Pub Date : 2024-06-01DOI: 10.1016/j.artd.2024.101395
Ryan T. Halvorson MD , Abel Torres-Espin PhD , Matthew Cherches MD , Matt Callahan MBA , Thomas P. Vail MD , Jeannie F. Bailey PhD
Background
Recovery following total joint arthroplasty is patient-specific, yet groups of patients tend to fall into certain similar patterns of recovery. The purpose of this study was to identify and characterize recovery patterns following total hip arthroplasty (THA) and total knee arthroplasty (TKA) using patient-reported outcomes that represent distinct health domains. We hypothesized that recovery patterns could be defined and predicted using preoperative data.
Methods
Adult patients were recruited from a large, urban academic center. To model postoperative responses to THA and TKA across domains such as physical health, mental health, and joint-specific measures, we employed a longitudinal clustering algorithm that incorporates each of these health domains. The clustering algorithm from multiple health domains allows the ability to define distinct recovery trajectories, which could then be predicted from preoperative and perioperative factors using a multinomial regression.
Results
Four hundred forty-one of 1134 patients undergoing THA and 346 of 921 undergoing TKA met eligibility criteria and were used to define distinct patterns of recovery. The clustering algorithm was optimized for 3 distinct patterns of recovery that were observed in THA and TKA patients. Patients recovering from THA were divided into 3 groups: standard responders (50.8%), late mental responders (13.2%), and substandard responders (36.1%). Multivariable, multinomial regression suggested that these 3 groups had defined characteristics. Late mental responders tended to be obese (P = .05) and use more opioids (P = .01). Substandard responders had a larger number of comorbidities (P = .02) and used more opioids (P = .001). Patients recovering from TKA were divided among standard responders (55.8%), poor mental responders (24%), and poor physical responders (20.2%). Poor mental responders were more likely to be female (P = .04) and American Society of Anesthesiologists class III/IV (P = .004). Poor physical responders were more likely to be female (P = .03), younger (P = .04), American Society of Anesthesiologists III/IV (P = .04), use more opioids (P = .02), and be discharged to a nursing facility (P = .001). The THA and TKA models demonstrated areas under the curve of 0.67 and 0.72.
Conclusions
This multidomain, longitudinal clustering analysis defines 3 distinct patterns in the recovery of THA and TKA patients, with most patients in both cohorts experiencing robust improvement, while others had equally well defined yet less optimal recovery trajectories that were either delayed in recovery or failed to achieve a desired outcome. Patients in the delayed recovery and poor outcome groups were slightly different between THA and TKA. These groups of patients with similar recovery patterns
{"title":"Predicting Recovery Following Total Hip and Knee Arthroplasty Using a Clustering Algorithm","authors":"Ryan T. Halvorson MD , Abel Torres-Espin PhD , Matthew Cherches MD , Matt Callahan MBA , Thomas P. Vail MD , Jeannie F. Bailey PhD","doi":"10.1016/j.artd.2024.101395","DOIUrl":"10.1016/j.artd.2024.101395","url":null,"abstract":"<div><h3>Background</h3><p>Recovery following total joint arthroplasty is patient-specific, yet groups of patients tend to fall into certain similar patterns of recovery. The purpose of this study was to identify and characterize recovery patterns following total hip arthroplasty (THA) and total knee arthroplasty (TKA) using patient-reported outcomes that represent distinct health domains. We hypothesized that recovery patterns could be defined and predicted using preoperative data.</p></div><div><h3>Methods</h3><p>Adult patients were recruited from a large, urban academic center. To model postoperative responses to THA and TKA across domains such as physical health, mental health, and joint-specific measures, we employed a longitudinal clustering algorithm that incorporates each of these health domains. The clustering algorithm from multiple health domains allows the ability to define distinct recovery trajectories, which could then be predicted from preoperative and perioperative factors using a multinomial regression.</p></div><div><h3>Results</h3><p>Four hundred forty-one of 1134 patients undergoing THA and 346 of 921 undergoing TKA met eligibility criteria and were used to define distinct patterns of recovery. The clustering algorithm was optimized for 3 distinct patterns of recovery that were observed in THA and TKA patients. Patients recovering from THA were divided into 3 groups: standard responders (50.8%), late mental responders (13.2%), and substandard responders (36.1%). Multivariable, multinomial regression suggested that these 3 groups had defined characteristics. Late mental responders tended to be obese (<em>P</em> = .05) and use more opioids (<em>P</em> = .01). Substandard responders had a larger number of comorbidities (<em>P</em> = .02) and used more opioids (<em>P</em> = .001). Patients recovering from TKA were divided among standard responders (55.8%), poor mental responders (24%), and poor physical responders (20.2%). Poor mental responders were more likely to be female (<em>P</em> = .04) and American Society of Anesthesiologists class III/IV (<em>P</em> = .004). Poor physical responders were more likely to be female (<em>P</em> = .03), younger (<em>P</em> = .04), American Society of Anesthesiologists III/IV (<em>P</em> = .04), use more opioids (<em>P</em> = .02), and be discharged to a nursing facility (<em>P</em> = .001). The THA and TKA models demonstrated areas under the curve of 0.67 and 0.72.</p></div><div><h3>Conclusions</h3><p>This multidomain, longitudinal clustering analysis defines 3 distinct patterns in the recovery of THA and TKA patients, with most patients in both cohorts experiencing robust improvement, while others had equally well defined yet less optimal recovery trajectories that were either delayed in recovery or failed to achieve a desired outcome. Patients in the delayed recovery and poor outcome groups were slightly different between THA and TKA. These groups of patients with similar recovery patterns","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124000803/pdfft?md5=3375ce42a247dabea4e8903c765585d3&pid=1-s2.0-S2352344124000803-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141035458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.artd.2024.101367
Paul A. Ulrich DO, Robert L. Zondervan DO, PhD, Jason M. Cochran DO
{"title":"Letter to the Editor Response: Failure of Cup Screw Interface in the Trident II Acetabular Cup in Total Hip Arthroplasty","authors":"Paul A. Ulrich DO, Robert L. Zondervan DO, PhD, Jason M. Cochran DO","doi":"10.1016/j.artd.2024.101367","DOIUrl":"10.1016/j.artd.2024.101367","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124000529/pdfft?md5=2ebbd25fd61fea3db5064fb6e296606d&pid=1-s2.0-S2352344124000529-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140764817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.artd.2024.101347
Colin C. Neitzke BS, Sonia K. Chandi MD, Elizabeth B. Gausden MD, MPH, Eytan M. Debbi MD, PhD, Peter K. Sculco MD, Brian P. Chalmers MD
Background
The outcomes of revision total hip arthroplasty (rTHA) have become increasingly important as their volume increases. Computer navigation, a reliable method to improve component positioning during primary total hip arthroplasty (THA), is not well studied in the rTHA setting. Given that dislocation rates following rTHA are significantly higher than those of primary THA, component positioning becomes paramount in these cases.
Methods
Here, we present two case reports and surgical techniques, one of a 77-year-old man undergoing rTHA for recurrent hip instability following primary THA, and one of a 61-year-old woman undergoing rTHA for severe iliopsoas bursitis who was at increased risk for instability and dislocation given her history of large segment spinal fusion.
Results
Both patients achieved optimal acetabular component positioning after rTHA with imageless computer navigation.
Conclusions
The use of imageless computer navigation in rTHA provides accurate and reproducible component positioning during acetabular rTHA.
{"title":"Use of Computer Navigation for Optimal Acetabular Cup Placement in Revision Total Hip Arthroplasty: Case Reports and Surgical Techniques","authors":"Colin C. Neitzke BS, Sonia K. Chandi MD, Elizabeth B. Gausden MD, MPH, Eytan M. Debbi MD, PhD, Peter K. Sculco MD, Brian P. Chalmers MD","doi":"10.1016/j.artd.2024.101347","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101347","url":null,"abstract":"<div><h3>Background</h3><p>The outcomes of revision total hip arthroplasty (rTHA) have become increasingly important as their volume increases. Computer navigation, a reliable method to improve component positioning during primary total hip arthroplasty (THA), is not well studied in the rTHA setting. Given that dislocation rates following rTHA are significantly higher than those of primary THA, component positioning becomes paramount in these cases.</p></div><div><h3>Methods</h3><p>Here, we present two case reports and surgical techniques, one of a 77-year-old man undergoing rTHA for recurrent hip instability following primary THA, and one of a 61-year-old woman undergoing rTHA for severe iliopsoas bursitis who was at increased risk for instability and dislocation given her history of large segment spinal fusion.</p></div><div><h3>Results</h3><p>Both patients achieved optimal acetabular component positioning after rTHA with imageless computer navigation.</p></div><div><h3>Conclusions</h3><p>The use of imageless computer navigation in rTHA provides accurate and reproducible component positioning during acetabular rTHA.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124000323/pdfft?md5=b945b8c50c69f870b6959f1439755729&pid=1-s2.0-S2352344124000323-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141485285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.artd.2024.101432
Travis R. Weiner BS , Catelyn A. Woelfle BA , Winnie Xu BA , Duke G. Yim MD , Roshan P. Shah MD , H. John Cooper MD
Background
Initial stability of cementless stems is important to minimize the risk of subsidence, pain, and periprosthetic fracture after total hip arthroplasty (THA). Collared stems improve initial component stability when contacting the femoral calcar. Direct contact is not always achieved, and collared stem performance has not been studied in this context. We hypothesized that collared stems achieving direct contact would demonstrate reduced subsidence.
Methods
A single-surgeon retrospective study of 482 consecutive primary THAs implanted between February 2020 and May 2023 using collared cementless stems was performed. The 2 cohorts included stems with initial collar-calcar contact vs stems without. Subsidence was evaluated by comparing intraoperative fluoroscopy to postoperative 8-week radiographs. Binary logistic regression identified independent risk factors for subsidence. Chi-square tests were used for categorical variables and t-tests for continuous variables.
Results
Of stems, 63.9% achieved initial collar-calcar contact, while 36.1% did not. The rate (1.3% vs 19.0%; P < .001) and magnitude (0.02 mm, range 0-3 mm vs 0.35 mm, range 0-3 mm; P < .001) of subsidence were significantly higher among stems without initial contact. Stems without initial collar-calcar contact (P < .001) and male gender (P = .007) were independent risk factors for subsidence. Two patients with initial contact had nondisplaced calcar cracks and <3 mm of subsidence at 4 weeks, which healed with protected weight-bearing. Stem survivorship was 100% in both groups, with all achieving osteointegration and none needing revision.
Conclusions
Excellent performance of collared cementless stems was observed at 8 weeks after primary THA. Initial collar-calcar contact lowered the risk and magnitude of minor subsidence but did not affect survivorship or fracture risk.
Level of Evidence
Level III.
背景无骨水泥柄的初始稳定性对于最大限度地降低全髋关节置换术（THA）后出现下沉、疼痛和假体周围骨折的风险非常重要。有领骨干在接触股骨髁时可提高组件的初始稳定性。直接接触并不总是能实现的，在这种情况下，尚未对有领骨干的性能进行研究。我们假设实现直接接触的有袢骨干会减少下沉。方法对2020年2月至2023年5月期间使用无骨水泥有袢骨干植入的482例连续初次THA进行了单外科医师回顾性研究。2个队列包括有颈圈-卡环初始接触的基台和无颈圈-卡环接触的基台。通过比较术中透视和术后8周X光片对下沉进行评估。二元逻辑回归确定了下沉的独立风险因素。对分类变量采用卡方检验，对连续变量采用t检验。没有初次接触的茎干的下沉率（1.3% vs 19.0%; P <.001）和下沉幅度（0.02 mm，范围 0-3 mm vs 0.35 mm，范围 0-3 mm; P <.001）明显更高。没有颈圈-卡环初次接触的骨干（P <.001）和男性性别（P = .007）是导致下沉的独立危险因素。两名有初次接触的患者在4周时出现了非移位的钙痕裂缝和<3毫米的下陷，在保护性负重下愈合。两组患者的柄存活率均为100%，所有患者都实现了骨整合，无一需要翻修。最初的基台-卡环接触降低了轻微下沉的风险和程度，但并不影响存活率或骨折风险。
{"title":"Does Lack of Initial Collar-Calcar Contact Influence Performance of Collared Cementless Femoral Stems?","authors":"Travis R. Weiner BS , Catelyn A. Woelfle BA , Winnie Xu BA , Duke G. Yim MD , Roshan P. Shah MD , H. John Cooper MD","doi":"10.1016/j.artd.2024.101432","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101432","url":null,"abstract":"<div><h3>Background</h3><p>Initial stability of cementless stems is important to minimize the risk of subsidence, pain, and periprosthetic fracture after total hip arthroplasty (THA). Collared stems improve initial component stability when contacting the femoral calcar. Direct contact is not always achieved, and collared stem performance has not been studied in this context. We hypothesized that collared stems achieving direct contact would demonstrate reduced subsidence.</p></div><div><h3>Methods</h3><p>A single-surgeon retrospective study of 482 consecutive primary THAs implanted between February 2020 and May 2023 using collared cementless stems was performed. The 2 cohorts included stems with initial collar-calcar contact vs stems without. Subsidence was evaluated by comparing intraoperative fluoroscopy to postoperative 8-week radiographs. Binary logistic regression identified independent risk factors for subsidence. Chi-square tests were used for categorical variables and <em>t</em>-tests for continuous variables.</p></div><div><h3>Results</h3><p>Of stems, 63.9% achieved initial collar-calcar contact, while 36.1% did not. The rate (1.3% vs 19.0%; <em>P</em> < .001) and magnitude (0.02 mm, range 0-3 mm vs 0.35 mm, range 0-3 mm; <em>P</em> < .001) of subsidence were significantly higher among stems without initial contact. Stems without initial collar-calcar contact (<em>P</em> < .001) and male gender (<em>P</em> = .007) were independent risk factors for subsidence. Two patients with initial contact had nondisplaced calcar cracks and <3 mm of subsidence at 4 weeks, which healed with protected weight-bearing. Stem survivorship was 100% in both groups, with all achieving osteointegration and none needing revision.</p></div><div><h3>Conclusions</h3><p>Excellent performance of collared cementless stems was observed at 8 weeks after primary THA. Initial collar-calcar contact lowered the risk and magnitude of minor subsidence but did not affect survivorship or fracture risk.</p></div><div><h3>Level of Evidence</h3><p>Level III.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124001171/pdfft?md5=35edc129e0b5a2822b85845f4a7fdd9e&pid=1-s2.0-S2352344124001171-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141244070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.artd.2024.101415
Simrun Chahal MSc , Rabail Siddiqui MPH, MHSc, CCRP , Liam Puskas BSc , Shalyn Littlefield MSc , Lahama Naeem MA , Caroline Fanti MScPT , Claude Cullinan MD , Kurt Droll MD , David Puskas MD , Travis E. Marion MD
Background
The coronavirus pandemic highlighted the need for remote patient monitoring to deliver and provide access to patient care and education. A mobile-based app providing interactive tools for patient education and monitoring was piloted at Thunder Bay Regional Health Sciences Centre (TBRHSC) in November 2020. We aimed to examine the platform’s impact on postoperative length of stay, hospital readmissions, and emergency department (ED) visits 60 days postsurgery in total hip and knee arthroplasty patients in Northwestern Ontario.
Methods
Data were assessed from patients undergoing primary total hip or knee arthroplasties at TBRHSC from March 1, 2020, to February 28, 2022. Patients were divided into 2 cohorts based on enrollment with the mobile-based app (SeamlessMD). Statistical differences in outcomes were determined using Mann-Whitney or χ2 tests. An odds ratio was calculated for ED visits.
Results
Patients enrolled in the mobile-based app had statistically lower length of stay (U = 7779.0, P < .001) and fewer ED visits (χ2(1,212) = 5.570, P = .018) than patients not enrolled in the program. Patients not enrolled had 2.31 times greater odds of visiting the ED postsurgery (odds ratio = 0.432, 95% confidence interval = 0.213-0.877, P = .022). There were no statistical differences found in readmission rates.
Conclusions
The implementation of the mobile-based app at TBRHSC showed its potential value as a tool to reduce costs in the healthcare system and improve patient outcomes. Consequentially, more formal studies are required to elucidate the magnitude of this effect.
{"title":"Impact of a Remote Patient Monitoring Platform on Outcomes Following a Total Hip or Knee Arthroplasty","authors":"Simrun Chahal MSc , Rabail Siddiqui MPH, MHSc, CCRP , Liam Puskas BSc , Shalyn Littlefield MSc , Lahama Naeem MA , Caroline Fanti MScPT , Claude Cullinan MD , Kurt Droll MD , David Puskas MD , Travis E. Marion MD","doi":"10.1016/j.artd.2024.101415","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101415","url":null,"abstract":"<div><h3>Background</h3><p>The coronavirus pandemic highlighted the need for remote patient monitoring to deliver and provide access to patient care and education. A mobile-based app providing interactive tools for patient education and monitoring was piloted at Thunder Bay Regional Health Sciences Centre (TBRHSC) in November 2020. We aimed to examine the platform’s impact on postoperative length of stay, hospital readmissions, and emergency department (ED) visits 60 days postsurgery in total hip and knee arthroplasty patients in Northwestern Ontario.</p></div><div><h3>Methods</h3><p>Data were assessed from patients undergoing primary total hip or knee arthroplasties at TBRHSC from March 1, 2020, to February 28, 2022. Patients were divided into 2 cohorts based on enrollment with the mobile-based app (SeamlessMD). Statistical differences in outcomes were determined using Mann-Whitney or χ<sup>2</sup> tests. An odds ratio was calculated for ED visits.</p></div><div><h3>Results</h3><p>Patients enrolled in the mobile-based app had statistically lower length of stay (<em>U</em> = 7779.0, <em>P</em> < .001) and fewer ED visits (χ<sup>2</sup><sub>(1,212)</sub> = 5.570, <em>P</em> = .018) than patients not enrolled in the program. Patients not enrolled had 2.31 times greater odds of visiting the ED postsurgery (odds ratio = 0.432, 95% confidence interval = 0.213-0.877, <em>P</em> = .022). There were no statistical differences found in readmission rates.</p></div><div><h3>Conclusions</h3><p>The implementation of the mobile-based app at TBRHSC showed its potential value as a tool to reduce costs in the healthcare system and improve patient outcomes. Consequentially, more formal studies are required to elucidate the magnitude of this effect.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124001006/pdfft?md5=08fd4de739a207b10f2f650dfb594afa&pid=1-s2.0-S2352344124001006-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141242970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.artd.2024.101419
Pete Gold MD , Armin Arshi MD
Rewarding and honorable, yet challenging and humbling, this is our chosen profession. No matter how robust of a residency and fellowship training we have had or how impactful our mentors have been, nothing can truly prepare us for dealing with complications as new attendings.
{"title":"Dealing With Complications as a Young Surgeon","authors":"Pete Gold MD , Armin Arshi MD","doi":"10.1016/j.artd.2024.101419","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101419","url":null,"abstract":"<div><p>Rewarding and honorable, yet challenging and humbling, this is our chosen profession. No matter how robust of a residency and fellowship training we have had or how impactful our mentors have been, nothing can truly prepare us for dealing with complications as new attendings.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124001043/pdfft?md5=bef5d30fe7431a7efae3eb8279d2d38d&pid=1-s2.0-S2352344124001043-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141482208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.artd.2024.101358
Thies J.N. van der Lelij MD, Perla J. Marang-van de Mheen PhD, Bart L. Kaptein PhD, Rob G.H.H. Nelissen MD, PhD
{"title":"Letter to the Editor: Failure of Screw/Shell Interface in Trident II Acetabular System in Total Hip Arthroplasty","authors":"Thies J.N. van der Lelij MD, Perla J. Marang-van de Mheen PhD, Bart L. Kaptein PhD, Rob G.H.H. Nelissen MD, PhD","doi":"10.1016/j.artd.2024.101358","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101358","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124000438/pdfft?md5=a9cea26428794134d35f39557262d5fb&pid=1-s2.0-S2352344124000438-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478618","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}
{"title":"National Registry Data Analysis on a Unique Highly-Crosslinked Polyethylene for Total Hip Arthroplasty","authors":"Elda Paoli MEng , Daria Bergadano MEng , Shuya Sheng , Hemant Pandit","doi":"10.1016/j.artd.2024.101345","DOIUrl":"https://doi.org/10.1016/j.artd.2024.101345","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S235234412400030X/pdfft?md5=b63afe6287f22bd54c2858118a604bb1&pid=1-s2.0-S235234412400030X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141482209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.artd.2024.101374
Brian T. Muffly MD , Erik M. Hegeman MD , Braden E. Hartline MD , Keerat Singh MD , Ajay Premkumar MD , George N. Guild III MD
The direct anterior approach (DAA) has been increasing in popularity for primary total hip arthroplasty (THA). Despite previously documented anatomic limitations to its direct distal extension, alternative exposure methods have been described to safely access the femoral diaphysis and facilitate increasingly complex primary and revision THA scenarios. The DAA has several purported advantages compared to alternative approaches (eg, posterior and lateral-based), including its muscle-sparing nature, use of an internervous plane, and preservation of posterior stabilizing structures. Proponents of the DAA cite decreased postoperative pain, quicker recovery times, potentially lower dislocation rates, ease of intraoperative fluoroscopy, and improved implant placement/restoration of leg lengths. The current literature, however, is sparse when considering the use of this approach in the setting of severely dysplastic hips necessitating a concurrent subtrochanteric shortening osteotomy. When utilizing a posterior approach in this population, previous work from Ollivier and colleagues demonstrated high rates of cementless implant osseointegration and significantly improved clinical outcomes at long-term follow-up. Although relatively few reports of addressing this pathology via the DAA currently exist, initial results are promising. This study seeks to provide a detailed description of a surgical technique for performing primary THA and ipsilateral subtrochanteric shortening osteotomy in this patient population utilizing an extensile DAA.
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