Pub Date : 2025-11-17DOI: 10.1016/j.artd.2025.101909
Enrique Alberto Vargas Meouchi MD , Ricard Llovera González-Adrio MD , David Beneitez Pastor MD , Veronica Pons MD , Marta Garcia Bernal MD , Victor Manuel Barro Ojeda MD
Sickle cell disease (SCD) is a known risk factor for femoral head osteonecrosis, often leading to early joint degeneration. We report a 17-year-old male with homozygous SCD and bilateral femoral head collapse who underwent simultaneous bilateral total hip arthroplasty through a direct anterior approach. Preoperative optimization included erythrocyte exchange transfusion effectively reducing hemoglobin S from 76% to 26%. The procedure was completed without complications, and the patient recovered uneventfully, with no sickling crises or acute chest syndrome. Cemented implants were used due to poor bone quality. The patient regained full, pain-free ambulation by three months. This case supports the safety and feasibility of simultaneous bilateral total hip arthroplasty in selected SCD patients when preceded by targeted erythrocyte exchange transfusion and managed by a multidisciplinary team.
{"title":"Erythrocyte Exchange Transfusion Enabling Simultaneous Bilateral Total Hip Arthroplasty by a direct anterior approach in a Young Patient with Sickle Cell Disease","authors":"Enrique Alberto Vargas Meouchi MD , Ricard Llovera González-Adrio MD , David Beneitez Pastor MD , Veronica Pons MD , Marta Garcia Bernal MD , Victor Manuel Barro Ojeda MD","doi":"10.1016/j.artd.2025.101909","DOIUrl":"10.1016/j.artd.2025.101909","url":null,"abstract":"<div><div>Sickle cell disease (SCD) is a known risk factor for femoral head osteonecrosis, often leading to early joint degeneration. We report a 17-year-old male with homozygous SCD and bilateral femoral head collapse who underwent simultaneous bilateral total hip arthroplasty through a direct anterior approach. Preoperative optimization included erythrocyte exchange transfusion effectively reducing hemoglobin S from 76% to 26%. The procedure was completed without complications, and the patient recovered uneventfully, with no sickling crises or acute chest syndrome. Cemented implants were used due to poor bone quality. The patient regained full, pain-free ambulation by three months. This case supports the safety and feasibility of simultaneous bilateral total hip arthroplasty in selected SCD patients when preceded by targeted erythrocyte exchange transfusion and managed by a multidisciplinary team.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101909"},"PeriodicalIF":2.1,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579119","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}
Knee osteoarthritis is the most common degenerative joint disease in the elderly. Depending on affected compartments, treatment options include unicondylar knee arthroplasty (UKA) or total knee arthroplasty (TKA). Studies show higher osteoarthritis incidence and disparities in arthroplasty use and outcomes among minority groups. This study aimed to compare demographic and clinical differences in UKA and TKA procedures.
Methods
Patients who underwent primary UKA or TKA at 2 different institutions between 2014 and 2024 were identified. Variables compared between UKA and TKA groups included patient sex, age, body mass index (BMI), ethnicity, smoking status, comorbidities, assistance in activities of daily living (ADL), number of falls, and the American Society of Anesthesiologists (ASA) class.
Results
Of the 58,794 patients identified, 2421 received a UKA, and 56,373 received a TKA. The UKA group had a higher proportion of men and a lower average BMI. UKA patients had a higher percentage of White patients and a lower percentage of African American patients. Fewer UKA patients required assistance in ADL, and fewer had experienced falls in the past year. TKA patients had higher percentages of diabetes, heart disease, and hypertension. A higher percentage of UKA patients were ASA class II, and a lower percentage were ASA class III.
Conclusions
Patients who underwent primary UKA vs TKA showed significant differences in sex, BMI, race, ADL, comorbidities, falls in the past year, and ASA class. The results suggest that UKA patients are generally younger, have lower BMI, fewer comorbidities, and better functional status compared to TKA patients.
{"title":"Demographic and Clinical Determinants of Unicondylar Vs Total Knee Arthroplasty Selection","authors":"Nikita Golovachev MD, Kassem Ghayyad MD, Ramakanth Yakkanti MD, Obinna Adigweme MD","doi":"10.1016/j.artd.2025.101904","DOIUrl":"10.1016/j.artd.2025.101904","url":null,"abstract":"<div><h3>Background</h3><div>Knee osteoarthritis is the most common degenerative joint disease in the elderly. Depending on affected compartments, treatment options include unicondylar knee arthroplasty (UKA) or total knee arthroplasty (TKA). Studies show higher osteoarthritis incidence and disparities in arthroplasty use and outcomes among minority groups. This study aimed to compare demographic and clinical differences in UKA and TKA procedures.</div></div><div><h3>Methods</h3><div>Patients who underwent primary UKA or TKA at 2 different institutions between 2014 and 2024 were identified. Variables compared between UKA and TKA groups included patient sex, age, body mass index (BMI), ethnicity, smoking status, comorbidities, assistance in activities of daily living (ADL), number of falls, and the American Society of Anesthesiologists (ASA) class.</div></div><div><h3>Results</h3><div>Of the 58,794 patients identified, 2421 received a UKA, and 56,373 received a TKA. The UKA group had a higher proportion of men and a lower average BMI. UKA patients had a higher percentage of White patients and a lower percentage of African American patients. Fewer UKA patients required assistance in ADL, and fewer had experienced falls in the past year. TKA patients had higher percentages of diabetes, heart disease, and hypertension. A higher percentage of UKA patients were ASA class II, and a lower percentage were ASA class III.</div></div><div><h3>Conclusions</h3><div>Patients who underwent primary UKA vs TKA showed significant differences in sex, BMI, race, ADL, comorbidities, falls in the past year, and ASA class. The results suggest that UKA patients are generally younger, have lower BMI, fewer comorbidities, and better functional status compared to TKA patients.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101904"},"PeriodicalIF":2.1,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526243","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}
Hip dislocations in adults are uncommon and usually follow high-energy trauma, with neglected cases being rarer but still encountered in low-resource settings. This report describes a 67-year-old man with 6 months of recurrent posterior hip dislocations after an initial injury. He first sought traditional treatment and eventually learned self-reduction techniques. Examination showed limb shortening, muscle wasting, and a neglected posterior acetabular wall fracture with major bone loss. He underwent cemented total hip arthroplasty via a posterior approach, with reconstruction of the posterior wall using an autologous femoral head-neck graft secured by cannulated screws. The case underscores the need for early recognition and proper surgical planning to prevent avascular necrosis, joint degeneration, and long-term disability, especially in developing regions.
{"title":"Self-Reducible Neglected Recurrent Posterior Hip Dislocation Treated With Cemented Total Hip Arthroplasty","authors":"Subhan Shahid MBBS, FCPS , Waqas Ahmad MBBS , Abdul Rafeh Awan MBBS , Meher Ayyazuddin MBBS, MD , Faisal Masood MBBS, FCPS, CMT","doi":"10.1016/j.artd.2025.101908","DOIUrl":"10.1016/j.artd.2025.101908","url":null,"abstract":"<div><div>Hip dislocations in adults are uncommon and usually follow high-energy trauma, with neglected cases being rarer but still encountered in low-resource settings. This report describes a 67-year-old man with 6 months of recurrent posterior hip dislocations after an initial injury. He first sought traditional treatment and eventually learned self-reduction techniques. Examination showed limb shortening, muscle wasting, and a neglected posterior acetabular wall fracture with major bone loss. He underwent cemented total hip arthroplasty via a posterior approach, with reconstruction of the posterior wall using an autologous femoral head-neck graft secured by cannulated screws. The case underscores the need for early recognition and proper surgical planning to prevent avascular necrosis, joint degeneration, and long-term disability, especially in developing regions.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101908"},"PeriodicalIF":2.1,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-12DOI: 10.1016/j.artd.2025.101886
Nathaniel T. Ondeck MD, MHS, Colin C. Neitzke MD, Yu-Fen Chiu MS, Sonia K. Chandi MD, Pravjit Bhatti MD, Alejandro Gonzalez Della Valle MD, Geoffrey H. Westrich MD, Brian P. Chalmers MD
Background
Robotic assistance minimizes bony resection and surrounding soft tissue damage during total knee arthroplasty (TKA), potentially decreasing postoperative pain. The objective of this study was to evaluate in-hospital opioid consumption, 90-day opioid prescribing patterns, length of stay (LOS), and patient-reported outcome measures (PROMs) following robotic-assisted vs manual primary TKA.
Methods
Utilizing an institutional database, all patients undergoing primary unilateral TKA between 2019 and 2022 with 90-day minimum follow-up were retrospectively queried. Patients were excluded if they had another surgery within 90 days of the index TKA, were discharged to a rehabilitation center, or were prescribed opioid or benzodiazepine medications preoperatively. One-to-one propensity score matching identified 1476 patients undergoing robotic-assisted (n = 738) or manual (n = 738) TKA. Multivariable regression analysis assessed in-hospital morphine milligram equivalents (MMEs) consumption, LOS, 90-day opioid prescribing patterns (not necessarily consumption), and PROMs (preoperative, 6 weeks, and 3 months).
Results
The robotic-assisted cohort consumed on average 12 fewer in-hospital MMEs (P = .026) and had an average LOS that was 8 hours shorter than the manual cohort (P < .001). There was no difference in MMEs prescribed at discharge (P = .12), but the robotic-assisted cohort had on average 113 fewer 90-day postdischarge MMEs prescribed (P = .001) and 145 fewer total 90-day MMEs (consumed in-hospital plus prescribed) (P < .001). There was no difference in PROMs at 6 weeks or 3 months.
Conclusions
Robotic-assisted TKA may confer shorter LOS with decreased 90-day opioid use patterns. This information is important given the increased scrutiny on opioid usage and recent focus on rapid recovery and ambulatory TKA pathways.
{"title":"Robotic-Assisted Primary Total Knee Arthroplasty is Associated With Decreased 90-Day Opioid Prescribing Patterns Compared to Manual Instrumentation","authors":"Nathaniel T. Ondeck MD, MHS, Colin C. Neitzke MD, Yu-Fen Chiu MS, Sonia K. Chandi MD, Pravjit Bhatti MD, Alejandro Gonzalez Della Valle MD, Geoffrey H. Westrich MD, Brian P. Chalmers MD","doi":"10.1016/j.artd.2025.101886","DOIUrl":"10.1016/j.artd.2025.101886","url":null,"abstract":"<div><h3>Background</h3><div>Robotic assistance minimizes bony resection and surrounding soft tissue damage during total knee arthroplasty (TKA), potentially decreasing postoperative pain. The objective of this study was to evaluate in-hospital opioid consumption, 90-day opioid prescribing patterns, length of stay (LOS), and patient-reported outcome measures (PROMs) following robotic-assisted vs manual primary TKA.</div></div><div><h3>Methods</h3><div>Utilizing an institutional database, all patients undergoing primary unilateral TKA between 2019 and 2022 with 90-day minimum follow-up were retrospectively queried. Patients were excluded if they had another surgery within 90 days of the index TKA, were discharged to a rehabilitation center, or were prescribed opioid or benzodiazepine medications preoperatively. One-to-one propensity score matching identified 1476 patients undergoing robotic-assisted (n = 738) or manual (n = 738) TKA. Multivariable regression analysis assessed in-hospital morphine milligram equivalents (MMEs) consumption, LOS, 90-day opioid prescribing patterns (not necessarily consumption), and PROMs (preoperative, 6 weeks, and 3 months).</div></div><div><h3>Results</h3><div>The robotic-assisted cohort consumed on average 12 fewer in-hospital MMEs (<em>P</em> = .026) and had an average LOS that was 8 hours shorter than the manual cohort (<em>P</em> < .001). There was no difference in MMEs prescribed at discharge (<em>P</em> = .12), but the robotic-assisted cohort had on average 113 fewer 90-day postdischarge MMEs prescribed (<em>P</em> = .001) and 145 fewer total 90-day MMEs (consumed in-hospital plus prescribed) (<em>P</em> < .001). There was no difference in PROMs at 6 weeks or 3 months.</div></div><div><h3>Conclusions</h3><div>Robotic-assisted TKA may confer shorter LOS with decreased 90-day opioid use patterns. This information is important given the increased scrutiny on opioid usage and recent focus on rapid recovery and ambulatory TKA pathways.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101886"},"PeriodicalIF":2.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526309","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}
Pub Date : 2025-11-12DOI: 10.1016/j.artd.2025.101898
Peter J. Schlieker MSc , Frank Lampe MD , Johann Zwirner MD , Benjamin Ondruschka MD , Michael M. Morlock PhD , Gerd Huber PhD
Background
Femoral stem impaction in total hip arthroplasty is commonly performed by mallet blows on a metal impactor attached to the stem. Factors including the surgeon, the impactor, and the patient can influence the impaction. A wide range of impactors, varying in design and thus in mass and stiffness, are available. However, little is known about their influence on the force transmission and, consequently, about the proportion of the mallet force that ultimately reaches the implant. This study aimed to investigate the force transmission through the impactor for different impactor designs, while investigating different patient-specific femur-tissue systems in situ and in silico.
Methods
The mallet and impactor forces of 9 consecutive blows on seated femoral stems were measured for 2 different approaches on each of 4 cadavers. The mallet-implant force transmission was calculated using a phenomenological model for 2 different impactor designs.
Results
The attenuated force in the impactor achieved approximately 65% to 75% of the corresponding mallet peak force, regardless of cadaver or surgical approach. Measuring the force distant from the tip resulted in an overestimation of the transferred forces. Depending on impactor design just 24% to 47% of the applied mallet peak force reached the implant itself.
Conclusions
The force transmission for overcritical mallet blows can be regarded as independent from patient- and approach-specific boundary conditions and primarily dependent on the impactor design. Surgeons must be aware of this relationship and exercise caution when using other or novel instruments to prevent intraoperative complications.
{"title":"Design of Surgical Impaction Instruments Matters","authors":"Peter J. Schlieker MSc , Frank Lampe MD , Johann Zwirner MD , Benjamin Ondruschka MD , Michael M. Morlock PhD , Gerd Huber PhD","doi":"10.1016/j.artd.2025.101898","DOIUrl":"10.1016/j.artd.2025.101898","url":null,"abstract":"<div><h3>Background</h3><div>Femoral stem impaction in total hip arthroplasty is commonly performed by mallet blows on a metal impactor attached to the stem. Factors including the surgeon, the impactor, and the patient can influence the impaction. A wide range of impactors, varying in design and thus in mass and stiffness, are available. However, little is known about their influence on the force transmission and, consequently, about the proportion of the mallet force that ultimately reaches the implant. This study aimed to investigate the force transmission through the impactor for different impactor designs, while investigating different patient-specific femur-tissue systems in situ and in silico.</div></div><div><h3>Methods</h3><div>The mallet and impactor forces of 9 consecutive blows on seated femoral stems were measured for 2 different approaches on each of 4 cadavers. The mallet-implant force transmission was calculated using a phenomenological model for 2 different impactor designs.</div></div><div><h3>Results</h3><div>The attenuated force in the impactor achieved approximately 65% to 75% of the corresponding mallet peak force, regardless of cadaver or surgical approach. Measuring the force distant from the tip resulted in an overestimation of the transferred forces. Depending on impactor design just 24% to 47% of the applied mallet peak force reached the implant itself.</div></div><div><h3>Conclusions</h3><div>The force transmission for overcritical mallet blows can be regarded as independent from patient- and approach-specific boundary conditions and primarily dependent on the impactor design. Surgeons must be aware of this relationship and exercise caution when using other or novel instruments to prevent intraoperative complications.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101898"},"PeriodicalIF":2.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-11DOI: 10.1016/j.artd.2025.101896
Samuel W. King BM, BCh, MRCSEd, Nicolas Silvestrini PhD, Anne Lübbeke MD, DSc, Hemant Pandit DPhil, FRCS, Hermes H. Miozzari MD, PD
{"title":"Response to: “Reconsidering Patellofemoral Outcomes in Medially Stabilized Total Knee Arthroplasty: The Role of Implant Design and Rotational Strategy in Kinematic Alignment”","authors":"Samuel W. King BM, BCh, MRCSEd, Nicolas Silvestrini PhD, Anne Lübbeke MD, DSc, Hemant Pandit DPhil, FRCS, Hermes H. Miozzari MD, PD","doi":"10.1016/j.artd.2025.101896","DOIUrl":"10.1016/j.artd.2025.101896","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101896"},"PeriodicalIF":2.1,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526308","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}
Orthostatic intolerance (OI), characterized by dizziness, blurred vision, syncope, can occur during ambulation after total knee arthroplasty (TKA) causing delayed rehabilitation and hospital discharge. Standardized guidelines to prevent OI during early ambulation are lacking. This study aimed to provide evidence regarding the impact of postural transition timing or lying-to-standing time (LTST) on OI during early postoperative ambulation following TKA.
Methods
We evaluated 120 patients undergoing unilateral primary TKA for OI with varying LTST. Patients with significant comorbidities, body mass index ≥40 kg/m2, or presence of preoperative OI or orthostatic hypotension were excluded. Preoperatively and at 12 hours postoperatively, patients performed three protocols with varying LTST: after changing position from lying to sitting, wait 60 seconds before standing (protocol A), wait 30 seconds before standing (protocol B), and immediate standing (protocol C). Systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation were measured at sitting and standing positions for each protocol. OI was defined if signs of cerebral hypoperfusion were detected, or decrease in systolic blood pressure >20 mmHg, or decrease in diastolic blood pressure >10 mmHg.
Results
From 120 TKAs, 98 patients were included (mean age 74 years, mean body mass index 26.46 kg/m2). The incidences of postoperative OI were 0% for protocol A, 16.3% for protocol B, and 44.9% for protocol C. All protocol B patients with OI also experienced it in protocol C.
Conclusions
This study demonstrates that a 60-second sitting interval between lying and standing effectively prevents OI during early ambulation after TKA.
{"title":"Avoiding Orthostatic Intolerance During Early Ambulation After Total Knee Arthroplasty: The Impact of Lying-to-Standing Time","authors":"Nonn Jaruthien MD , Supparurk Suksumran MD , Chotetawan Tanavalee MD , Chavarin Amarase MD , Aree Tanavalee MD , Wirinaree Kampitak MD , Srihatach Ngarmukos MD","doi":"10.1016/j.artd.2025.101905","DOIUrl":"10.1016/j.artd.2025.101905","url":null,"abstract":"<div><h3>Background</h3><div>Orthostatic intolerance (OI), characterized by dizziness, blurred vision, syncope, can occur during ambulation after total knee arthroplasty (TKA) causing delayed rehabilitation and hospital discharge. Standardized guidelines to prevent OI during early ambulation are lacking. This study aimed to provide evidence regarding the impact of postural transition timing or lying-to-standing time (LTST) on OI during early postoperative ambulation following TKA.</div></div><div><h3>Methods</h3><div>We evaluated 120 patients undergoing unilateral primary TKA for OI with varying LTST. Patients with significant comorbidities, body mass index ≥40 kg/m<sup>2</sup>, or presence of preoperative OI or orthostatic hypotension were excluded. Preoperatively and at 12 hours postoperatively, patients performed three protocols with varying LTST: after changing position from lying to sitting, wait 60 seconds before standing (protocol A), wait 30 seconds before standing (protocol B), and immediate standing (protocol C). Systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation were measured at sitting and standing positions for each protocol. OI was defined if signs of cerebral hypoperfusion were detected, or decrease in systolic blood pressure >20 mmHg, or decrease in diastolic blood pressure >10 mmHg.</div></div><div><h3>Results</h3><div>From 120 TKAs, 98 patients were included (mean age 74 years, mean body mass index 26.46 kg/m<sup>2</sup>). The incidences of postoperative OI were 0% for protocol A, 16.3% for protocol B, and 44.9% for protocol C. All protocol B patients with OI also experienced it in protocol C.</div></div><div><h3>Conclusions</h3><div>This study demonstrates that a 60-second sitting interval between lying and standing effectively prevents OI during early ambulation after TKA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101905"},"PeriodicalIF":2.1,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526310","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}
Pub Date : 2025-11-08DOI: 10.1016/j.artd.2025.101902
Kareem Omran MD, MPhil (Cantab) , Colleen Wixted MD, MBA , Daniel Waren MSPH, CCRP , Joshua C. Rozell MD , Ran Schwarzkopf MD, MSc
Background
Technological advancements in total hip arthroplasty (THA), including robotic-assisted (RA-THA) and navigation-assisted (NA-THA) techniques, aim to improve outcomes. However, impact on recovery timing remains unclear. This study examined whether these technologies reduce the time to reach the minimal clinically important difference (MCID) on the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement compared with conventional THA.
Methods
This retrospective study analyzed osteoarthritic THA patients (01/2020-04/2023) who completed preoperative and postoperative Hip Disability and Osteoarthritis Outcome Score for Joint Replacement questionnaires. The exclusion criteria included bilateral procedures or revision within 1 year. MCID was defined using anchor-based (23 points) and distribution-based thresholds (7.6 points). Multivariable interval-censored accelerated failure time models assessed time to MCID.
Results
Among the 1395 patients, 181 (12.9%) underwent RA-THA, 754 (54.1%) underwent NA-THA, and 460 (33.0%) underwent conventional THA. Anchor-based MCID rates were 65.2%, 63.4%, and 66.5%, respectively (P > .05), with median times of 38.9, 48.4, and 45.1 days. Neither RA-THA (time ratio [TR] = 0.86, 95% confidence interval [CI]: 0.63-1.18, P = .347) nor NA-THA (TR = 1.07, 95% CI: 0.87-1.32, P = .502) significantly affected time to MCID vs conventional distribution-based thresholds yielded higher MCID rates (93.9%, 88.9%, 89.8%; P > .05) with median times of 8.6, 11.4, and 12.9 days, respectively. RA-THA reached MCID 33.5% faster than conventional THA (TR = 0.66, 95% 26 CI: 0.52-0.86, P = .002) and 24.3% faster than NA-THA (TR = 0.76, 95% CI: 0.60-0.95, P = .019), while NA-THA showed no significant difference vs conventional THA (TR = 0.88, 95% CI: 0.74-1.04, P = .140).
Conclusions
Anchor-based MCID demonstrated comparable recovery times across RA, NA, and conventional THA, suggesting no patient-perceived advantage with technology. Distribution-based thresholds indicated RA-THA achieved faster statistically significant improvement, though the relevance remains uncertain.
{"title":"Time to Achieve a Minimal Clinically Important Difference After Total Hip Arthroplasty: A Retrospective Cohort Comparison of Robotic-Assisted, Navigation-Assisted, and Conventional Techniques","authors":"Kareem Omran MD, MPhil (Cantab) , Colleen Wixted MD, MBA , Daniel Waren MSPH, CCRP , Joshua C. Rozell MD , Ran Schwarzkopf MD, MSc","doi":"10.1016/j.artd.2025.101902","DOIUrl":"10.1016/j.artd.2025.101902","url":null,"abstract":"<div><h3>Background</h3><div>Technological advancements in total hip arthroplasty (THA), including robotic-assisted (RA-THA) and navigation-assisted (NA-THA) techniques, aim to improve outcomes. However, impact on recovery timing remains unclear. This study examined whether these technologies reduce the time to reach the minimal clinically important difference (MCID) on the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement compared with conventional THA.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed osteoarthritic THA patients (01/2020-04/2023) who completed preoperative and postoperative Hip Disability and Osteoarthritis Outcome Score for Joint Replacement questionnaires. The exclusion criteria included bilateral procedures or revision within 1 year. MCID was defined using anchor-based (23 points) and distribution-based thresholds (7.6 points). Multivariable interval-censored accelerated failure time models assessed time to MCID.</div></div><div><h3>Results</h3><div>Among the 1395 patients, 181 (12.9%) underwent RA-THA, 754 (54.1%) underwent NA-THA, and 460 (33.0%) underwent conventional THA. Anchor-based MCID rates were 65.2%, 63.4%, and 66.5%, respectively (<em>P</em> > .05), with median times of 38.9, 48.4, and 45.1 days. Neither RA-THA (time ratio [TR] = 0.86, 95% confidence interval [CI]: 0.63-1.18, <em>P</em> = .347) nor NA-THA (TR = 1.07, 95% CI: 0.87-1.32, <em>P</em> = .502) significantly affected time to MCID vs conventional distribution-based thresholds yielded higher MCID rates (93.9%, 88.9%, 89.8%; <em>P</em> > .05) with median times of 8.6, 11.4, and 12.9 days, respectively. RA-THA reached MCID 33.5% faster than conventional THA (TR = 0.66, 95% 26 CI: 0.52-0.86, <em>P</em> = .002) and 24.3% faster than NA-THA (TR = 0.76, 95% CI: 0.60-0.95, <em>P</em> = .019), while NA-THA showed no significant difference vs conventional THA (TR = 0.88, 95% CI: 0.74-1.04, <em>P</em> = .140).</div></div><div><h3>Conclusions</h3><div>Anchor-based MCID demonstrated comparable recovery times across RA, NA, and conventional THA, suggesting no patient-perceived advantage with technology. Distribution-based thresholds indicated RA-THA achieved faster statistically significant improvement, though the relevance remains uncertain.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101902"},"PeriodicalIF":2.1,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466853","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}
Pub Date : 2025-11-07DOI: 10.1016/j.artd.2025.101903
Emily Tufford BS , Andrew H. Kim BS , Peter F. Monahan BS , Peter Tortora BS , Luke B. Elias BA , Andrew B. Harris MD , Gregory J. Kirchner MD, MPH , Mark W. Mason MD
Background
The research benchmarks necessary for a successful adult reconstruction fellowship match remain unclear. This study aimed to characterize and identify trends in the academic profiles of adult reconstruction fellows in the United States.
Methods
The American Association of Hip and Knee Surgeons fellowship directory was used to identify U.S. adult reconstruction fellowships programs that listed fellows graduating from 2019 to 2023. For each fellow, total number of publications, authorship position, number of publications with an adult reconstruction focus, and number of citations were collected using Scopus. Only publications accepted or published before the fellow’s match year were compiled. Research productivity was compared across medical degree, sex, fellowship year, and residency program geographic region.
Results
A total of 247 fellows from 46 programs were identified. Fellows published an average of 5.5 ± 9.7 publications during residency, with 66.6 ± 190.4 citations. There was no significant change in research productivity from 2019 to 2023. Average number of publications per fellow was significantly greater for fellows with an MD degree compared with a DO degree (5.8 ± 10.0 vs 2.1 ± 4.2; P < .05). Fellows who completed residency in the northeast had the highest average number of publications per fellow (9.9 ± 16.3) and average number of first author publications per fellow (2.6 ± 4.0) among all regions.
Conclusions
There was no change in research output among adult reconstruction fellows graduating from 2019 to 2023, suggesting that research may not be driving the increased competitiveness of adult reconstruction fellowships.
成功的成人重建奖学金匹配所需的研究基准尚不清楚。本研究旨在描述和确定美国成人重建研究员学术概况的趋势。方法使用美国髋关节和膝关节外科协会奖学金目录来确定列出2019年至2023年毕业的美国成人重建奖学金项目。使用Scopus收集每位研究员的总发表数、作者地位、成人重构重点的发表数和被引次数。只有在同一年之前被接受或出版的出版物才会被编辑。研究效率在医学学位、性别、奖学金年份和住院医师项目地理区域之间进行了比较。结果共筛选到46个专业的247名研究员。住院期间平均发表论文5.5±9.7篇，被引用次数66.6±190.4次。从2019年到2023年，科研生产力没有显著变化。医学博士的人均发表论文数量显著高于医学博士（5.8±10.0 vs 2.1±4.2;P < 0.05）。东北地区住院研究员人均发表论文数（9.9±16.3篇）和人均第一作者发表论文数（2.6±4.0篇）在各地区中最高。结论2019年至2023年毕业的成人重建研究人员的研究产出没有变化，这表明研究可能没有推动成人重建研究人员竞争力的提高。
{"title":"Evaluating Research Productivity Trends Among Orthopaedic Adult Reconstruction Fellowship Applicants: A Bibliometric Study","authors":"Emily Tufford BS , Andrew H. Kim BS , Peter F. Monahan BS , Peter Tortora BS , Luke B. Elias BA , Andrew B. Harris MD , Gregory J. Kirchner MD, MPH , Mark W. Mason MD","doi":"10.1016/j.artd.2025.101903","DOIUrl":"10.1016/j.artd.2025.101903","url":null,"abstract":"<div><h3>Background</h3><div>The research benchmarks necessary for a successful adult reconstruction fellowship match remain unclear. This study aimed to characterize and identify trends in the academic profiles of adult reconstruction fellows in the United States.</div></div><div><h3>Methods</h3><div>The American Association of Hip and Knee Surgeons fellowship directory was used to identify U.S. adult reconstruction fellowships programs that listed fellows graduating from 2019 to 2023. For each fellow, total number of publications, authorship position, number of publications with an adult reconstruction focus, and number of citations were collected using Scopus. Only publications accepted or published before the fellow’s match year were compiled. Research productivity was compared across medical degree, sex, fellowship year, and residency program geographic region.</div></div><div><h3>Results</h3><div>A total of 247 fellows from 46 programs were identified. Fellows published an average of 5.5 ± 9.7 publications during residency, with 66.6 ± 190.4 citations. There was no significant change in research productivity from 2019 to 2023. Average number of publications per fellow was significantly greater for fellows with an MD degree compared with a DO degree (5.8 ± 10.0 vs 2.1 ± 4.2; <em>P</em> < .05). Fellows who completed residency in the northeast had the highest average number of publications per fellow (9.9 ± 16.3) and average number of first author publications per fellow (2.6 ± 4.0) among all regions.</div></div><div><h3>Conclusions</h3><div>There was no change in research output among adult reconstruction fellows graduating from 2019 to 2023, suggesting that research may not be driving the increased competitiveness of adult reconstruction fellowships.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101903"},"PeriodicalIF":2.1,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466859","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}
Total knee arthroplasty (TKA) effectively relieves pain and restores function in patients with degenerative knee diseases. Complications like postoperative flexion contracture (FC) can impair functional outcomes. Assessing FC intraoperatively remains challenging due to the limitations imposed by surgical drapes. The "Airplane Test" offers a novel intraoperative assessment method for FC, addressing the limitations of traditional evaluation techniques. This study evaluates its utility in FC correction and predicting postoperative resolution.
Methods
A prospective cohort study evaluated 126 knees in 122 patients undergoing primary TKA. Our data included demographics, comorbidities, and clinical findings such as FC severity. Intraoperative FC assessments using the Airplane Test guided surgical adjustments, including additional femoral cuts or posterior capsular release. Statistical analyses compared outcomes between groups with and without initial FC.
Results
Demographics revealed a predominantly female cohort (88.52%) with a median age of 68 years. Preoperative FC averaged 8.5°, with a higher prevalence of severe FC (>15°) in males. In a comparison between patients with or without preoperative FC, despite significant difference in early postoperative FC, by 6 months, both groups achieved a comparable FC resolution (≤5°) and ROM. With negative Airplane Test, more than 99% of patients with or without preoperative FC experienced spontaneous resolution (≤5°) of postoperative FC after 6 months.
Conclusions
The Airplane Test is a simple intraoperative tool for assessing and addressing FC during TKA. Patients with negative Airplane Test results achieved near-complete FC resolution (≤5°), supporting its role in intraoperative decision-making. Ethical constraints precluded a control group with uncorrected FC.
{"title":"Airplane Test: An Intraoperative Assessment for Flexion Contracture in Total Knee Arthroplasty","authors":"Hamidreza Yazdi MD , Mahmoud Jabalameli MD , Seyed Arman Moein MD , Seyyed Hamidreza Ayatizadeh MD , Mohammad Amin Ahmadi MD , Amir Mohsen Khorrami MD","doi":"10.1016/j.artd.2025.101901","DOIUrl":"10.1016/j.artd.2025.101901","url":null,"abstract":"<div><h3>Background</h3><div>Total knee arthroplasty (TKA) effectively relieves pain and restores function in patients with degenerative knee diseases. Complications like postoperative flexion contracture (FC) can impair functional outcomes. Assessing FC intraoperatively remains challenging due to the limitations imposed by surgical drapes. The \"Airplane Test\" offers a novel intraoperative assessment method for FC, addressing the limitations of traditional evaluation techniques. This study evaluates its utility in FC correction and predicting postoperative resolution.</div></div><div><h3>Methods</h3><div>A prospective cohort study evaluated 126 knees in 122 patients undergoing primary TKA. Our data included demographics, comorbidities, and clinical findings such as FC severity. Intraoperative FC assessments using the Airplane Test guided surgical adjustments, including additional femoral cuts or posterior capsular release. Statistical analyses compared outcomes between groups with and without initial FC.</div></div><div><h3>Results</h3><div>Demographics revealed a predominantly female cohort (88.52%) with a median age of 68 years. Preoperative FC averaged 8.5°, with a higher prevalence of severe FC (>15°) in males. In a comparison between patients with or without preoperative FC, despite significant difference in early postoperative FC, by 6 months, both groups achieved a comparable FC resolution (≤5°) and ROM. With negative Airplane Test, more than 99% of patients with or without preoperative FC experienced spontaneous resolution (≤5°) of postoperative FC after 6 months.</div></div><div><h3>Conclusions</h3><div>The Airplane Test is a simple intraoperative tool for assessing and addressing FC during TKA. Patients with negative Airplane Test results achieved near-complete FC resolution (≤5°), supporting its role in intraoperative decision-making. Ethical constraints precluded a control group with uncorrected FC.</div></div><div><h3>Level of Evidence</h3><div>II.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101901"},"PeriodicalIF":2.1,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466852","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}
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