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Synovial Fistula Associated With Total Knee Replacement Aseptic Loosening and Polyethylene Wear 与全膝关节置换术无菌松动和聚乙烯磨损有关的滑膜瘘
IF 1.5 Q3 ORTHOPEDICS Pub Date : 2024-10-12 DOI: 10.1016/j.artd.2024.101447
Saul Hernandez-Rodriguez MD, FAAOS, Liannette Padilla-Martinez MLS, MD
Synovial fistula of the knee occurs when a defect in the joint capsule creates a connection between skin, bursa, and a near tissue, manifesting as an opening with continuous draining fluid or a cyst. This is a case of an 80-year-old male who developed a synovial fistula with cystic presentation 6 years after the primary total knee arthroplasty. Management included a total knee arthroplasty revision surgery with intraoperative identification of the fistula with methylene blue, and using a gelatin-thrombin matrix for closure. This case shows a possible complication of catastrophic polyethylene insert wear and management.
膝关节滑膜瘘发生于关节囊缺损时,皮肤、滑囊和附近组织之间产生连接,表现为开口并不断引流液体或囊肿。这是一例 80 岁男性患者的病例,他在初次全膝关节置换术后 6 年出现滑膜瘘并伴有囊肿。处理方法包括进行全膝关节置换翻修手术,术中用亚甲蓝对瘘管进行鉴定,并使用明胶-凝血酶原基质进行闭合。本病例显示了灾难性聚乙烯插入物磨损和处理可能造成的并发症。
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引用次数: 0
Total Hip Arthroplasty for Avascular Necrosis in a Patient With Hemophilia B 血友病 B 患者因血管性坏死而接受全髋关节置换术
IF 1.5 Q3 ORTHOPEDICS Pub Date : 2024-10-12 DOI: 10.1016/j.artd.2024.101482
Siddhartha Dandamudi BBA , Joyee Tseng BS , John Ratz BS , Lisa Boggio MD, MS , Brett R. Levine MD, MS
Avascular necrosis (AVN) of the femoral head accounts for up to 10% of all total hip arthroplasties performed annually. Typically associated with intravascular coagulation, AVN is extremely rare in patients with bleeding disorders such as hemophilia B. In this report, we describe the therapeutic management of a 46-year-old male with hemophilia B, presenting with chronic left hip pain and AVN of the femoral head. He presented with progressive groin pain for 6 months and was unable to ambulate without the assistance of crutches. Radiographs showed evidence of degenerative joint disease secondary to AVN of the femoral head. After exhausting treatment options, the patient elected to proceed with an elective total hip arthroplasty. Intricate preoperative planning and hemophilia management were required by a multidisciplinary team to mitigate bleeding risks and promote success of the surgery. Postoperatively, the patient experienced a short-term rise in creatinine, but experienced no bleeding complications. The long-term follow-up revealed significant functional improvement without any complications of hemophilia B. There are no reports outlining AVN in hemophilia B (factor IX deficiency) or step-by-step treatment strategies for successful hip replacement in these patients.
在每年进行的全髋关节置换术中,股骨头血管性坏死(AVN)的发生率高达 10%。AVN 通常与血管内凝血有关,但在 B 型血友病等出血性疾病患者中却极为罕见。在本报告中,我们介绍了一名 46 岁 B 型血友病男性患者的治疗方法,该患者出现慢性左髋关节疼痛和股骨头无血管坏死。他的腹股沟疼痛持续了 6 个月,没有拐杖的帮助无法行走。X光片显示,股骨头坏死继发关节退行性病变。在用尽各种治疗方案后,患者选择进行选择性全髋关节置换术。多学科团队需要进行复杂的术前规划和血友病管理,以降低出血风险并促进手术成功。术后,患者肌酐短期内有所升高,但未出现出血并发症。长期随访显示,患者功能明显改善,未出现任何 B 型血友病并发症。目前还没有报告概述 B 型血友病(IX 因子缺乏症)患者的房室缺损情况,也没有为这些患者制定成功实施髋关节置换术的逐步治疗策略。
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引用次数: 0
Total Hip Arthroplasty Complications in Patients With Sickle Cell Disease: A Comparison Study 镰状细胞病患者的全髋关节置换术并发症:对比研究
IF 1.5 Q3 ORTHOPEDICS Pub Date : 2024-10-12 DOI: 10.1016/j.artd.2024.101512
Christian DeMaio BS , Conner Patrick MD , Grayson Domingue MD , Jake Fox MD , Justin Dvorak PhD , Rishi Thakral MD

Background

Total hip arthroplasty (THA) is one of the most common orthopaedic procedures performed in the United States, but there are rare complications which can be devastating. Sickle cell disease (SCD) can lead to avascular necrosis of the femoral head, often necessitating THA. This article seeks to better characterize the complication risks in patients undergoing THA with SCD when compared to osteoarthritis (OA) using a large database from the National Inpatient Sample.

Methods

National Inpatient Sample data from 2006 through the third quarter of 2015 were analyzed using International Classification of Diseases, Ninth Revision codes. A weighted frequency of 4,350,961 THAs were recorded for OA and 4279 for SCD. These were compared using a Rao-Scott chi-squared test, and the prespecified complications were given sampling weights to approximate national estimates.

Results

The following complications were found to occur at a significantly increased frequency in patients with OA with SCD vs OA only: wound infection (0.69% vs 0.36%), dislocation (1.68% vs 0.80%), and urinary complications (3.61% vs 2.35%). SCD, when evaluated independent of avascular necrosis, was reported with higher frequency wound infection (0.86% vs 0.36%), and overall complications (7.25% vs 5.06%). Additionally, multiple comorbidities were significantly more prevalent in the SCD population compared to OA patients.

Conclusions

This study illustrates that patients with SCD have increased complication rates when compared to OA patients. This information benefits orthopaedic surgeons in preoperative and postoperative planning and counseling patients for realistic expectations. Furthermore, this study provides data that could benefit decision-making on bundled reimbursement for this specific patient population.
背景全髋关节置换术(THA)是美国最常见的骨科手术之一,但也存在一些罕见的并发症,这些并发症可能具有毁灭性。镰状细胞病(SCD)可导致股骨头血管性坏死,通常需要进行全髋关节置换术。本文试图利用全国住院病人抽样调查的大型数据库,更好地描述与骨关节炎(OA)相比,接受 THA 手术的 SCD 患者的并发症风险。方法利用国际疾病分类第九版代码分析了 2006 年至 2015 年第三季度的全国住院病人抽样调查数据。根据加权频率记录,OA 的 THAs 数量为 4,350,961 例,SCD 的 THAs 数量为 4279 例。结果发现以下并发症在伴有 SCD 的 OA 患者和仅伴有 OA 的患者中发生的频率显著增加:伤口感染(0.69% vs 0.36%)、脱位(1.68% vs 0.80%)和泌尿系统并发症(3.61% vs 2.35%)。在独立于血管性坏死进行评估时,SCD的伤口感染(0.86% vs 0.36%)和整体并发症(7.25% vs 5.06%)发生率较高。结论这项研究表明,与 OA 患者相比,SCD 患者的并发症发生率更高。这一信息有利于矫形外科医生制定术前和术后计划,并向患者提供切合实际期望的咨询服务。此外,本研究提供的数据还有利于针对这一特殊患者群体的捆绑报销决策。
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引用次数: 0
Evaluating the Quality and Reliability of Total Knee Arthroplasty Rehabilitation Exercises on the Social Media Platform TikTok 评估社交媒体平台 TikTok 上全膝关节置换术康复训练的质量和可靠性
IF 1.5 Q3 ORTHOPEDICS Pub Date : 2024-10-12 DOI: 10.1016/j.artd.2024.101486
Sarah Welch BS , Kian Bagheri DO , Mikhail Bethell MS , Albert T. Anastasio MD , Troy Q. Tabarestani MD , Michael Bolognesi MD

Background

The utilization of social media for health-related purposes has surged, especially during the COVID-19 pandemic. TikTok, a short-form video platform, has seen substantial growth, becoming a prominent medium for health information dissemination. However, the lack of regulation poses challenges in evaluating the validity of TikTok content.

Methods

This cross-sectional study assesses TikTok videos related to total knee arthroplasty rehabilitation exercises. Search terms identified 84 videos, with 64 meeting the inclusion criteria. Engagement metrics and quality scores were analyzed, utilizing the DISCERN tool and the Total Knee Replacement Exercises Education Score.

Results

The analyzed videos accumulated nearly 6 million views, with a median of 10,293.5 (interquartile range = 4139.3-26,100.0). Health-care professionals contributed 48% of the content. Despite higher engagement metrics for health-care professional videos, the overall quality, as indicated by DISCERN and Total Knee Replacement Exercises Education scores, remained poor. No videos achieved an “excellent” rating, with the majority categorized as “poor.”

Conclusions

This study underscores TikTok’s substantial role in total knee arthroplasty rehabilitation information dissemination but reveals a critical deficit in content quality and reliability. Health-care professionals marginally outperformed general users but displayed overall inadequacy. The study emphasizes the necessity for improving the quality of health-related content on emerging social media platforms, especially within the realm of orthopaedic surgery.

Level of Evidence

Level III, Cross-sectional study.
背景社交媒体在健康相关领域的使用激增,尤其是在 COVID-19 大流行期间。短视频平台 TikTok 增长迅速,已成为传播健康信息的重要媒介。本横断面研究评估了与全膝关节置换术康复锻炼相关的 TikTok 视频。通过搜索词确定了 84 个视频,其中 64 个符合纳入标准。利用DISCERN工具和全膝关节置换术锻炼教育评分对参与度指标和质量评分进行了分析。结果分析的视频累计观看次数近600万次,中位数为10293.5次(四分位间范围=4139.3-26100.0)。医护人员贡献了 48% 的内容。尽管医护人员视频的参与度指标较高,但从 DISCERN 和全膝关节置换运动教育评分来看,整体质量仍然较差。本研究强调了 TikTok 在全膝关节置换术康复信息传播中的重要作用,但也揭示了内容质量和可靠性方面的严重不足。医疗保健专业人员的使用率略高于普通用户,但总体表现不佳。该研究强调了提高新兴社交媒体平台上健康相关内容质量的必要性,尤其是在矫形外科领域。
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引用次数: 0
Patient-Reported Outcomes in Robotic-Assisted vs Manual Cementless Total Knee Arthroplasty 机器人辅助与手动无骨水泥全膝关节置换术的患者报告结果对比
IF 1.5 Q3 ORTHOPEDICS Pub Date : 2024-10-12 DOI: 10.1016/j.artd.2024.101488
Michael J. Stoltz MD , Nolan S. Smith MD , Sarag Abhari MD , John Whitaker MD , James F. Baker MD , Langan S. Smith BS , Rohat Bhimani MD , Madhusudhan R. Yakkanti MD , Arthur L. Malkani MD

Background

Robotic-assisted total knee arthroplasty (RA-TKA) was introduced to provide surgeons with virtual preoperative planning and intraoperative information to achieve the desired surgical goals in an effort to improve patient outcomes. The purpose of this study was to compare clinical outcomes and patient-reported outcome measures following primary TKA using RA-TKA vs manual instrumentation.

Methods

This was a retrospective cohort review study comparing 393 primary RA-TKAs vs 312 manual TKAs at a minimum 2-year follow-up. The same cementless implant design was utilized in all cases at a single institution. There were no significant differences in age or gender between groups. Outcome measures included range-of-motion, Knee Society (KSS), Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score-12, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and overall patient satisfaction scores along with complications and survivorship.

Results

Compared to manual TKA, the RA-TKA group had significant higher postoperative KSS Function and Knee scores, Western Ontario and McMaster Universities Osteoarthritis Index, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores (P < .001). A total percentage of 95.0% of RA-TKA vs 87.4% of manual TKAs were very satisfied or satisfied (P = .001). Survivorship with all-cause failure as the endpoint at 3 years was 96.9% in the RA-TKA group compared to 95.8% in the manual group (P = .54).

Conclusions

RA-TKA demonstrated significant improvement over manual jig-based instruments in KSS Function, KSS Knee, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and patient satisfaction scores following primary TKA with no differences in complications and revision incidence. RA-TKA provided a virtual 3-dimensional preoperative plan along with intraoperative information for adjustments to approximate the patients' native joint line and achieve a well-balanced soft-tissue sleeve about the knee for primary TKA.
背景引入机器人辅助全膝关节置换术(RA-TKA)是为了向外科医生提供虚拟术前计划和术中信息,以实现预期的手术目标,从而改善患者的预后。本研究的目的是比较使用RA-TKA与手动器械进行初次TKA后的临床疗效和患者报告的疗效指标。方法这是一项回顾性队列回顾研究,比较了393例RA-TKA与312例手动TKA在至少2年随访后的临床疗效。所有病例均在一家医疗机构采用相同的无骨水泥植入设计。两组患者的年龄和性别无明显差异。结果测量包括活动范围、膝关节协会(KSS)、西安大略和麦克马斯特大学骨关节炎指数、Forgotten Joint Score-12、膝关节损伤和关节置换骨关节炎结果评分、患者总体满意度评分以及并发症和存活率。结果与徒手 TKA 相比,RA-TKA 组的术后 KSS 功能和膝关节评分、西安大略和麦克马斯特大学骨关节炎指数以及膝关节损伤和骨关节炎关节置换结果评分均明显更高(P <.001)。95.0%的RA-TKA患者与87.4%的人工TKA患者表示非常满意或满意(P = .001)。结论RA-TKA在初级TKA后的KSS功能、KSS膝关节、西安大略和麦克马斯特大学骨关节炎指数、膝关节损伤和骨关节炎关节置换结果评分以及患者满意度评分方面都比基于手动夹具的工具有显著改善,而在并发症和翻修发生率方面没有差异。RA-TKA提供了虚拟三维术前计划和术中调整信息,以接近患者的原生关节线,并在初次TKA中实现膝关节软组织套筒的良好平衡。
{"title":"Patient-Reported Outcomes in Robotic-Assisted vs Manual Cementless Total Knee Arthroplasty","authors":"Michael J. Stoltz MD ,&nbsp;Nolan S. Smith MD ,&nbsp;Sarag Abhari MD ,&nbsp;John Whitaker MD ,&nbsp;James F. Baker MD ,&nbsp;Langan S. Smith BS ,&nbsp;Rohat Bhimani MD ,&nbsp;Madhusudhan R. Yakkanti MD ,&nbsp;Arthur L. Malkani MD","doi":"10.1016/j.artd.2024.101488","DOIUrl":"10.1016/j.artd.2024.101488","url":null,"abstract":"<div><h3>Background</h3><div>Robotic-assisted total knee arthroplasty (RA-TKA) was introduced to provide surgeons with virtual preoperative planning and intraoperative information to achieve the desired surgical goals in an effort to improve patient outcomes. The purpose of this study was to compare clinical outcomes and patient-reported outcome measures following primary TKA using RA-TKA vs manual instrumentation.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort review study comparing 393 primary RA-TKAs vs 312 manual TKAs at a minimum 2-year follow-up. The same cementless implant design was utilized in all cases at a single institution. There were no significant differences in age or gender between groups. Outcome measures included range-of-motion, Knee Society (KSS), Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score-12, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and overall patient satisfaction scores along with complications and survivorship.</div></div><div><h3>Results</h3><div>Compared to manual TKA, the RA-TKA group had significant higher postoperative KSS Function and Knee scores, Western Ontario and McMaster Universities Osteoarthritis Index, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores (<em>P</em> &lt; .001). A total percentage of 95.0% of RA-TKA vs 87.4% of manual TKAs were very satisfied or satisfied (<em>P</em> = .001). Survivorship with all-cause failure as the endpoint at 3 years was 96.9% in the RA-TKA group compared to 95.8% in the manual group (<em>P</em> = .54).</div></div><div><h3>Conclusions</h3><div>RA-TKA demonstrated significant improvement over manual jig-based instruments in KSS Function, KSS Knee, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and patient satisfaction scores following primary TKA with no differences in complications and revision incidence. RA-TKA provided a virtual 3-dimensional preoperative plan along with intraoperative information for adjustments to approximate the patients' native joint line and achieve a well-balanced soft-tissue sleeve about the knee for primary TKA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101488"},"PeriodicalIF":1.5,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427041","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
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 Pub Date : 2024-10-12 DOI: 10.1016/j.artd.2024.101473
Gabrielle N. Swartz BS , Sandeep S. Bains MD, DC, MBA , Jeremy A. Dubin BA , Reza Katanbaf MD, MBA , Hunter Hayes DO , James Nace DO, MPT , Michael A. Mont MD , Ronald E. Delanois MD

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。
{"title":"Robotic-Assistance in Total Hip Arthroplasty Is Associated With Decreased Dislocation Rates","authors":"Gabrielle N. Swartz BS ,&nbsp;Sandeep S. Bains MD, DC, MBA ,&nbsp;Jeremy A. Dubin BA ,&nbsp;Reza Katanbaf MD, MBA ,&nbsp;Hunter Hayes DO ,&nbsp;James Nace DO, MPT ,&nbsp;Michael A. Mont MD ,&nbsp;Ronald E. Delanois MD","doi":"10.1016/j.artd.2024.101473","DOIUrl":"10.1016/j.artd.2024.101473","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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 <em>chi</em>-square tests to assess categorical variables. We utilized student’s <em>t</em>-tests to compare continuous variables, including ages and comorbidities. Odds ratios (ORs) were calculated for complications using 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>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, <em>P</em> = .007), 1 year (1.32 vs 1.92%, OR 0.68, 95% CI 0.53-0.88, <em>P</em> = .004), and 2 years (1.66 vs 2.1%, OR 0.79, 95% CI 0.62-0.99, <em>P</em> = .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, <em>P</em> = .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 <em>P</em> &gt; .05). The rates of periprosthetic joint infections, aseptic revision, periprosthetic fractures, and aseptic loosening were similar at all time points (all <em>P</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101473"},"PeriodicalIF":1.5,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427499","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
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 Pub Date : 2024-10-12 DOI: 10.1016/j.artd.2024.101483
Philip Mark Anderson MD , Thiemo Frank , Michaela Herz MD , Oliver Kurzai MD , Maximilian Rudert MD , Tizian Heinz MD , Thiên-Trí Lâm MD

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。
{"title":"Qualitative Comparison of Cultured Skin Microbiota From the Inguinal Region of Obese and Nonobese Patients Eligible for Hip Arthroplasty","authors":"Philip Mark Anderson MD ,&nbsp;Thiemo Frank ,&nbsp;Michaela Herz MD ,&nbsp;Oliver Kurzai MD ,&nbsp;Maximilian Rudert MD ,&nbsp;Tizian Heinz MD ,&nbsp;Thiên-Trí Lâm MD","doi":"10.1016/j.artd.2024.101483","DOIUrl":"10.1016/j.artd.2024.101483","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>The study group consisted of 28 patients, the control group of 36 patients. The most frequent potential pathogen on the skin was <em>Staphylococcus epidermidis</em> 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101483"},"PeriodicalIF":1.5,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426815","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
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 Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101490
Samuel Yan Jin Fang MBBS (HK) , Kwong Yuen Chiu MBBS (HK), FRCSEd (Orth), FHKCOS, FHKAM , Wai Kiu Thomas Liu MBBS (HK) , Amy Cheung MBBS (HK), FRCSEd (Orth), FHKCOS, FHKAM , Ping Keung Chan MBBS, MRCSEd, FHKCOS, FHKAM, FRCSEd (Orth) , Henry Fu MBBS (HK), MMedSc (HK), FRCSEd (Orth), FHKCOS, FHKAM

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。
{"title":"Factors Affecting Successful Restricted Kinematic Alignment With Robotic Assisted Total Knee Arthroplasty in Patients With Severe Varus Preoperative Alignment","authors":"Samuel Yan Jin Fang MBBS (HK) ,&nbsp;Kwong Yuen Chiu MBBS (HK), FRCSEd (Orth), FHKCOS, FHKAM ,&nbsp;Wai Kiu Thomas Liu MBBS (HK) ,&nbsp;Amy Cheung MBBS (HK), FRCSEd (Orth), FHKCOS, FHKAM ,&nbsp;Ping Keung Chan MBBS, MRCSEd, FHKCOS, FHKAM, FRCSEd (Orth) ,&nbsp;Henry Fu MBBS (HK), MMedSc (HK), FRCSEd (Orth), FHKCOS, FHKAM","doi":"10.1016/j.artd.2024.101490","DOIUrl":"10.1016/j.artd.2024.101490","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> &lt; .05). Medial tibial osteophyte size was 6.1% ± 2.9% and was smaller in all groups that achieved rKA (<em>P</em> &lt; .05). Both were positively correlated with degree of deformity correction, <em>r</em> = 0.718 (<em>P</em> &lt; .01) and <em>r</em> = 0.281 (<em>P</em> &lt; .01), respectively.</div></div><div><h3>Conclusions</h3><div>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°).</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101490"},"PeriodicalIF":1.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427476","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
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 Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101511
Eric M. Slotkin DO , Francesca Coxe MD , Tristan Jones BaSC, MPT, MBA , Thomas Morton PA-C , Stefan Kreutzer MD , Allejandro Della-Valle MD

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":"Eric M. Slotkin DO ,&nbsp;Francesca Coxe MD ,&nbsp;Tristan Jones BaSC, MPT, MBA ,&nbsp;Thomas Morton PA-C ,&nbsp;Stefan Kreutzer MD ,&nbsp;Allejandro Della-Valle MD","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":"30 ","pages":"Article 101511"},"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
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 Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101523
Kosuke Shiga MD , Takao Kaneko MD, PhD , Ayakane Yamamoto MD , Kazuki Amemiya PT , Masaru Omata PT
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。
{"title":"Failure of the Femoral and Tibial Components Following Anterior Cruciate Ligament Injury After Robotic-Assisted Bicruciate-Retaining Total Knee Arthroplasty","authors":"Kosuke Shiga MD ,&nbsp;Takao Kaneko MD, PhD ,&nbsp;Ayakane Yamamoto MD ,&nbsp;Kazuki Amemiya PT ,&nbsp;Masaru Omata PT","doi":"10.1016/j.artd.2024.101523","DOIUrl":"10.1016/j.artd.2024.101523","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101523"},"PeriodicalIF":1.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427482","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
期刊
Arthroplasty Today
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