医生相媲美。虽然外科医生生成的模板在偏移量预测方面优于PM模板，但这些发现表明，行业生成的模板可能是医院手术计划和库存管理的有价值的工具。

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引用次数: 0

Outcomes After Definitive Knee Resection Arthroplasty for Recurrent Periprosthetic Joint Infection 膝关节置换术治疗复发性假体周围关节感染的疗效

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-23 DOI: 10.1016/j.artd.2025.101883

Kiran Kittur BS , Josue G. Layuno-Matos Ba , Matthew Nester BS , Connor C. Diaz MD , Michael Miranda DO , Thomas Bernasek MD

Background

Knee resection arthroplasty (KRA) is performed as definitive treatment for recurrent periprosthetic joint infection (PJI). This study aims to evaluate infection eradication and functional outcomes following KRA as a definitive treatment of PJI.

Methods

We reviewed all KRAs performed between 2002 and 2022. We identified 28 knees (27 patients) treated with definitive KRA for recurrent PJI. Primary outcomes included infection eradication, ambulatory status, and ambulatory aid use. Failure to eradicate infection was defined as any reoperation for infection. Ambulation was defined as any level of weight-bearing mobility using assistive devices, such as a walker.

Results

The mean age at KRA was 72 years and average follow-up was 22 months. Patients had on average 3 knee operations prior to KRA. Of the 28 infections, 79% were eradicated by KRA. Of the remaining 6 persistently infected knees, 4 required an average of 4 irrigation and debridement to eventually control infection, resulting in 93% of infections eradicated overall. At latest visit, 33% of patients were on chronic antibiotic suppression. A total of 67% of patients could ambulate. Most patients (85%) required knee–ankle–foot orthoses for instability. Subsequent knee fusion was chosen by 3 patients. A patient with bilateral KRAs died within 90 days of surgery. The overall reoperation rate for KRA patients was 29%, and the overall mortality rate was 15%.

Conclusions

Definitive treatment with KRA demonstrated effectiveness in eradicating infection, although with moderate rate of reoperation. Postoperatively, most patients could ambulate with assistive devices. The KRA is an effective alternative for knee salvage when managing chronic, recalcitrant PJI.

Level of evidence

IV, case series.

背景：膝关节切除术（KRA）是复发性假体周围关节感染（PJI）的最终治疗方法。本研究旨在评估KRA作为PJI的最终治疗后的感染根除和功能结果。方法回顾2002年至2022年间所有KRAs。我们确定了28个膝关节（27例患者）接受了复发性PJI的明确KRA治疗。主要结局包括感染根除、门诊状态和门诊辅助使用情况。未能根除感染被定义为任何感染的再手术。步行被定义为使用辅助设备（如助行器）进行任何程度的负重活动。结果患者平均年龄72岁，平均随访22个月。患者在KRA之前平均有3次膝关节手术。在28例感染中，KRA根除了79%。在其余6例持续感染的膝关节中，4例平均需要4次冲洗和清创才能最终控制感染，导致93%的感染总体根除。最近一次就诊时，33%的患者正在接受慢性抗生素抑制治疗。67%的患者可以走动。大多数患者（85%）因不稳定需要使用膝-踝-足矫形器。3例患者选择后续膝关节融合术。一例双侧KRAs患者在手术后90天内死亡。KRA患者总再手术率为29%，总死亡率为15%。结论虽然再手术率适中，但KRA的最终治疗可有效根除感染。术后，大多数患者可以借助辅助装置行走。当治疗慢性顽固性PJI时，KRA是一种有效的膝关节修复方法。证据等级iv，案例系列。

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引用次数: 0

Intraosseous Vancomycin in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis 万古霉素在全膝关节置换术中的应用：一项系统综述和荟萃分析

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-22 DOI: 10.1016/j.artd.2025.101878

Troy B. Puga DO , Vincent Dieu MS , Kyle P. O’Connor MD , Logan Tackett BS , McKenna W. Box MD , John T. Riehl MD

Background

Prosthetic joint infections (PJIs) are a major concern in total knee arthroplasty (TKA). One recent measure of interest has been the use of intraosseous vancomycin (IOV). This systematic review aims to evaluate the efficacy of IOV to prevent infection in TKA.

Methods

A search was conducted across MEDLINE/Pubmed, Wiley Central, Google Scholar, Web of Science, and Embase databases. Demographics and results of the studies were extracted from the articles that met inclusion criteria. Meta-analysis was conducted on primary TKA studies.

Results

Eight studies were included in this systematic review. IOV correlated with decreased odds of infection in primary TKA (odds ratio: 0.31, P = .02) when compared with controls of intravenous antibiotic and no regional IOV. IOV showed no increase in AKI or creatinine concentration in primary TKA when compared with controls. IOV and increased concentration of vancomycin in fat and subcutaneous tissues had a strong correlation (Cohen’s d = 0.9, P = .01). IOV and increased concentration of vancomycin in bone had a moderate correlation (Cohen’s d = 0.59, P = .01). No patients where IOV was used across all studies developed Red Man Syndrome.

Conclusions

IOV is an effective adjunctive treatment for preventing infection in primary TKA, with this study showing a 69% decreased odds of infection when compared with controls of intravenous antibiotic and no regional IOV. IOV also appears to be a safe treatment, and with limited data there seems to not be an increase in AKI or creatinine concentration.

Level of Evidence

Level IV; Therapeutic.

假体关节感染（PJIs）是全膝关节置换术（TKA）中的主要问题。最近的一项措施是使用骨内万古霉素（IOV）。本系统综述旨在评价IOV预防TKA感染的疗效。方法检索MEDLINE/Pubmed、Wiley Central、谷歌Scholar、Web of Science和Embase数据库。从符合纳入标准的文章中提取研究的人口统计学和结果。对主要TKA研究进行meta分析。结果本系统综述纳入8项研究。与静脉注射抗生素和无局部静脉注射的对照组相比，静脉注射与原发性TKA感染几率降低相关（优势比：0.31,P = 0.02）。与对照组相比，IOV未显示原发性TKA患者AKI或肌酐浓度增加。IOV与万古霉素在脂肪和皮下组织中的浓度升高有很强的相关性（Cohen’s d = 0.9, P = 0.01）。骨内万古霉素浓度升高与IOV有中等相关性（Cohen’s d = 0.59, P = 0.01）。在所有研究中使用IOV的患者均未出现红人综合征。结论siv是预防原发性TKA感染的有效辅助治疗方法，本研究显示，与静脉注射抗生素和不注射局部IOV的对照组相比，siv可使TKA感染的几率降低69%。IOV似乎也是一种安全的治疗方法，根据有限的数据，似乎没有AKI或肌酐浓度的增加。证据等级：IV级；治疗。

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引用次数: 0

Pelvic Position at Cup Placement Compared With Intraoperative Pelvic Motion in the Lateral Decubitus Position 盆腔放置杯位与侧卧位术中盆腔运动的比较

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-21 DOI: 10.1016/j.artd.2025.101877

Hiromasa Tanino MD, PhD, Ryo Mitsutake MD, PhD, Hiroshi Ito MD, PhD

Background

It is important for surgeons to consider the pelvic position at cup placement for accurate cup placement. This position depends on both the pelvic position at set-up and the degree of intraoperative pelvic motion from set-up to cup placement. The present study aimed to characterize and compare the pelvic position at cup placement with intraoperative pelvic motion during primary total hip arthroplasty in the lateral decubitus position. This study also investigated whether the pelvic position at set-up or intraoperative pelvic motion had a greater impact on the pelvic position at cup placement.

Methods

Pelvic positions were measured in 86 hips using an augmented reality-based portable hip navigation system. The pelvic reference plane was registered in the supine position, and patients were then positioned in the lateral decubitus position for surgery. Pelvic positions were recorded at set-up and at the time of cup placement.

Results

Mean pitch and roll angles at cup placement were significantly different from those of intraoperative pelvic motion (P < .001, .009), with greater variations in pitch and roll angles at cup placement. Directional differences in pitch and roll were also observed. Comparison of means showed that the pelvic position at set-up was close to the pelvic position at cup placement for pitch, whereas intraoperative pelvic motion was close to the pelvic position at cup placement for roll.

Conclusions

The pelvic position at cup placement differed from intraoperative pelvic motion. The pelvic position at set-up and intraoperative pelvic motion contributed differently to the pelvic position at cup placement.

背景：对于外科医生来说，考虑盆腔位置对于准确放置杯子是很重要的。这个位置取决于盆腔放置时的位置和术中盆腔从放置到放置的运动程度。本研究旨在描述和比较初次全髋关节置换术中侧卧位盆腔运动与置换术中盆腔位置。本研究还调查了盆腔放置时盆腔位置或术中盆腔运动对盆腔放置时的位置有更大的影响。方法采用基于增强现实的便携式髋关节导航系统测量86例髋关节的骨盆位置。将骨盆参考平面登记为仰卧位，然后将患者定位为侧卧位进行手术。盆腔位置记录在安装时和放置杯时。结果置杯时的平均俯仰角和侧滚角与术中盆腔运动时的平均俯仰角和侧滚角差异有统计学意义（P < 0.001, P < 0.05）。009)，在杯的位置有较大的俯仰角和滚转角变化。俯仰和横摇的方向性差异也被观察到。均数比较显示，术中盆腔运动接近于置杯时的骨盆位置，而术中盆腔运动接近于置杯时的骨盆位置。结论盆腔杯放置时盆腔位置与术中盆腔运动不同。盆腔放置时的位置和术中盆腔运动对盆腔放置时的位置影响不同。

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引用次数: 0

Primary Total Hip Arthroplasty With Concomitant Gluteus Medius Repair: Mid-term Outcomes With Nested Propensity-Matched Benchmark Control 初次全髋关节置换术合并臀中肌修复：巢式倾向匹配基准对照的中期结果

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-15 DOI: 10.1016/j.artd.2025.101775

Roger Quesada-Jimenez MD , Yasemin E. Kingham BA , Tyler R. McCarroll MD , Jessica C. Keane BS , Ady H. Kahana-Rojkind MD , Benjamin G. Domb MD

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Level of Evidence

Level III.

背景：接受全髋关节置换术（THA）而不解决臀中肌（GM）病理的患者往往会经历较差的结果。该研究旨在评估接受原发性THA合并GM撕裂修复的患者的中期预后，与没有GM病理的原发性THA患者的基准对照组进行比较。方法回顾性分析2015年至2018年期间接受原发性THA合并GM修复的患者的数据。纳入患者完成术前和至少5年Harris髋关节评分问卷、视觉模拟量表、退伍军人兰德12项（VR-12）健康调查、12项简短表格（SF-12）健康调查、遗忘关节评分、髋关节残疾和骨关节炎关节置换术结局评分。根据手术年龄、体重指数、性别、手术方式和机器人辅助手术，将转基因队列与无转基因病理的原发性tha对照组按1:3的比例匹配。包括功能结局的阈值。结果40例原发性全髋关节置换术患者与120例对照患者成功配对。研究组报告的Harris髋关节评分、视觉模拟量表、VR-12 Physical、VR-12 Mental、SF-12 Physical和SF-12 Mental评分均有显著改善。尽管有臀中肌病变，但伴随着修复，研究组实现了患者报告的结果改善，最小临床重要差异率和患者可接受的症状状态与对照组相当。结论：与无GM撕裂的基准对照组相比，tha合并GM修复可显著改善功能状态和临床结果。外科医生可能会考虑在原发性全髋关节置换术中处理GM撕裂。证据等级：III级。

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引用次数: 0

Donning Gloves Using the Sliding-Closed Technique Has a Larger Distance to Contamination at the Gown-Glove Interface 使用滑动闭合技术戴手套在手套-手套界面与污染的距离更大

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-10 DOI: 10.1016/j.artd.2025.101862

Hailee E. Reist MD, Michael B. DiCosmo MD, Luke C. Seeker MD, Andrew H. Root BS, James D. Michelson MD, Nathaniel J. Nelms MD

Background

The surgical gown-glove interface is a known cause of bacterial contamination. Minimizing contamination from this interface can be achieved by optimizing the technique for donning gloves with the help of a sterile assistant. The purpose of this study was to evaluate the level of contamination of the inside of the glove cuff when employing a novel sliding-closed (SC) gloving technique vs a traditional open gloving technique.

Methods

We conducted a comparative study between a traditional open gloving technique and a novel SC gloving technique. Surgeons applied ultraviolet indicator lotion before donning a surgical gown and sterile gloves using either technique. Three surgeons were experienced with the SC technique and 3 surgeons had no experience with this technique. Contamination of each glove was analyzed by 2 blinded inspectors in a darkened room by measuring the distance from the cuff to the closest contamination.

Results

Regardless of previous experience, the SC technique had a significantly greater distance to contamination compared to the open technique (open = 65 mm [interquartile range 46.3-98.8], SC = 150 mm [interquartile range 110-170], P ≤ 0.001). Surgeons with experience using the SC technique had a greater median distance to contamination (125 mm) than those who without experience with this technique (90 mm, P = .002).

Conclusions

Performing the SC-assisted gloving technique results in a significantly greater cuff to contamination distance, compared to the traditional open gloving technique. Surgeons should consider adopting this technique to help minimize infection risk alongside standard infection control measures.

背景手术服-手套界面是细菌污染的已知原因。通过在无菌助手的帮助下优化戴手套的技术，可以最大限度地减少这个界面的污染。本研究的目的是评估采用新型滑闭（SC）手套技术与传统开放式手套技术时手套袖口内部的污染程度。方法对传统的开放式手套技术和新型的SC手套技术进行了对比研究。外科医生在穿上手术服和无菌手套之前使用紫外线指示剂。3名外科医生对SC技术有经验，3名外科医生对该技术没有经验。每只手套的污染情况由两名盲检人员在一个黑暗的房间里通过测量手套袖口到最近污染点的距离来分析。结果无论以往的经验如何，与开放技术相比，SC技术与污染的距离明显更大（开放= 65 mm[四分位数范围46.3-98.8],SC = 150 mm[四分位数范围110-170]，P≤0.001）。有使用SC技术经验的外科医生与污染的中位距离（125 mm）比没有使用该技术经验的外科医生（90 mm, P = 0.002）大。结论与传统的开放式手套技术相比，sc辅助手套技术的袖口与污染的距离明显增大。外科医生应考虑采用这种技术，以帮助降低感染风险，同时采取标准的感染控制措施。

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引用次数: 0

Global Hip Offset is an Important Factor in the Success of Abductor Mechanism Insufficiency Repair After Total Hip Arthroplasty: A Case Series 髋关节整体偏移是全髋关节置换术后外展机制不全修复成功的重要因素：一个病例系列

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-10 DOI: 10.1016/j.artd.2025.101861

Samo Roškar MD , Neža Trebše MD , René Mihalič MD, PhD , Nejc Kurinčič MD , Mateja Blas MSc , Rihard Trebše MD, PhD

Background

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.

Methods

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.

Results

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) (P < .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], P = .001).

Conclusions

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.

背景：在全髋关节置换术（THA）中，由于外展肌腱退变、撕裂或术中损伤引起的髋关节外展机制缺陷可能导致严重的行走障碍。对于严重的髋关节外展肌无力，怀特塞德肌肉转移是一个很好的解决方案。然而，关于THA后外展肌机制重建（AMR）结果的文献仍然有限。我们的研究旨在评估患有Milwaukee III型和IV型髋关节外展肌缺乏的THA患者AMR的结果。方法对髋关节外展机制缺陷行AMR手术治疗的THA患者进行单中心回顾性队列研究。数据收集于2011年1月至2019年12月，包括以下参数：患者数据、主观疼痛程度、哈里斯髋关节评分（HHS）、步态模式、髋关节外展肌撕裂程度和偏移测量。结果该队列包括16例AMR患者的16例THAs。全组HHS中位数由37.1（31.0-38.7）改善至73.9 (63.5-83.7)（P < .001）。在9髋的亚组中，THA后整体偏移量保留，而其余7髋的偏移量减少。与整体偏移减少组相比，所有保留整体偏移的患者的临床结果明显更好（HHS改善的中位数为48 IQR[46-53]，而22 IQR [18-25]， P = .001）。结论我们的研究显示AMR治疗髋关节置换术后慢性、Milwaukee III型和IV型髋关节外展肌缺损的预后良好。这是第一个研究表明，在THA后恢复整体偏移对于避免慢性外展机制缺陷至关重要。

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引用次数: 0

Preoperative Patient Education as a Tool for Reducing Postoperative Opioid Use Following Primary Total Hip Arthroplasty: One Institution’s Experience 术前患者教育作为减少初次全髋关节置换术后阿片类药物使用的工具：一个机构的经验

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-01 DOI: 10.1016/j.artd.2025.101870

Catherine M. Call MD , Zoë A. Walsh MPH , Diane Jeselskis BSN , Ryan J. Mountjoy MD , Brian J. McGrory MD, MS , Adam J. Rana MD

Background

Minimizing postoperative opioids remaining after total hip arthroplasty (THA) is important for patient outcomes and community safety. The purpose of this study was to investigate whether completion of one preoperative patient education class prior to THA was associated with reduced opioid consumption at 2 weeks postoperatively. Secondary goals included evaluating whether satisfaction scores and postoperative healthcare utilization were impacted by class attendance, and whether demographic characteristics varied between groups that may highlight care disparities for our practice to address.

Methods

Patients undergoing primary THA between January 2022 and December 2024 at a single large academic institution were retrospectively evaluated for inclusion, identifying 372 patients who completed the education class and 30 patients who did not. All patients received a multimodal perioperative pain management protocol standardized at our institution.

Results

The number of morphine milligram equivalents (MMEs) consumed in the 2 weeks following THA was significantly lower among the class completion group (84.60 vs 127.30 MMEs; P = .04). On multivariable analysis, patients who attended the preoperative education class consumed 41.57 fewer MMEs compared to those who do not attend (95% confidence interval: −75.87 to −7.27; P = .018). No differences in complications, 2-week refill requests, emergency department visits, or readmission were noted. Functional outcome and satisfaction scores were high among both groups.

Conclusions

THA patients who completed an education class preoperatively consumed significantly fewer prescribed opioids as measured at the 2-week mark following surgery compared to those who did receive education. Our results support the role of patient education in reducing opioid use following arthroplasty.

背景：减少全髋关节置换术（THA）术后残留阿片类药物对患者预后和社区安全至关重要。本研究的目的是调查THA术前患者教育课程的完成是否与术后2周阿片类药物消耗减少有关。次要目标包括评估满意度评分和术后医疗保健利用是否受到课堂出勤的影响，以及组间人口统计学特征是否存在差异，这可能会突出我们实践中需要解决的护理差异。方法回顾性评估2022年1月至2024年12月在一家大型学术机构接受初级THA治疗的患者，确定372名完成教育课程的患者和30名未完成教育课程的患者。所有患者均接受了我院标准化的多模式围手术期疼痛管理方案。结果完成课程组THA术后2周吗啡毫克当量（MMEs）用量（84.60 vs 127.30 MMEs）显著低于完成课程组（P = 0.04）。在多变量分析中，参加术前教育课程的患者比未参加的患者消耗的MMEs减少41.57（95%置信区间：−75.87至−7.27;P = 0.018）。并发症、2周再填充请求、急诊科就诊或再入院均无差异。两组患者的功能结局和满意度得分均较高。结论：术前完成教育课程的tha患者在术后2周时消耗的处方阿片类药物明显少于接受教育的患者。我们的结果支持患者教育在减少关节置换术后阿片类药物使用中的作用。

{"title":"Preoperative Patient Education as a Tool for Reducing Postoperative Opioid Use Following Primary Total Hip Arthroplasty: One Institution’s Experience","authors":"Catherine M. Call MD , Zoë A. Walsh MPH , Diane Jeselskis BSN , Ryan J. Mountjoy MD , Brian J. McGrory MD, MS , Adam J. Rana MD","doi":"10.1016/j.artd.2025.101870","DOIUrl":"10.1016/j.artd.2025.101870","url":null,"abstract":"<div><h3>Background</h3><div>Minimizing postoperative opioids remaining after total hip arthroplasty (THA) is important for patient outcomes and community safety. The purpose of this study was to investigate whether completion of one preoperative patient education class prior to THA was associated with reduced opioid consumption at 2 weeks postoperatively. Secondary goals included evaluating whether satisfaction scores and postoperative healthcare utilization were impacted by class attendance, and whether demographic characteristics varied between groups that may highlight care disparities for our practice to address.</div></div><div><h3>Methods</h3><div>Patients undergoing primary THA between January 2022 and December 2024 at a single large academic institution were retrospectively evaluated for inclusion, identifying 372 patients who completed the education class and 30 patients who did not. All patients received a multimodal perioperative pain management protocol standardized at our institution.</div></div><div><h3>Results</h3><div>The number of morphine milligram equivalents (MMEs) consumed in the 2 weeks following THA was significantly lower among the class completion group (84.60 vs 127.30 MMEs; <em>P</em> = .04). On multivariable analysis, patients who attended the preoperative education class consumed 41.57 fewer MMEs compared to those who do not attend (95% confidence interval: −75.87 to −7.27; <em>P</em> = .018). No differences in complications, 2-week refill requests, emergency department visits, or readmission were noted. Functional outcome and satisfaction scores were high among both groups.</div></div><div><h3>Conclusions</h3><div>THA patients who completed an education class preoperatively consumed significantly fewer prescribed opioids as measured at the 2-week mark following surgery compared to those who did receive education. Our results support the role of patient education in reducing opioid use following arthroplasty.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101870"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265700","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}

引用次数: 0