Arthroplasty Today最新文献_第8页

Malnutrition is Common in Patients Utilizing Glucagon-Like Peptide-1 Agonists Prior to Total Joint Arthroplasty 营养不良在全关节置换术前使用胰高血糖素样肽-1激动剂的患者中很常见

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-01 DOI: 10.1016/j.artd.2025.101865

Zachary Jodoin MD, William H. Young MD, Daanish Sheikh BS, Belinda Pena FNP, Chance C. Moore MD, Frank Buttacavoli MD

Background

The rising prevalence of obesity and the increased use of glucagon-like-peptide-1 (GLP-1) receptor agonists for weight loss and diabetes has led to more patients qualifying for elective total joint arthroplasty (TJA). While these medications promote weight reduction, they may predispose patients to nutritional deficiencies. This study aims to evaluate the preoperative nutritional status of GLP-1 users undergoing TJA compared to nonusers.

Methods

A retrospective chart review was conducted at a high-volume center on patients who underwent elective primary TJA between January 1 and May 1, 2025. Patients were included if they had complete preoperative nutritional labs. Nutritional markers included hemoglobin, albumin, total protein, prealbumin, calcium, alkaline phosphatase, and 25-hydroxy vitamin D. Malnutrition was defined as ≥1 laboratory deficiency; severe malnutrition as ≥2 deficiencies. GLP-1 use, indication, and duration were recorded. Statistical analyses included t-tests, chi-square tests, and odds ratio calculations.

Results

A total of 165 patients met inclusion criteria, with 29 (17.6%) actively using GLP-1 receptor agonists. The cohorts were matched for comorbidities. GLP-1 users had higher rates of malnutrition (38% vs 8.8%, P < .001; odds ratio = 6.2), severe malnutrition (17.2% vs 2.9%, P = .009; odds ratio = 6.88), and lower albumin (P < .001), prealbumin (P = .003), and total protein (P = .024) levels compared to controls.

Conclusions

GLP-1 agonist use is associated with significantly higher rates of preoperative nutritional deficiencies in patients undergoing elective TJA. Given the high risk of malnutrition in this growing patient population, targeted nutritional screening and optimization should be considered standard practice in the preoperative evaluation of GLP-1 users.

背景：肥胖患病率的上升和胰高血糖素样肽-1 （GLP-1）受体激动剂用于减肥和糖尿病的增加，导致更多的患者符合选择性全关节置换术（TJA）的条件。虽然这些药物有助于减肥，但它们可能使患者易患营养缺乏。本研究旨在评估GLP-1服用者术前与非服用者术前的营养状况。方法回顾性分析某大容量中心于2025年1月1日至5月1日期间接受选择性原发性TJA治疗的患者。如果患者有完整的术前营养检查，则纳入研究。营养指标包括血红蛋白、白蛋白、总蛋白、前白蛋白、钙、碱性磷酸酶和25-羟基维生素d。营养不良定义为≥1实验室缺乏；严重营养不良≥2个缺陷。记录GLP-1的使用、适应症和持续时间。统计分析包括t检验、卡方检验和比值比计算。结果165例患者符合纳入标准，其中29例（17.6%）患者积极使用GLP-1受体激动剂。根据合并症对队列进行匹配。GLP-1使用者的营养不良发生率较高（38% vs 8.8%, P < 0.001；比值比= 6.2），严重营养不良（17.2% vs 2.9%, P = 0.009；比值比= 6.88），白蛋白（P < 0.001）、前白蛋白（P = 0.003）和总蛋白（P = 0.024）水平较对照组低。结论：glp -1激动剂的使用与选择性TJA患者术前营养缺乏率显著升高相关。鉴于这一不断增长的患者群体中营养不良的高风险，有针对性的营养筛查和优化应被视为GLP-1使用者术前评估的标准做法。

{"title":"Malnutrition is Common in Patients Utilizing Glucagon-Like Peptide-1 Agonists Prior to Total Joint Arthroplasty","authors":"Zachary Jodoin MD, William H. Young MD, Daanish Sheikh BS, Belinda Pena FNP, Chance C. Moore MD, Frank Buttacavoli MD","doi":"10.1016/j.artd.2025.101865","DOIUrl":"10.1016/j.artd.2025.101865","url":null,"abstract":"<div><h3>Background</h3><div>The rising prevalence of obesity and the increased use of glucagon-like-peptide-1 (GLP-1) receptor agonists for weight loss and diabetes has led to more patients qualifying for elective total joint arthroplasty (TJA). While these medications promote weight reduction, they may predispose patients to nutritional deficiencies. This study aims to evaluate the preoperative nutritional status of GLP-1 users undergoing TJA compared to nonusers.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted at a high-volume center on patients who underwent elective primary TJA between January 1 and May 1, 2025. Patients were included if they had complete preoperative nutritional labs. Nutritional markers included hemoglobin, albumin, total protein, prealbumin, calcium, alkaline phosphatase, and 25-hydroxy vitamin D. Malnutrition was defined as ≥1 laboratory deficiency; severe malnutrition as ≥2 deficiencies. GLP-1 use, indication, and duration were recorded. Statistical analyses included t-tests, chi-square tests, and odds ratio calculations.</div></div><div><h3>Results</h3><div>A total of 165 patients met inclusion criteria, with 29 (17.6%) actively using GLP-1 receptor agonists. The cohorts were matched for comorbidities. GLP-1 users had higher rates of malnutrition (38% vs 8.8%, <em>P</em> < .001; odds ratio = 6.2), severe malnutrition (17.2% vs 2.9%, <em>P</em> = .009; odds ratio = 6.88), and lower albumin (<em>P</em> < .001), prealbumin (<em>P</em> = .003), and total protein (<em>P</em> = .024) levels compared to controls.</div></div><div><h3>Conclusions</h3><div>GLP-1 agonist use is associated with significantly higher rates of preoperative nutritional deficiencies in patients undergoing elective TJA. Given the high risk of malnutrition in this growing patient population, targeted nutritional screening and optimization should be considered standard practice in the preoperative evaluation of GLP-1 users.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101865"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Rheumatoid Arthritis Flare Presenting as Prosthetic Joint Infection With Synovial Next Generation Sequencing Guiding Treatment: A Case Report 类风湿性关节炎爆发表现为假体关节感染，新一代滑膜测序指导治疗：一例报告

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-01 DOI: 10.1016/j.artd.2025.101875

Jonathan Lash MD, Andrew Murphy MD, Marcus Voigt MD, Alexander Burbelo BS, Matthew Bullock DO, MPT

A patient with rheumatoid arthritis (RA) experienced a flare that mimicked a prosthetic joint infection several years after undergoing total knee arthroplasty. She presented with gradual worsening knee pain following discontinuation of her RA medication. Elevated inflammatory markers and an increased synovial cell count were noted, but synovial fluid polymerase chain reaction testing was negative. A nonoperative treatment approach was chosen, and she resumed her RA medication which led to symptom resolution. Next-generation sequencing played a pivotal role in ruling out infection and identifying the rheumatic cause of the knee pain, thereby avoiding unnecessary revision surgery. Next-generation sequencing may be a valuable diagnostic tool in clinically ambiguous cases.

一例类风湿关节炎（RA）患者在接受全膝关节置换术几年后出现了类似假体关节感染的发作。停药后膝关节疼痛逐渐加重。炎症标志物升高，滑膜细胞计数增加，但滑膜液聚合酶链反应试验呈阴性。选择了非手术治疗方法，她恢复了RA药物治疗，导致症状缓解。下一代测序在排除感染和确定膝关节疼痛的风湿病原因方面发挥了关键作用，从而避免了不必要的翻修手术。下一代测序可能是一个有价值的诊断工具，在临床上模棱两可的情况下。

引用次数: 0

Coronal Alignment in Revision Total Knee Arthroplasty: A Comparison of Cemented Vs Press-Fit Stems for Restoring Mechanical Axis 改良全膝关节置换术中的冠状面对齐：骨水泥与压合假体修复机械轴的比较

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-01 DOI: 10.1016/j.artd.2025.101863

Niccolò Giabbani MD , Matteo Innocenti MD , Rudy Sangaletti MD , Fabrizio Matassi MD , Francesco Benazzo MD , Roberto Civinini MD , Marco Mugnaini MD , Luigi Zanna MD

Background

Restoring a neutral coronal alignment in revision total knee arthroplasty (rTKA) is paramount. Stem length and fixation type influence final limb alignment. This study compared overall limb alignment, measured by hip-knee-ankle (HKA) angle, in revisions using short-cemented (<75 mm), long-cemented (>75 mm), and press-fit stems. Secondary aims included evaluating coronal and sagittal alignment of tibial and femoral components and assessing canal fill ratio (CFR) in the press-fit group.

Methods

A retrospective multicenter review of 124 rTKAs from January 2019 to January 2022 was conducted. Included cases had revision of both femoral and tibial components using stems, with postoperative weight-bearing radiographs. Patients were divided into 3 groups based on stem type. Radiographic assessments included HKA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and CFR. analysis of variance and chi-square tests were used for statistical analysis.

Results

Data from 81 rTKAs were analyzed. Mean HKA was similar across all groups (group A: 178.9°, group B: 178.7°, group C: 178.7°; P = .985). No significant differences were found in mLDFA or mMPTA between groups. However, mLDFA showed more variability than mMPTA (P = .021), indicating greater femoral alignment deviation. CFR in press-fit stems averaged 77.3%, with no significant side-to-side differences.

Conclusions

Short-cemented stems achieved alignment comparable to long-cemented and press-fit stems. Femoral alignment was more variable than tibial. Short-cemented stems provide a flexible option with reliable alignment outcomes.

背景：在全膝关节翻修成形术（rTKA）中，恢复中性冠状位排列是至关重要的。茎长和固定方式影响最终的肢体对中。本研究比较了使用短骨水泥（< 75mm）、长骨水泥（> 75mm）和压合式骨水泥进行翻修时，以髋关节-膝关节-踝关节（HKA）角度测量的整体肢体对齐情况。次要目的包括评估胫骨和股骨组件的冠状面和矢状面对齐以及评估压合组的管填充率（CFR）。方法对2019年1月至2022年1月124例rtka进行回顾性多中心评价。纳入的病例使用假体对股骨和胫骨假体进行翻修，并进行术后负重x线片检查。根据干细胞类型将患者分为3组。影像学评估包括HKA、机械股骨外侧远端角（mLDFA）、机械胫骨内侧近端角（mMPTA）和CFR。采用方差分析和卡方检验进行统计分析。结果对81例rtka的数据进行分析。各组平均HKA相似（A组：178.9°，B组：178.7°，C组：178.7°，P = .985）。两组间mLDFA和mMPTA无显著差异。然而，mLDFA比mMPTA表现出更多的变异性（P = 0.021），表明更大的股骨对准偏差。压合杆的CFR平均为77.3%，两侧无显著差异。结论：短骨水泥支架与长骨水泥支架和压合支架的对准效果相当。股骨对线比胫骨对线变化更大。短胶结阀杆提供了灵活的选择和可靠的对准结果。

{"title":"Coronal Alignment in Revision Total Knee Arthroplasty: A Comparison of Cemented Vs Press-Fit Stems for Restoring Mechanical Axis","authors":"Niccolò Giabbani MD , Matteo Innocenti MD , Rudy Sangaletti MD , Fabrizio Matassi MD , Francesco Benazzo MD , Roberto Civinini MD , Marco Mugnaini MD , Luigi Zanna MD","doi":"10.1016/j.artd.2025.101863","DOIUrl":"10.1016/j.artd.2025.101863","url":null,"abstract":"<div><h3>Background</h3><div>Restoring a neutral coronal alignment in revision total knee arthroplasty (rTKA) is paramount. Stem length and fixation type influence final limb alignment. This study compared overall limb alignment, measured by hip-knee-ankle (HKA) angle, in revisions using short-cemented (<75 mm), long-cemented (>75 mm), and press-fit stems. Secondary aims included evaluating coronal and sagittal alignment of tibial and femoral components and assessing canal fill ratio (CFR) in the press-fit group.</div></div><div><h3>Methods</h3><div>A retrospective multicenter review of 124 rTKAs from January 2019 to January 2022 was conducted. Included cases had revision of both femoral and tibial components using stems, with postoperative weight-bearing radiographs. Patients were divided into 3 groups based on stem type. Radiographic assessments included HKA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and CFR. analysis of variance and chi-square tests were used for statistical analysis.</div></div><div><h3>Results</h3><div>Data from 81 rTKAs were analyzed. Mean HKA was similar across all groups (group A: 178.9°, group B: 178.7°, group C: 178.7°; <em>P</em> = .985). No significant differences were found in mLDFA or mMPTA between groups. However, mLDFA showed more variability than mMPTA (<em>P</em> = .021), indicating greater femoral alignment deviation. CFR in press-fit stems averaged 77.3%, with no significant side-to-side differences.</div></div><div><h3>Conclusions</h3><div>Short-cemented stems achieved alignment comparable to long-cemented and press-fit stems. Femoral alignment was more variable than tibial. Short-cemented stems provide a flexible option with reliable alignment outcomes.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101863"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Outcomes and Penalties: Why Am I being Sent to the Penalty Box? 结果和惩罚：为什么我被送到了受罚席？

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-01 DOI: 10.1016/j.artd.2025.101897

Daniel Schmitt MD, Nicholas Brown MD

引用次数: 0

Validation of Articular Cartilage Depth in Total Knee Arthroplasty 全膝关节置换术中关节软骨深度的验证

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-01 DOI: 10.1016/j.artd.2025.101869

Evan P. Johnson MD , Nicholas M. Brown MD , Michael D. Hellman MD , Tyler E. Calkins MD , Nuanqiu Hou MS , John R. Crockarell MD , James L. Guyton MD , Christopher T. Holland MD, MS , William M. Mihalko MD, PhD , Marcus C. Ford MD

Background

Understanding cartilage thickness is critical for execution of an unrestricted, calipered kinematic total knee arthroplasty (TKA). Historically, condylar cartilage was assumed to be 2 mm thick. However, thickness may vary based on age, sex, body mass index, anterior cruciate ligament (ACL) status, and alignment. This study aimed to determine in vivo cartilage thickness in patients undergoing TKA and evaluate which factors affect variation. Our hypothesis was in vivo cartilage thickness would be 2 mm on average, but some patients would have greater than 2 mm based on demographic factors.

Methods

This multicenter, prospective cross-sectional cohort study evaluated condyle cartilage thickness from resected fragments. Univariate statistics and general linear models were used.

Results

Among 806 TKA cases, the mean unworn femoral cartilage thickness was as follows: distal medial 2.0 mm; distal lateral 2.2 mm; posterior medial 2.0 mm; and posterior lateral 2.2 mm. The mean unworn tibia cartilage thickness was as follows: medial spine 2.4 mm; medial center 1.4 mm; lateral spine 2.1 mm; and lateral center 2.5 mm. In patients with unworn femoral cartilage, approximately 18.5% had cartilage greater than 3 mm. In patients with unworn tibial cartilage, approximately 34.7% had cartilage greater than 3 mm. An incompetent ACL was correlated with thinner posteromedial femoral cartilage. Increased thickness was correlated with younger age, men.

Conclusions

A subset had unworn cartilage thickness greater than 3.0 mm, supporting our hypothesis. In an ACL deficient knee, the posteromedial cartilage was partially worn and should be considered for MCL isometry. Significant correlations were found based on age, gender, ACL status, alignment, body mass index, and race.

Level of Evidence

Level 2, Prospective cohort study.

背景：了解软骨厚度对于执行不受限制的、卡尺式运动学全膝关节置换术（TKA）至关重要。历史上，髁突软骨被认为是2毫米厚。然而，厚度可能因年龄、性别、体重指数、前交叉韧带（ACL）状态和排列而异。本研究旨在确定TKA患者的体内软骨厚度，并评估哪些因素会影响软骨厚度的变化。我们的假设是体内软骨厚度平均为2mm，但根据人口统计学因素，有些患者的软骨厚度会大于2mm。方法本研究是一项多中心、前瞻性横断面队列研究，评估髁突软骨切除碎片的厚度。采用单变量统计和一般线性模型。结果806例TKA患者未磨损股骨软骨平均厚度为：内侧远端2.0 mm；远侧2.2 mm；后内侧2.0 mm；后外侧2.2毫米。未磨损胫骨软骨平均厚度如下：脊柱内侧2.4 mm；中心1.4 mm；侧棘2.1 mm；外侧中心2.5毫米。在未磨损的股骨软骨患者中，约18.5%的患者软骨大于3mm。在胫骨软骨未磨损的患者中，约34.7%的患者软骨大于3mm。前交叉韧带功能不全与股骨后内侧软骨较薄有关。厚度的增加与年龄的年轻有关。结论a组未磨损软骨厚度大于3.0 mm，支持我们的假设。在ACL缺失的膝关节中，后内侧软骨部分磨损，应考虑MCL等距测量。年龄、性别、前交叉韧带状态、排列、体重指数和种族之间存在显著相关性。证据等级：2级，前瞻性队列研究。

{"title":"Validation of Articular Cartilage Depth in Total Knee Arthroplasty","authors":"Evan P. Johnson MD , Nicholas M. Brown MD , Michael D. Hellman MD , Tyler E. Calkins MD , Nuanqiu Hou MS , John R. Crockarell MD , James L. Guyton MD , Christopher T. Holland MD, MS , William M. Mihalko MD, PhD , Marcus C. Ford MD","doi":"10.1016/j.artd.2025.101869","DOIUrl":"10.1016/j.artd.2025.101869","url":null,"abstract":"<div><h3>Background</h3><div>Understanding cartilage thickness is critical for execution of an unrestricted, calipered kinematic total knee arthroplasty (TKA). Historically, condylar cartilage was assumed to be 2 mm thick. However, thickness may vary based on age, sex, body mass index, anterior cruciate ligament (ACL) status, and alignment. This study aimed to determine in vivo cartilage thickness in patients undergoing TKA and evaluate which factors affect variation. Our hypothesis was in vivo cartilage thickness would be 2 mm on average, but some patients would have greater than 2 mm based on demographic factors.</div></div><div><h3>Methods</h3><div>This multicenter, prospective cross-sectional cohort study evaluated condyle cartilage thickness from resected fragments. Univariate statistics and general linear models were used.</div></div><div><h3>Results</h3><div>Among 806 TKA cases, the mean unworn femoral cartilage thickness was as follows: distal medial 2.0 mm; distal lateral 2.2 mm; posterior medial 2.0 mm; and posterior lateral 2.2 mm. The mean unworn tibia cartilage thickness was as follows: medial spine 2.4 mm; medial center 1.4 mm; lateral spine 2.1 mm; and lateral center 2.5 mm. In patients with unworn femoral cartilage, approximately 18.5% had cartilage greater than 3 mm. In patients with unworn tibial cartilage, approximately 34.7% had cartilage greater than 3 mm. An incompetent ACL was correlated with thinner posteromedial femoral cartilage. Increased thickness was correlated with younger age, men.</div></div><div><h3>Conclusions</h3><div>A subset had unworn cartilage thickness greater than 3.0 mm, supporting our hypothesis. In an ACL deficient knee, the posteromedial cartilage was partially worn and should be considered for MCL isometry. Significant correlations were found based on age, gender, ACL status, alignment, body mass index, and race.</div></div><div><h3>Level of Evidence</h3><div>Level 2, Prospective cohort study.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101869"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Unstable Lumbar Vertebral Body Fracture During Total Hip Arthroplasty Using the Anterolateral Spine Approach in Diffuse Idiopathic Skeletal Hyperostosis: A Case Report and Literature Review 采用脊柱前外侧入路治疗弥漫性特发性骨骼肥厚的全髋关节置换术中不稳定腰椎椎体骨折：1例报告和文献回顾

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-01 DOI: 10.1016/j.artd.2025.101874

Shinichi Ueki MD , Takeshi Shoji MD, PhD , Naosuke Kamei MD, PhD , Hiroki Kaneta MD , Hiroyuki Morita MD , Yosuke Kozuma MD , Naoto Nakayama MD , Nobuo Adachi MD, PhD

This case report describes a 72-year-old man with diffuse idiopathic skeletal hyperostosis who sustained a rare unstable lumbar vertebral body fracture during total hip arthroplasty (THA) using the anterolateral supine approach. Despite a successful THA, the patient developed severe postoperative back pain, leading to the diagnosis of a lumbar vertebral fracture. Prompt posterior spinal fusion effectively relieved the pain. This report emphasizes recognizing high-risk patients, such as those with diffuse idiopathic skeletal hyperostosis complicated by obesity or kyphosis, before THA, and underscores the need for careful perioperative management and intraoperative positioning to reduce stress on the lumbar spine.

本病例报告描述了一名72岁的男性，患有弥漫性特发性骨骼肥大症，他在全髋关节置换术（THA）中使用仰卧前外侧入路时持续了罕见的不稳定腰椎椎体骨折。尽管THA手术成功，但患者术后出现严重的背部疼痛，导致诊断为腰椎骨折。及时的后路脊柱融合术有效地缓解了疼痛。本报告强调在THA术前识别高风险患者，如弥漫性特发性骨骼增生合并肥胖或后凸，并强调需要仔细的围手术期管理和术中定位，以减少腰椎的压力。

引用次数: 0

Dislocated Dual-Mobility Hip Implants Are Unlikely to Be Successfully Closed Reduced and Are More Likely to Require Revision Than Standard Articulation Implants 脱位的双活动髋关节植入物不太可能成功闭合复位，并且比标准关节植入物更有可能需要翻修

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-10-01 DOI: 10.1016/j.artd.2025.101860

Janyne Mallender DO, Kendall Schwartz BS, Christian Leber BS, Tony Huyhn MD, Paulo Castaneda MD, J. Brock Walker MD

Background

The natural history of dislocated dual-mobility (DM) total hip arthroplasties remains unclear, particularly regarding closed reduction success and revision rates compared to standard articulations (SAs). This study compared closed reduction success and subsequent reoperation rates between dislocated DM and SA hips.

Methods

A retrospective review was conducted across a large health system, identifying patients with dislocated total hip arthroplasties using International Classification of Disease, Tenth Revision codes. Inclusion required an attempted closed reduction. Patients were stratified by implant type (DM vs SA). Data collected included demographics, prior surgeries, reduction attempts, intraprosthetic dissociation (IPD), subsequent instability, and revision surgery. Outcomes were compared between groups.

Results

Seventy-four patients met the inclusion criteria (26 DM, 48 SA). Successful closed reduction was significantly lower in the DM vs SA group (34.6% vs 90%; P < .001). Among the 26 dislocated DM hips, 15 experienced IPD, including five initially missed. Revision surgery was more frequent in the DM group compared to SA (79.2% vs 53.4%; P < .004). Among those with initially successful closed reductions, rates of recurrent instability requiring revision surgery did not differ significantly (DM 44.4% vs SA 41.9%; P = .84).

Conclusions

Dislocated DM implants are significantly less likely to be successfully closed reduced and more likely to require revision surgery than SA implants, largely due to the high rate of IPD. Missed IPD contributes substantially to the increased reoperation risk and highlights the importance of accurate diagnosis following dislocation.

双活动脱位（DM）全髋关节置换术的自然历史尚不清楚，特别是与标准关节（SAs）相比，闭合复位成功率和翻修率。本研究比较了脱位DM和SA髋的闭合复位成功率和随后的再手术率。方法采用国际疾病分类第十版代码对大型卫生系统中脱位全髋关节置换术患者进行回顾性分析。纳入需要尝试闭合复位。根据种植体类型（DM vs SA）对患者进行分层。收集的数据包括人口统计学、既往手术、复位尝试、假体内游离（IPD）、随后的不稳定和翻修手术。比较两组间的结果。结果74例患者符合纳入标准（糖尿病26例，SA 48例）。DM组闭合复位成功率明显低于SA组（34.6% vs 90%; P < 0.001）。在26例脱位的糖尿病髋中，15例发生IPD，其中5例最初未发生IPD。与SA组相比，DM组的翻修手术更频繁（79.2% vs 53.4%; P < 0.004）。在最初成功闭合复位的患者中，复发性不稳定需要翻修手术的比例没有显著差异（DM 44.4% vs SA 41.9%; P = 0.84）。结论与SA假体相比，脱位DM假体成功闭合复位的可能性更低，需要翻修手术的可能性更大，这主要是由于IPD的高发生率。错过IPD大大增加了再手术的风险，并强调了脱位后准确诊断的重要性。

{"title":"Dislocated Dual-Mobility Hip Implants Are Unlikely to Be Successfully Closed Reduced and Are More Likely to Require Revision Than Standard Articulation Implants","authors":"Janyne Mallender DO, Kendall Schwartz BS, Christian Leber BS, Tony Huyhn MD, Paulo Castaneda MD, J. Brock Walker MD","doi":"10.1016/j.artd.2025.101860","DOIUrl":"10.1016/j.artd.2025.101860","url":null,"abstract":"<div><h3>Background</h3><div>The natural history of dislocated dual-mobility (DM) total hip arthroplasties remains unclear, particularly regarding closed reduction success and revision rates compared to standard articulations (SAs). This study compared closed reduction success and subsequent reoperation rates between dislocated DM and SA hips.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted across a large health system, identifying patients with dislocated total hip arthroplasties using International Classification of Disease, Tenth Revision codes. Inclusion required an attempted closed reduction. Patients were stratified by implant type (DM vs SA). Data collected included demographics, prior surgeries, reduction attempts, intraprosthetic dissociation (IPD), subsequent instability, and revision surgery. Outcomes were compared between groups.</div></div><div><h3>Results</h3><div>Seventy-four patients met the inclusion criteria (26 DM, 48 SA). Successful closed reduction was significantly lower in the DM vs SA group (34.6% vs 90%; <em>P</em> < .001). Among the 26 dislocated DM hips, 15 experienced IPD, including five initially missed. Revision surgery was more frequent in the DM group compared to SA (79.2% vs 53.4%; <em>P</em> < .004). Among those with initially successful closed reductions, rates of recurrent instability requiring revision surgery did not differ significantly (DM 44.4% vs SA 41.9%; <em>P</em> = .84).</div></div><div><h3>Conclusions</h3><div>Dislocated DM implants are significantly less likely to be successfully closed reduced and more likely to require revision surgery than SA implants, largely due to the high rate of IPD. Missed IPD contributes substantially to the increased reoperation risk and highlights the importance of accurate diagnosis following dislocation.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101860"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association Between Lithium Use and Periprosthetic Fracture After Total Hip Arthroplasty 全髋关节置换术后使用锂与假体周围骨折的关系

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-09-26 DOI: 10.1016/j.artd.2025.101851

Rafa Rahman MD, MPH, Billy Kim MD, Benjamin Basseri MD, Michael Mazzucco BS, Alexander McLawhorn MD, MBA

Background

Periprosthetic fracture (PPFx) is a devastating complication following total hip arthroplasty (THA), with concern for higher risk in osteoporotic patients. Lithium is associated with higher bone mineral density, and has emerged as a potential low-cost, widely available method for preventing fractures, promoting fracture healing, and improving implant osseointegration. This study investigated the association between lithium use and risk of PPFx following THA.

Methods

Retrospective review of the PearlDiver Mariner Patient Claims Database was performed, querying all patients who underwent THA for osteoarthritis from 2010 to 2022. Lithium-use patients were those who filled lithium prescriptions for at least 90 days before and 90 days after THA. These patients were propensity-score matched to controls not on lithium in a 1:4 ratio, matching for age, diagnosis of bipolar disorder, gender, body mass index, Charlson Comorbidity Index, and insurance. PPFx rate was compared between groups at 90 days and 2 years postoperatively. Secondarily, rate of aseptic loosening, revision, and prosthetic joint infection were compared between groups.

Results

Four thousand six hundred seventy patients were included, with 934 patients on lithium and 3736 controls. There was no difference in PPFx rate (90 day: lithium 1.3% vs no lithium 1.2%, P = .97; 2 year: lithium 1.7% vs no lithium 1.9%, P = .93), aseptic loosening, revision, or prosthetic joint infection.

Conclusions

Despite the theoretical benefit of lithium on bone density, it was not associated with a difference in the rate of PPFx or other surgical complication following THA. Further work is needed to address treatment of osteoporosis and prevention of periprosthetic fracture in the arthroplasty population.

背景：假体周围骨折（PPFx）是全髋关节置换术（THA）后的一种破坏性并发症，骨质疏松患者的风险更高。锂与较高的骨密度有关，已成为一种潜在的低成本、广泛可用的预防骨折、促进骨折愈合和改善种植体骨整合的方法。本研究调查了全髋关节置换术后使用锂与PPFx风险之间的关系。方法对PearlDiver Mariner患者索赔数据库进行回顾性分析，查询2010年至2022年期间因骨关节炎接受THA治疗的所有患者。使用锂的患者是那些在THA之前和之后至少90天服用锂处方的患者。这些患者的倾向评分与未服用锂的对照组按1:4的比例匹配，与年龄、双相情感障碍诊断、性别、体重指数、Charlson合并症指数和保险相匹配。比较两组术后90天和2年PPFx率。其次，比较两组间无菌性松动、翻修和假体关节感染的发生率。结果纳入4670例患者，其中锂治疗组934例，对照组3736例。PPFx率（90天：锂1.3% vs无锂1.2%,P = 0.97； 2年：锂1.7% vs无锂1.9%,P = 0.93）、无菌性松动、翻修或假体关节感染均无差异。结论：尽管理论上锂对骨密度有好处，但它与全髋关节置换术后PPFx或其他手术并发症的发生率差异无关。在关节置换术人群中，骨质疏松症的治疗和假体周围骨折的预防需要进一步的研究。

{"title":"Association Between Lithium Use and Periprosthetic Fracture After Total Hip Arthroplasty","authors":"Rafa Rahman MD, MPH, Billy Kim MD, Benjamin Basseri MD, Michael Mazzucco BS, Alexander McLawhorn MD, MBA","doi":"10.1016/j.artd.2025.101851","DOIUrl":"10.1016/j.artd.2025.101851","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic fracture (PPFx) is a devastating complication following total hip arthroplasty (THA), with concern for higher risk in osteoporotic patients. Lithium is associated with higher bone mineral density, and has emerged as a potential low-cost, widely available method for preventing fractures, promoting fracture healing, and improving implant osseointegration. This study investigated the association between lithium use and risk of PPFx following THA.</div></div><div><h3>Methods</h3><div>Retrospective review of the PearlDiver Mariner Patient Claims Database was performed, querying all patients who underwent THA for osteoarthritis from 2010 to 2022. Lithium-use patients were those who filled lithium prescriptions for at least 90 days before and 90 days after THA. These patients were propensity-score matched to controls not on lithium in a 1:4 ratio, matching for age, diagnosis of bipolar disorder, gender, body mass index, Charlson Comorbidity Index, and insurance. PPFx rate was compared between groups at 90 days and 2 years postoperatively. Secondarily, rate of aseptic loosening, revision, and prosthetic joint infection were compared between groups.</div></div><div><h3>Results</h3><div>Four thousand six hundred seventy patients were included, with 934 patients on lithium and 3736 controls. There was no difference in PPFx rate (90 day: lithium 1.3% vs no lithium 1.2%, <em>P</em> = .97; 2 year: lithium 1.7% vs no lithium 1.9%, <em>P</em> = .93), aseptic loosening, revision, or prosthetic joint infection.</div></div><div><h3>Conclusions</h3><div>Despite the theoretical benefit of lithium on bone density, it was not associated with a difference in the rate of PPFx or other surgical complication following THA. Further work is needed to address treatment of osteoporosis and prevention of periprosthetic fracture in the arthroplasty population.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101851"},"PeriodicalIF":2.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Femoral and Patellar Radiographic Metrics Are Improved With Robotic-Assisted Total Knee Arthroplasty 机器人辅助全膝关节置换术改善了股骨和髌骨影像学指标

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-09-24 DOI: 10.1016/j.artd.2025.101838

Mouhanad M. El Othmani MD, Prerana Katiyar MD, Klara I.M. Aastroem BS, Nana O. Sarpong MD, MBA, Alexander L. Neuwirth MD, H. John Cooper MD, Roshan P. Shah MD, JD

Background

Although robotic technology enhanced surgery does not directly address the patella, its associated improvement in knee reconstruction and flexion balance may result in improved patellar function and radiographs. In this retrospective observational analysis, we aimed to 1) compare patellar and femoral radiographic metrics between robotic-assisted and conventional total knee arthroplasty (RA-TKA and C-TKA) and 2) assess the correlation between these radiographic metrics and postoperative patient-reported outcomes in the RA-TKA cohort.

Methods

Fifty RA-TKAs were compared with 50 C-TKAs at an average 2.8 years of follow-up. Age, gender, body mass index, type of arthritis, preoperative range of motion, preoperative pain localization, type of implant, precut patellar thickness at the expected location of the apex, postcut patellar thickness at the same location, patellar button thickness, and length of stay were compared, along with patient reported outcome measures. Descriptive stats, t-tests, chi-squared, and Fisher’s exact tests were applied.

Results

A significantly lower postoperative patellar displacement (1.92 vs 3.16; P = .008) and posterior femoral overstuffing (21.97 vs 23.97; P = .017) were noted among the RA-TKA group. The RA-TKA group had a significantly smaller number of patients with patellar tilt >5 degrees (10% vs 32%; P = .013). The regression analysis of patellar and femoral radiographic metrics revealed no statistically significant correlation between radiographic metrics and majority of patient-reported outcomes within the RA-TKA cohort.

Conclusions

RA-TKA had better patellofemoral metrics than conventional TKA. The RA-TKA group showed a significant improvement in patellar displacement and posterior femoral overstuffing, and lower incidence of patellar tilt >5 degrees compared to the C-TKA cohort.

虽然机器人技术增强手术不能直接治疗髌骨，但其相关的膝关节重建和屈曲平衡的改善可能导致髌骨功能和x线片的改善。在这项回顾性观察分析中，我们的目的是1)比较机器人辅助和传统全膝关节置换术（RA-TKA和C-TKA）的髌骨和股骨放射学指标，2)评估这些放射学指标与RA-TKA队列中术后患者报告的结果之间的相关性。方法50例ra - tka患者与50例c - tka患者在平均2.8年的随访期间进行比较。比较年龄、性别、体重指数、关节炎类型、术前活动范围、术前疼痛定位、植入物类型、预期尖端位置的切开前髌骨厚度、同一位置的切开后髌骨厚度、髌骨钮扣厚度、住院时间以及患者报告的结果测量。应用了描述性统计、t检验、卡方检验和Fisher精确检验。结果RA-TKA组术后髌骨移位（1.92 vs 3.16, P = 0.008）和股骨后路填充（21.97 vs 23.97, P = 0.017）明显降低。RA-TKA组髌骨倾斜5度的患者数量明显较少（10% vs 32%; P = 0.013）。髌骨和股骨放射学指标的回归分析显示，放射学指标与RA-TKA队列中大多数患者报告的结果之间没有统计学上显著的相关性。结论ra -TKA的髌股指标优于传统TKA。与C-TKA组相比，RA-TKA组髌骨移位和股骨后侧过度填充显著改善，髌骨倾斜发生率降低5度。

{"title":"Femoral and Patellar Radiographic Metrics Are Improved With Robotic-Assisted Total Knee Arthroplasty","authors":"Mouhanad M. El Othmani MD, Prerana Katiyar MD, Klara I.M. Aastroem BS, Nana O. Sarpong MD, MBA, Alexander L. Neuwirth MD, H. John Cooper MD, Roshan P. Shah MD, JD","doi":"10.1016/j.artd.2025.101838","DOIUrl":"10.1016/j.artd.2025.101838","url":null,"abstract":"<div><h3>Background</h3><div>Although robotic technology enhanced surgery does not directly address the patella, its associated improvement in knee reconstruction and flexion balance may result in improved patellar function and radiographs. In this retrospective observational analysis, we aimed to 1) compare patellar and femoral radiographic metrics between robotic-assisted and conventional total knee arthroplasty (RA-TKA and C-TKA) and 2) assess the correlation between these radiographic metrics and postoperative patient-reported outcomes in the RA-TKA cohort.</div></div><div><h3>Methods</h3><div>Fifty RA-TKAs were compared with 50 C-TKAs at an average 2.8 years of follow-up. Age, gender, body mass index, type of arthritis, preoperative range of motion, preoperative pain localization, type of implant, precut patellar thickness at the expected location of the apex, postcut patellar thickness at the same location, patellar button thickness, and length of stay were compared, along with patient reported outcome measures. Descriptive stats, <em>t</em>-tests, chi-squared, and Fisher’s exact tests were applied.</div></div><div><h3>Results</h3><div>A significantly lower postoperative patellar displacement (1.92 vs 3.16; <em>P</em> = .008) and posterior femoral overstuffing (21.97 vs 23.97; <em>P</em> = .017) were noted among the RA-TKA group. The RA-TKA group had a significantly smaller number of patients with patellar tilt >5 degrees (10% vs 32%; <em>P</em> = .013). The regression analysis of patellar and femoral radiographic metrics revealed no statistically significant correlation between radiographic metrics and majority of patient-reported outcomes within the RA-TKA cohort.</div></div><div><h3>Conclusions</h3><div>RA-TKA had better patellofemoral metrics than conventional TKA. The RA-TKA group showed a significant improvement in patellar displacement and posterior femoral overstuffing, and lower incidence of patellar tilt >5 degrees compared to the C-TKA cohort.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101838"},"PeriodicalIF":2.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Automated Impaction Improves Femoral Component Canal Fit in Total Hip Arthroplasty: A Matched Study 全髋关节置换术中自动内塞改善股骨假体管配合度：一项匹配研究

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-09-21 DOI: 10.1016/j.artd.2025.101839

Andrew R. Grant MD , Erin R. Pichiotino MD , Ruijia Niu MPH , Daniel Sun MD , Eric L. Smith MD , Chris Sambaziotis MD, MPH

Background

Automated impaction in total hip arthroplasty (THA) is a new technology in femoral canal preparation. Recent studies have shown that it improves component alignment and fit and reduces operative time. The purpose of our study is to further investigate this technology’s impact on femoral component canal fit, fracture risk, and operative time.

Methods

We conducted a retrospective, matched analysis of 274 patients who underwent THA via automated impaction (N = 137) or manual impaction (N = 137). Postoperative radiographs were assessed to measure canal fill (CF) at the level of the neck cut, the lesser trochanter (LT), and 10 mm above (LT+10) and 60 mm below (LT−60) the LT. The average CF across these measurement points was calculated. The incidence of intraoperative fracture and average CF percentage were compared between the two cohorts.

Results

The average CF percentage was significantly higher in the automated cohort (79.6 ± 5.6) than in the manual cohort (76.3 ± 5.6) (P < .001) as well as at each individually measured level. Operative time was significantly less in the automated cohort (93.9 ± 12.5) vs manual (100.6 ± 21.7 mins) (P = .006). There was no difference in the risk of intraoperative fracture (automated = 1/137 [0.7%] vs manual = 2/137 [1.5%], P = 1.00).

Conclusions

Our study results suggest that automated femoral canal impaction improved CF and reduced operative time without introducing additional risk of intraoperative fracture in THA. Of note, these results cannot determine whether automated impaction has clinical benefit with respect to pain, function, or survivorship of the femoral component.

背景全髋关节置换术（THA）中的自动内压是股骨管预备的新技术。最近的研究表明，它改善了组件对齐和配合，缩短了手术时间。我们研究的目的是进一步探讨该技术对股骨假体管配合度、骨折风险和手术时间的影响。方法我们对274例通过自动压入（N = 137）或手动压入（N = 137）行THA的患者进行回顾性匹配分析。评估术后x线片以测量颈部切口、小转子（LT）以及LT上方10 mm （LT+10）和下方60 mm （LT - 60）的管腔填充（CF）。计算这些测量点的平均CF。比较两组患者术中骨折发生率和平均CF百分比。结果自动队列的平均CF百分比（79.6±5.6）显著高于人工队列（76.3±5.6）（P < 0.001），且各单项水平均显著高于人工队列（76.3±5.6）。自动队列的手术时间（93.9±12.5分钟）明显少于手动队列（100.6±21.7分钟）（P = 0.006）。术中骨折风险无差异（自动= 1/137 [0.7%]vs手动= 2/137 [1.5%],P = 1.00）。结论自动股骨管内嵌可改善CF，缩短手术时间，且不会增加THA术中骨折的风险。值得注意的是，这些结果不能确定自动内塞是否对股骨假体的疼痛、功能或存活有临床益处。

{"title":"Automated Impaction Improves Femoral Component Canal Fit in Total Hip Arthroplasty: A Matched Study","authors":"Andrew R. Grant MD , Erin R. Pichiotino MD , Ruijia Niu MPH , Daniel Sun MD , Eric L. Smith MD , Chris Sambaziotis MD, MPH","doi":"10.1016/j.artd.2025.101839","DOIUrl":"10.1016/j.artd.2025.101839","url":null,"abstract":"<div><h3>Background</h3><div>Automated impaction in total hip arthroplasty (THA) is a new technology in femoral canal preparation. Recent studies have shown that it improves component alignment and fit and reduces operative time. The purpose of our study is to further investigate this technology’s impact on femoral component canal fit, fracture risk, and operative time.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, matched analysis of 274 patients who underwent THA via automated impaction (N = 137) or manual impaction (N = 137). Postoperative radiographs were assessed to measure canal fill (CF) at the level of the neck cut, the lesser trochanter (LT), and 10 mm above (LT+10) and 60 mm below (LT−60) the LT. The average CF across these measurement points was calculated. The incidence of intraoperative fracture and average CF percentage were compared between the two cohorts.</div></div><div><h3>Results</h3><div>The average CF percentage was significantly higher in the automated cohort (79.6 ± 5.6) than in the manual cohort (76.3 ± 5.6) (<em>P</em> < .001) as well as at each individually measured level. Operative time was significantly less in the automated cohort (93.9 ± 12.5) vs manual (100.6 ± 21.7 mins) (<em>P</em> = .006). There was no difference in the risk of intraoperative fracture (automated = 1/137 [0.7%] vs manual = 2/137 [1.5%], <em>P</em> = 1.00).</div></div><div><h3>Conclusions</h3><div>Our study results suggest that automated femoral canal impaction improved CF and reduced operative time without introducing additional risk of intraoperative fracture in THA. Of note, these results cannot determine whether automated impaction has clinical benefit with respect to pain, function, or survivorship of the femoral component.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101839"},"PeriodicalIF":2.1,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0