Arthroplasty Today最新文献_第9页

Primary Care Patient Engagement With Patient-Reported Outcomes to Assess Osteoarthritis Symptoms 初级保健患者参与患者报告的结果评估骨关节炎症状

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-09-17 DOI: 10.1016/j.artd.2025.101850

Martha Burla MPH , T. Jacob Selph Jr. BS , Finola M. Summerville BS , Rachel Bergman MD , Isaac Sontag-Milobsky BS , Patricia D. Franklin MD, MBA, MPH , Linda I. Suleiman MD

Background

Knee osteoarthritis (OA) is a common chronic condition in the United States, significantly impacting quality of life and health-care costs. Disparities in OA treatment across racial, ethnic, and socioeconomic groups highlight the importance of federally qualified health centers (FQHCs) in managing under-treated populations. This study assessed the feasibility of using a text message-based system to collect patient-reported outcomes (PROs) on knee OA prevalence and symptom severity among FQHC primary care patients.

Methods

A multimethod pilot study invited 223 FQHC patients with knee OA via text to complete a PRO survey on knee pain and function. Nonresponders received text and phone reminders. Researchers evaluated response rates, reasons for noncompletion, and patient perspectives on symptom monitoring.

Results

Overall, 24.7% of patients completed the PRO survey—28% among English speakers and 17% among Spanish speakers. The most common barrier was disconnected phone numbers. Qualitative feedback from both responders and nonresponders showed strong support (92%) for ongoing symptom monitoring. Responders found the survey user-friendly, while nonresponders noted technical and trust-related challenges.

Conclusions

Text message-based PRO collection is a feasible and acceptable method for knee OA symptom tracking in FQHCs. While the approach is scalable and well-received, patient education about the purpose of PROs is essential. Improved communication and accessibility strategies are recommended to increase engagement and fully leverage PROs for managing chronic conditions in low-resource settings.

背景：膝关节骨关节炎（OA）是美国常见的慢性疾病，严重影响生活质量和医疗保健费用。OA治疗在种族、民族和社会经济群体中的差异突出了联邦合格医疗中心（FQHCs）在管理治疗不足人群中的重要性。本研究评估了在FQHC初级保健患者中使用基于短信的系统收集患者报告的膝关节OA患病率和症状严重程度的结果（PROs）的可行性。方法一项多方法先导研究邀请223例FQHC膝关节OA患者通过文本完成膝关节疼痛和功能的PRO调查。没有回应的人会收到短信和电话提醒。研究人员评估了反应率、不完成的原因和患者对症状监测的看法。结果总体而言，24.7%的患者完成了PRO调查，其中英语为28%，西班牙语为17%。最常见的障碍是断开的电话号码。来自应答者和无应答者的定性反馈都显示出对持续症状监测的强烈支持（92%）。回应者认为调查用户友好，而非回应者指出了技术和信任相关的挑战。结论基于短信的PRO采集是fqhc患者膝关节炎症状追踪的一种可行且可接受的方法。虽然该方法可扩展且广受欢迎，但对患者进行有关pro目的的教育是必不可少的。建议改进沟通和无障碍战略，以增加参与，并充分利用专业人员在资源匮乏的环境中管理慢性病。

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引用次数: 0

Euglycemic Diabetic Ketoacidosis and Its Prevention in Elective Surgical Patients Taking Sodium-Glucose Linked Transporter 2 Inhibitors: An International Perspective 择期手术患者服用钠-葡萄糖结合转运蛋白2抑制剂的糖尿病酮症酸中毒及其预防：国际视角

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-09-16 DOI: 10.1016/j.artd.2025.101840

James H.J. Selbie MbCHb , Shuhei Hiyama MD , Hemant Pandit FRCS, DPhil

Background

Sodium-glucose linked transporter 2 (SGLT-2) inhibitors are becoming ubiquitous in medical practice. While beneficial in many areas, they have been implicated in a number of cases of euglycemic diabetic ketoacidosis, a serious and potentially fatal complication, in surgical patients. Therefore, it is important for health professionals to have clear guidelines on how to avoid this. The purpose of this study was to collate and evaluate the available guidelines for the perioperative management of patients taking SGLT-2 inhibitors and to outline the pathophysiology of EDKA in surgical patients.

Methods

A review of the available guidelines was performed using databases from 2010 to 2024. Nine guidelines from across the world were identified and reviewed for specific recommendations related to preoperative withholding time, ketone monitoring, postoperative reintroduction of SGLT-2 inhibitors, and emergency surgery.

Results

The most commonly recommended preoperative withholding time was 4 days for ertugliflozin and 3 days for all other SGLT-2 inhibitors. Most guidelines recommended regular ketone monitoring, but only one presented a detailed strategy. Most guidelines had no recommendation on reintroduction of SGLT-2 inhibitors, but those that did suggested that this should only happen given normal serum ketones and oral intake. Most guidelines had no consideration for emergency surgery, but those that did advocated for immediate treatment cessation.

Conclusions

There was little consensus between the guidelines, suggesting that this is a poorly understood subject. There is clearly a need for dissemination of the pathophysiological basis for the correct management of surgical patients taking SGLT-2 inhibitors, to avoid EDKA.

背景钠-葡萄糖连接转运蛋白2 （SGLT-2）抑制剂在医学实践中越来越普遍。虽然在许多领域有益，但它们与许多正常血糖糖尿病酮症酸中毒病例有关，这是手术患者的一种严重且可能致命的并发症。因此，重要的是卫生专业人员有明确的指导方针，如何避免这种情况。本研究的目的是整理和评估服用SGLT-2抑制剂患者围手术期管理的现有指南，并概述手术患者EDKA的病理生理学。方法利用2010年至2024年的数据库对现有指南进行回顾。我们确定并审查了来自世界各地的9项指南，以确定与术前保留时间、酮监测、术后重新引入SGLT-2抑制剂和急诊手术相关的具体建议。结果厄图格列净最常用的术前保留时间为4天，其他SGLT-2抑制剂为3天。大多数指南建议定期监测酮类，但只有一份指南提出了详细的策略。大多数指南没有建议重新引入SGLT-2抑制剂，但那些建议只有在正常血清酮和口服摄入的情况下才会发生这种情况。大多数指南没有考虑紧急手术，但那些建议立即停止治疗的指南。结论：指南之间几乎没有共识，这表明这是一个知之甚少的主题。显然，需要传播正确管理使用SGLT-2抑制剂的手术患者的病理生理基础，以避免EDKA。

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引用次数: 0

A Single-Reamer Technique is an Effective Strategy for Acetabular Preparation in Primary Total Hip Arthroplasty 单铰刀技术是初次全髋关节置换术中髋臼准备的有效策略

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-09-14 DOI: 10.1016/j.artd.2025.101841

Catelyn A. Woelfle BA, Geordie C. Lonza MD, Alexander L. Neuwirth MD, H. John Cooper MD

Background

Effective acetabular preparation is a critical step of primary total hip arthroplasty (THA). Most techniques begin with a small reamer and subsequently utilize multiple larger reamers until the desired size is achieved. We reported the effectiveness of a more efficient, single-reamer technique by evaluating component success rates and determining its safety by reporting any intraoperative complications.

Methods

All primary, elective THAs performed through a direct anterior approach using fluoroscopic guidance by 2 fellowship-trained surgeons between October 2019 and May 2023 were retrospectively reviewed. Our inclusion criterion was use of a single-reamer technique and minimum 1-year follow-up. The single reamer was chosen as the largest one that fully seated in the native acetabulum without any anteroposterior translation between the walls.

Results

Data for 836 THAs were reviewed. Ninety-six hips (11%) with significant acetabular deformity where a single reamer technique could not be effectively used were excluded, leaving 740 (89%) that met the inclusion criteria. There were no intraoperative acetabular fractures. One (0.1%) cup was explanted during revision for periprosthetic joint infection. Of the 739 remaining cups, 25 (3%) required acetabular screws while 714 were placed without supplemental screw fixation. Overall, 99.7% of acetabular components implanted using a single-reamer technique achieved successful radiographic osseointegration at 1 year. One cup (0.1%) failed to achieve radiographic bony ingrowth yet has stable fibrous fixation that has not required revision.

Conclusions

When applied within a structured workflow to hips with normal acetabular morphology, a single-reamer technique is an effective and safe method for acetabular preparation.

背景有效的髋臼准备是初次全髋关节置换术（THA）的关键步骤。大多数技术从一个小扩眼器开始，随后使用多个更大的扩眼器，直到达到所需的尺寸。我们通过评估组件的成功率，并通过报告任何术中并发症来确定其安全性，报告了一种更有效的单铰刀技术的有效性。方法回顾性分析2019年10月至2023年5月期间由2名奖学金培训的外科医生在透视引导下通过直接前路行原发性选择性tha手术的病例。我们的入选标准是使用单扩眼器技术和至少1年的随访。选择单个铰刀作为最大的铰刀，完全固定在原生髋臼内，在髋臼壁之间没有任何前后平移。结果回顾了836例tha的数据。96例（11%）髋臼明显畸形且不能有效使用单铰刀技术的患者被排除在外，剩下740例（89%）符合纳入标准。术中无髋臼骨折。假体周围关节感染翻修时取出1杯（0.1%）。在剩余的739个髋臼杯中，25个（3%）需要髋臼螺钉，而714个没有补充螺钉固定。总体而言，使用单铰刀技术植入的99.7%的髋臼假体在1年内获得了成功的x线骨整合。1杯（0.1%）未能实现影像学上的骨长入，但有稳定的纤维固定，不需要翻修。结论：在髋臼形态正常的髋臼的结构化工作流程中，单铰刀技术是一种有效且安全的髋臼准备方法。

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引用次数: 0

Fracture of Dual-Mobility Polyethylene Liner in a Primary Total Hip Arthroplasty: A New Complication to a Modern Design: A Case Report 初次全髋关节置换术中双活动聚乙烯衬垫骨折：现代设计的新并发症：1例报告

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-09-08 DOI: 10.1016/j.artd.2025.101800

Evan P. Bailey MD , Bryce T. Hrudka BS , Bailey J. Ross MD , Ajay Premkumar MD, MPH , Jacob M. Wilson MD , Galen E. Berdis MD

We present the first documented case of polyethylene liner fracture in a primary dual-mobility cup (DMC) total hip arthroplasty leading to intraprosthetic dislocation. A 50-year-old female with a history of hip dysplasia and leg length discrepancy underwent primary total hip arthroplasty with a DMC. She presented with an anterior intraprosthetic hip dislocation. Revision surgery revealed a fractured highly cross-linked polyethylene liner. The liner and fragments were removed and a new liner was implanted. This case underscores the potential mechanical limitations of highly cross-linked polyethylene in DMC configurations.

我们提出了第一例记录的聚乙烯衬垫骨折在原发性双活动杯（DMC）全髋关节置换术导致假体内脱位。一位患有髋关节发育不良和腿长不一致病史的50岁女性接受了DMC的原发性全髋关节置换术。她表现为髋关节前侧假体内脱位。翻修手术显示高度交联聚乙烯衬垫骨折。取出衬垫和碎片，植入新的衬垫。这个案例强调了高交联聚乙烯在DMC结构中的潜在机械限制。

引用次数: 0

Defining “Paradoxical Instability” and Other Indications for Aseptic Single-Component Polyethylene Revision: A Cohort Study Including Mid-flexion Instability and Limited Arc of Motion 定义无菌单组分聚乙烯改良术的“矛盾不稳定性”和其他适应症：包括中屈曲不稳定性和有限运动弧度的队列研究

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-09-04 DOI: 10.1016/j.artd.2025.101835

Robert Schmidt MD , Winston Scambler BS , Jack A. Will BS , David Shau MD, MBA

Background

Single-component polyethylene revision (SCPR) is a less invasive approach for addressing polyethylene wear in total knee arthroplasty by replacing only the tibial polyethylene component. While traditionally used for aseptic ligamentous mid-flexion instability and limited arc of motion, this study introduces paradoxical instability as a third indication, characterized by ligamentous laxity with knee effusion causing mid-flexion instability and secondary flexion contracture.

Methods

A retrospective study analyzed 58 consecutive SCPR patients treated by a single fellowship-trained surgeon between 2012 and 2024, with a minimum 2-year follow-up. The cohort included 20 men (34%) and 38 women (66%), with a mean age of 70.2 years and average follow-up of 2.83 years. Patients were categorized into 3 groups: mid-flexion instability (n = 43), limited arc of motion (n = 9), and paradoxical instability (n = 6). Outcomes were assessed using clinical examinations and Knee Society Score 2011 and UCLA activity scores.

Results

Clinical success rates defined as good to excellent clinical outcomes were 88.3% (38 of 43) for mid-flexion instability, 88.8% (8 of 9) for limited arc of motion, and 100% (6 of 6) for paradoxical instability patients. No readmissions or reoperations occurred within 90 days postsurgery. The mean hospital stay was 0.87 days.

Conclusions

SCPR demonstrated effectiveness in treating all 3 indications, with particularly promising results for paradoxical instability cases. This study establishes paradoxical instability as a distinct clinical entity characterized by knee imbalance, mid-flexion instability, recurrent effusions, and limited motion arc. This limited motion arc is paradoxically treated with an increase of polyethylene thickness. The findings support SCPR as a viable treatment option for carefully selected patients with these conditions.

背景：单组件聚乙烯翻修术（SCPR）是一种侵入性较小的方法，通过仅更换胫骨聚乙烯组件来解决全膝关节置换术中聚乙烯磨损的问题。虽然传统上用于无菌韧带中屈曲不稳定和有限的运动弧度，但本研究引入了矛盾不稳定作为第三个适应症，其特征是韧带松弛伴膝关节积液导致中屈曲不稳定和继发性屈曲挛缩。方法一项回顾性研究分析了2012年至2024年间由一名研究员培训的外科医生治疗的58例连续SCPR患者，随访时间至少为2年。该队列包括20名男性（34%）和38名女性（66%），平均年龄70.2岁，平均随访时间2.83年。患者分为3组：中屈曲不稳定（n = 43），有限运动弧度（n = 9）和矛盾不稳定（n = 6）。结果评估采用临床检查和膝关节社会评分2011和UCLA活动评分。结果中屈曲不稳定患者的临床成功率为88.3%(38 / 43)，有限运动弧度患者为88.8%(8 / 9)，矛盾不稳定患者为100%（6 / 6）。术后90天内无再入院或再手术。平均住院时间0.87天。结论scpr对所有3种适应症均有效，尤其对矛盾不稳定病例疗效显著。本研究确立了矛盾不稳定作为一个独特的临床实体，其特征是膝关节不平衡、中屈曲不稳定、反复积液和运动弧度受限。这种有限的运动弧被矛盾地用聚乙烯厚度的增加来处理。研究结果支持SCPR作为一种可行的治疗选择，为精心挑选的患者这些条件。

{"title":"Defining “Paradoxical Instability” and Other Indications for Aseptic Single-Component Polyethylene Revision: A Cohort Study Including Mid-flexion Instability and Limited Arc of Motion","authors":"Robert Schmidt MD , Winston Scambler BS , Jack A. Will BS , David Shau MD, MBA","doi":"10.1016/j.artd.2025.101835","DOIUrl":"10.1016/j.artd.2025.101835","url":null,"abstract":"<div><h3>Background</h3><div>Single-component polyethylene revision (SCPR) is a less invasive approach for addressing polyethylene wear in total knee arthroplasty by replacing only the tibial polyethylene component. While traditionally used for aseptic ligamentous mid-flexion instability and limited arc of motion, this study introduces paradoxical instability as a third indication, characterized by ligamentous laxity with knee effusion causing mid-flexion instability and secondary flexion contracture.</div></div><div><h3>Methods</h3><div>A retrospective study analyzed 58 consecutive SCPR patients treated by a single fellowship-trained surgeon between 2012 and 2024, with a minimum 2-year follow-up. The cohort included 20 men (34%) and 38 women (66%), with a mean age of 70.2 years and average follow-up of 2.83 years. Patients were categorized into 3 groups: mid-flexion instability (n = 43), limited arc of motion (n = 9), and paradoxical instability (n = 6). Outcomes were assessed using clinical examinations and Knee Society Score 2011 and UCLA activity scores.</div></div><div><h3>Results</h3><div>Clinical success rates defined as good to excellent clinical outcomes were 88.3% (38 of 43) for mid-flexion instability, 88.8% (8 of 9) for limited arc of motion, and 100% (6 of 6) for paradoxical instability patients. No readmissions or reoperations occurred within 90 days postsurgery. The mean hospital stay was 0.87 days.</div></div><div><h3>Conclusions</h3><div>SCPR demonstrated effectiveness in treating all 3 indications, with particularly promising results for paradoxical instability cases. This study establishes paradoxical instability as a distinct clinical entity characterized by knee imbalance, mid-flexion instability, recurrent effusions, and limited motion arc. This limited motion arc is paradoxically treated with an increase of polyethylene thickness. The findings support SCPR as a viable treatment option for carefully selected patients with these conditions.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101835"},"PeriodicalIF":2.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988505","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

Extramedullary Relapse of Multiple Myeloma After Total Knee Arthroplasty: Implications for Orthopaedic Surgeons—A Case Report and Literature Review 全膝关节置换术后多发性骨髓瘤髓外复发：对骨科医生的启示-一例报告和文献回顾

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-09-03 DOI: 10.1016/j.artd.2025.101834

Donald C. Hefelfinger MD, Mohamed-Ali Sareini MD, Drew D. Moore MD

Multiple myeloma (MM) is a hematologic B-cell malignancy characterized by clonal plasma cell proliferation in the bone marrow. Extramedullary disease is a more aggressive form of MM, in which monoclonal cells proliferate outside the bone marrow, forming plasmacytomas. This case highlights a 56-year-old male presenting with an extramedullary recurrence of MM in the soft tissue surrounding the incision site of his total knee arthroplasty. Fortunately, following radiation and chemotherapy, his most recent evaluation demonstrated complete resolution of the nodules within the radiation field. As orthopaedic surgeons, this case serves as an important reminder to remain vigilant about prior malignancies that may complicate perioperative management.

多发性骨髓瘤（MM）是一种血液学b细胞恶性肿瘤，其特征是骨髓中克隆性浆细胞增殖。髓外疾病是一种更具侵袭性的MM，其中单克隆细胞在骨髓外增殖，形成浆细胞瘤。这个病例突出了一个56岁的男性，在他的全膝关节置换术切口周围的软组织中出现髓外MM复发。幸运的是，在放疗和化疗后，他最近的评估显示在放疗范围内结节完全消退。作为骨科医生，这个病例是一个重要的提醒，要对可能使围手术期管理复杂化的既往恶性肿瘤保持警惕。

引用次数: 0

Hip Hemiarthroplasty vs Total Hip Arthroplasty for Femoral Neck Fractures: Reverse Fragility of Reoperation Rates in Randomized Controlled Trials 股骨颈骨折半髋关节置换术与全髋关节置换术：随机对照试验中再手术率的反向脆弱性

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-08-28 DOI: 10.1016/j.artd.2025.101805

Joseph McCafferty MD , Jack Bragg MD , Kevin Quindlen MD , Alexis Driscoll BS , Nicholas Pagani MD , Matthew Gordon MD , Matthew Salzler MD

Background

Total hip arthroplasty (THA) has theoretical advantages and disadvantages over hemiarthroplasty for femoral neck fractures. Numerous studies have suggested equivalent reoperation rates between the procedures. The purpose of this study was to use the reverse fragility index (RFI) to evaluate the statistical robustness of randomized controlled trials (RCTs) reporting nonsignificant differences in reoperation rates between hip hemiarthroplasty and THA for femoral neck fractures.

Methods

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, all RCTs that compared reoperation rates between THA and hemiarthroplasty for femoral neck fractures were identified. Studies that reported nonsignificant differences in reoperation rates were included. The RFI and patients lost to follow-up were calculated for each study.

Results

We identified 9 RCTs comparing THA and hemiarthroplasty for femoral neck fractures with nonsignificant reoperation rates. The overall median reoperation rate was 6.7%, 7.9% in the hemiarthroplasty group and 5.0% in the THA group. The median RFI was 3, indicating that had the outcome of 3 patients in 1 treatment arm been reversed, the studies' nonsignificant result would change to statistically significant (P < .05). Six of the 9 included studies had a loss to follow-up greater than or equal to the studies' RFI.

Conclusions

The results of clinical trials reporting nonsignificant differences in reoperation rates between hemiarthroplasty and THA for femoral neck fractures would become significant if the outcomes of a few patients were reversed. The number of patients needed to reverse these studies' results was frequently less than those lost to follow-up; thus, the neutrality of these studies is fragile.

Level of Evidence

1.

背景：与半髋关节置换术相比，全髋关节置换术治疗股骨颈骨折具有理论上的优点和缺点。许多研究表明两种手术之间的再手术率相当。本研究的目的是使用反向脆弱性指数（RFI）来评估随机对照试验（rct）的统计稳健性。随机对照试验（rct）报告了半髋关节置换术与THA治疗股骨颈骨折的再手术率无显著差异。方法根据系统评价和荟萃分析指南的首选报告项目，确定所有比较全髋关节置换术和股骨颈骨折半关节置换术再手术率的随机对照试验。纳入了报道再手术率无显著差异的研究。计算每项研究的RFI和失去随访的患者。结果我们确定了9项随机对照试验，比较THA和半关节置换术治疗股骨颈骨折的再手术率无显著性差异。整体中位再手术率为6.7%，半关节置换术组为7.9%，THA组为5.0%。RFI中位数为3，表明如果1个治疗组中有3例患者的结局发生逆转，则研究无统计学意义的结果变为具有统计学意义（P < 0.05）。纳入的9项研究中有6项随访损失大于或等于研究的RFI。结论：一些临床试验报告的股骨颈骨折半关节置换术与全髋关节置换术在再手术率上无显著差异的结果，如果少数患者的预后发生逆转，则具有显著性。需要逆转这些研究结果的患者数量往往少于随访失败的患者；因此，这些研究的中立性是脆弱的。证据水平

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引用次数: 0

Improved Walking Steadiness Following total Hip Arthroplasty Compared to Total Knee Arthroplasty 与全膝关节置换术相比，全髋关节置换术后行走稳定性的改善

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-08-25 DOI: 10.1016/j.artd.2025.101802

Kevin A. Wu BS , David N. Kugelman MD , Samuel Rosas MD, PhD, MBA , Sharrieff N. Shah BS , Sean P. Ryan MD , Samuel S. Wellman MD , Michael P. Bolognesi MD , Thorsten M. Seyler MD, PhD

Background

Total knee (TKA) and hip arthroplasty (THA) effectively treat end-stage osteoarthritis by restoring mobility and reducing pain; however, it is unclear how balance and steadiness compare between TKA and THA patients. This study utilized wearable technology to objectively compare functional recovery between TKA and THA patients.

Methods

Two Hundred Nine patients underwent TKA (n = 152) or THA (n = 57) and were followed for 1 year. Participants wore Apple Watches with HealthKit to track daily step count, steadiness, standing duration, gait speed, and estimated 6-minute walk test distance. Data were analyzed at baseline, 6 weeks, 6 months, and 12 months postsurgery. Propensity score matching (1:1 ratio) yielded a final cohort of 110 patients (55 TKA, 55 THA). A multivariate regression analysis was conducted to evaluate the effect of THA vs TKA on steadiness, adjusting for contralateral Kellgren–Lawrence classification, age, sex, and body mass index.

Results

Both groups improved mobility and endurance, with similar increases in step count, standing duration, and 6-minute walk test distance over 12 months. THA patients showed significantly greater steadiness at 6 (0.63 vs 0.49, P = .031) and 12 months (0.84 vs 0.66, P = .044). Multivariate analysis confirmed that TKA was associated with lower steadiness scores.

Conclusions

This study, the first to utilize Apple HealthKit data to compare TKA and THA recovery, found that THA patients exhibit better steadiness and balance recovery at 6 and 12 months. These findings suggest that balance-focused rehabilitation may benefit TKA patients. Wearable technology provides valuable, objective insights, enabling personalized guidance and enhancing patient outcomes.

背景：全膝关节（TKA）和髋关节置换术（THA）通过恢复活动能力和减轻疼痛有效治疗终末期骨关节炎；然而，尚不清楚TKA和THA患者的平衡性和稳定性如何比较。本研究利用可穿戴技术客观比较TKA和THA患者的功能恢复情况。方法239例患者行TKA（152例）或THA（57例），随访1年。参与者佩戴带有HealthKit的苹果手表，跟踪每天的步数、稳定性、站立时间、步态速度和估计的6分钟步行测试距离。在基线、术后6周、6个月和12个月分析数据。倾向评分匹配（1:1比例）产生了110例患者的最终队列（55例TKA， 55例THA）。采用多元回归分析评估THA与TKA对稳定性的影响，调整对侧Kellgren-Lawrence分类、年龄、性别和体重指数。结果在12个月的时间里，两组患者的活动能力和耐力都有所提高，步数、站立时间和6分钟步行测试距离都有相似的增加。THA患者在6个月（0.63 vs 0.49, P = 0.031）和12个月（0.84 vs 0.66, P = 0.044）时表现出更大的稳定性。多变量分析证实TKA与较低的稳定性评分相关。本研究首次利用Apple HealthKit数据比较全髋关节置换术和全髋关节置换术的恢复情况，发现全髋关节置换术患者在6个月和12个月时表现出更好的稳定性和平衡恢复。这些发现表明以平衡为中心的康复可能对TKA患者有益。可穿戴技术提供了有价值的、客观的见解，实现了个性化指导，提高了患者的治疗效果。

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引用次数: 0

C-Reactive Protein as a Predictor of the Success of Debridement, Antibiotics and Implant Retention in Patients With Periprosthetic Joint Infection: A 17-year Retrospective Study of 2 Major Joint Arthroplasty Centers c反应蛋白作为假体周围关节感染患者清创、抗生素和种植体保留成功的预测因子：一项对2个主要关节置换术中心的17年回顾性研究

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-08-20 DOI: 10.1016/j.artd.2025.101799

Cheryl Cheuk Wing Kong MBBS , Dennis King-Hang Yee FRCSEd , Yan-Chun Cheung FRCSEd , Wai-Wang Chau MSc (Epi & Biostat) , Gloria Yan-Ting Lam FRCSEd , Tsz-Lung Choi FRCSEd , Jonathan Patrick Ng MRCSEd , Kevin Ki-Wai Ho FRCS , Michael Tim-Yun Ong FRCSEd , Patrick Shu-Hang Yung FRCSEd

Background

This retrospective study aims to investigate whether C-reactive protein (CRP) value following debridement, antibiotics, and implant retention (DAIR) procedure is a sensitive and specific marker to monitor the clinical course and predict the outcome of the DAIR procedure.

Methods

The electronic clinical management system was used to identify patients who suffered from the first episode of periprosthetic joint infection (PJI) following a total hip or knee arthroplasty and 2) and received DAIR as their first surgical treatment in 2 tertiary hospitals.

Results

Sixty-five patients were included in this study. Mean age was 68.5 and 55.7% were female. Mean follow-up duration was 3.31 years. 42 (64.6%) patients had successful DAIR while 23 (35.4%) had failed DAIR. Statistical analysis was carried out. Patients with PJI within 3 months from initial arthroplasty, infected by organism without drug resistance, and symptom onset within 3 days, and who could achieve a CRP cutoff at 5 mg/dL by 2 weeks, were significantly more likely to have successful DAIR (P = .037). The area under the curve was 0.892 (95% confidence interval: 0.811-1.000). Patients with PJI more than 3 months after the initial operation were 24.9 times more likely to fail DAIR after adjustments (P = .019).

Conclusions

This is the first study to report a CRP cutoff at 5 mg/dL at 2 weeks was able to assist in identifying patients at higher risk of failure following DAIR procedure.

本回顾性研究旨在探讨清创、抗生素和种植体保留（DAIR）手术后的c反应蛋白（CRP）值是否为监测临床过程和预测DAIR手术结果的敏感和特异性标志物。方法采用电子临床管理系统对2家三级医院全髋关节置换术后首次发生假体周围关节感染（PJI）并首次行DAIR手术的患者进行分析。结果共纳入65例患者。平均年龄68.5岁，女性55.7%。平均随访时间为3.31年。DAIR成功42例（64.6%），失败23例（35.4%）。进行统计分析。在初始关节置换术后3个月内出现PJI，感染无耐药性的生物体，症状在3天内出现，并且在2周内达到5 mg/dL的CRP切断的患者，DAIR成功的可能性更大（P = 0.037）。曲线下面积为0.892（95%置信区间：0.811-1.000）。术后3个月以上PJI患者调整后DAIR失败的可能性为24.9倍（P = 0.019）。这是第一个报道CRP在2周时达到5 mg/dL的临界值能够帮助识别DAIR手术失败风险较高的患者的研究。

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引用次数: 0

Inverse Kinematic Alignment in Robot-Assisted Total Knee Arthroplasty: A Simplified Surgical Technique 机器人辅助全膝关节置换术中的逆运动学对齐：一种简化的手术技术

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-08-15 DOI: 10.1016/j.artd.2025.101798

Ugonna N. Ihekweazu MD , Timothy B. Alton MD , Shawn O. Okpara MD , Philip G. Ghobrial MD , Corey F. Hryc PhD

Inverse kinematic alignment (iKA) is an emerging technique in total knee arthroplasty (TKA) that aims to restore the patients' native tibial joint line obliquity with femoral resections adjusted to balance the knee. By emphasizing joint line restoration and patient-specific balancing, iKA has gained interest as a potentially favorable alternative to traditional alignment techniques. This step-by-step surgical technique aims to outline the essential principles of iKA in robotic-assisted TKA. The method prioritizes an anatomic tibia resection and then a tensioner-based gap balancing technique to recreate natural kinematics. Since the technique is applicable to a wide range of patients and can be integrated to a variety of robotic platforms, iKA offers a promising pathway to standardize personalized alignment in TKA.

逆运动学对齐（iKA）是全膝关节置换术（TKA）中的一项新兴技术，旨在通过调整股骨切除以平衡膝关节来恢复患者原有的胫骨关节线倾斜度。通过强调关节线修复和患者特定的平衡，iKA作为传统对齐技术的潜在有利替代方案而受到关注。这一步一步的手术技术旨在概述机器人辅助TKA的基本原则。该方法优先考虑解剖胫骨切除，然后采用基于张力器的间隙平衡技术来重建自然运动学。由于该技术适用于广泛的患者，并且可以集成到各种机器人平台上，因此iKA为TKA中标准化个性化对齐提供了一条有前途的途径。

引用次数: 0