Pub Date : 2025-09-20DOI: 10.1016/j.artd.2025.101837
Sebastian Braun MD, PhD , Kristen I. Barton MD, PhD , Brent A. Lanting MD , James L. Howard MD
Success in total knee arthroplasty (TKA) depends on restoring proper joint alignment and implant positioning. While robotic-assisted systems enhance precision in primary TKA, their use in revision TKA is limited due to challenges like bone loss, soft tissue contractures, and metal artifacts. This manuscript presents an imageless robotic navigation technique for revision TKA, eliminating the need for preoperative imaging and allowing intraoperative flexibility. After registering anatomical landmarks and implant removal, the system reassesses anatomy for iterative adjustments based on bone and soft tissue conditions. Unlike traditional canal-referenced methods, this approach aligns components relative to the joint line, enabling individualized positioning. Real-time feedback guides accurate bone cuts and soft tissue balancing. A case example illustrates the procedure. Further studies are needed to confirm long-term clinical benefits.
{"title":"Surgical Technique for Imageless Robotic-Assisted Revision Total Knee Arthroplasty","authors":"Sebastian Braun MD, PhD , Kristen I. Barton MD, PhD , Brent A. Lanting MD , James L. Howard MD","doi":"10.1016/j.artd.2025.101837","DOIUrl":"10.1016/j.artd.2025.101837","url":null,"abstract":"<div><div>Success in total knee arthroplasty (TKA) depends on restoring proper joint alignment and implant positioning. While robotic-assisted systems enhance precision in primary TKA, their use in revision TKA is limited due to challenges like bone loss, soft tissue contractures, and metal artifacts. This manuscript presents an imageless robotic navigation technique for revision TKA, eliminating the need for preoperative imaging and allowing intraoperative flexibility. After registering anatomical landmarks and implant removal, the system reassesses anatomy for iterative adjustments based on bone and soft tissue conditions. Unlike traditional canal-referenced methods, this approach aligns components relative to the joint line, enabling individualized positioning. Real-time feedback guides accurate bone cuts and soft tissue balancing. A case example illustrates the procedure. Further studies are needed to confirm long-term clinical benefits.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101837"},"PeriodicalIF":2.1,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105369","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}
The optimal dose of intravenous (IV) dexamethasone for bilateral one-stage total knee arthroplasty (BTKA) remains controversial. Therefore, this study aimed to evaluate the efficacy of administering repeated high-dose IV dexamethasone compared to repeated intermediate-dose dexamethasone for BTKA.
Methods
In this randomized, triple-blinded, clinical trial of 46 patients who underwent BTKA were randomly divided into 2 groups. The high-dose group received 16 mg of IV dexamethasone before surgical incision and a repeated dose at 24 hours postoperatively. The intermediate-dose group received 8 mg of dexamethasone at the same time points. The outcomes measured included visual analog scale (VAS) for pain intensity during motion and at rest, morphine consumption (MC), knee flexion angle, knee strength, knee circumference, timed up and go, frequency of postoperative nausea and vomiting, high-sensitivity C-reactive protein, blood glucose levels, and complications.
Results
No significant differences were found between groups regarding VAS, except the high-dose group reporting lower VAS during motion only at 24 hours postoperatively (mean difference: −0.9, P < .001). The high-dose group had lower overall MC during the hospital stay (mean difference: −2.22 mg, P = .030) and smaller knee circumference at 24 and 72 hours (P < .05). However, the difference in VAS and MC did not reach the minimal clinically important difference (1.8 points and 10 mg, respectively). No significant differences were found between groups regarding functional recovery outcomes and biomarkers.
Conclusions
Repeated high-dose IV dexamethasone provides comparable clinical outcomes to the intermediate-dose IV dexamethasone. Therefore, intermediate-dose IV dexamethasone may be sufficient for controlling pain and inflammatory response in BTKA setting.
{"title":"Efficacy of Repeated High-Dose Versus Intermediate-Dose Intravenous Dexamethasone in Reducing Pain After Bilateral Total Knee Arthroplasty: A Randomized Clinical Trial","authors":"Burin Sutthapakti MD , Wiboon Wanitcharoenporn MD , Katawut Kumplean MD , Kritsada Sukha MD , Artit Laoruengthana MD","doi":"10.1016/j.artd.2025.101852","DOIUrl":"10.1016/j.artd.2025.101852","url":null,"abstract":"<div><h3>Background</h3><div>The optimal dose of intravenous (IV) dexamethasone for bilateral one-stage total knee arthroplasty (BTKA) remains controversial. Therefore, this study aimed to evaluate the efficacy of administering repeated high-dose IV dexamethasone compared to repeated intermediate-dose dexamethasone for BTKA.</div></div><div><h3>Methods</h3><div>In this randomized, triple-blinded, clinical trial of 46 patients who underwent BTKA were randomly divided into 2 groups. The high-dose group received 16 mg of IV dexamethasone before surgical incision and a repeated dose at 24 hours postoperatively. The intermediate-dose group received 8 mg of dexamethasone at the same time points. The outcomes measured included visual analog scale (VAS) for pain intensity during motion and at rest, morphine consumption (MC), knee flexion angle, knee strength, knee circumference, timed up and go, frequency of postoperative nausea and vomiting, high-sensitivity C-reactive protein, blood glucose levels, and complications.</div></div><div><h3>Results</h3><div>No significant differences were found between groups regarding VAS, except the high-dose group reporting lower VAS during motion only at 24 hours postoperatively (mean difference: −0.9, <em>P</em> < .001). The high-dose group had lower overall MC during the hospital stay (mean difference: −2.22 mg, <em>P</em> = .030) and smaller knee circumference at 24 and 72 hours (<em>P</em> < .05). However, the difference in VAS and MC did not reach the minimal clinically important difference (1.8 points and 10 mg, respectively). No significant differences were found between groups regarding functional recovery outcomes and biomarkers.</div></div><div><h3>Conclusions</h3><div>Repeated high-dose IV dexamethasone provides comparable clinical outcomes to the intermediate-dose IV dexamethasone. Therefore, intermediate-dose IV dexamethasone may be sufficient for controlling pain and inflammatory response in BTKA setting.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101852"},"PeriodicalIF":2.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105370","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 : 2025-09-18DOI: 10.1016/j.artd.2025.101849
Narayan Hulse FRCS (Tr&Orth), MCh, MRCS, MS, DNB
We describe a robotic-assisted triple reaming technique during total hip arthroplasty in protrusio acetabuli. This technique uses computerized tomography–based 3-dimensional preoperative planning and intraoperative dynamic referencing to prepare the acetabulum. Two separate surgical plans are created using the robotic workflow. Using the first plan, the protrusio defect is prepared utilizing a reamer that matches the size and location of the defect. Using the second plan, the true acetabulum is reamed, using a reamer that restores the hip center and provides an adequate rim fit. Thirdly, the impacted bone grafts are also reverse reamed using the second plan. The 3-step sequential reaming as well as final insertion of the acetabular component are performed with real-time robotic feedback. The robotic-assisted triple reaming technique can facilitate restoring the hip biomechanics in protrusio acetabuli.
{"title":"Robotic-Assisted Triple Reaming Technique for Total Hip Arthroplasty in Protrusio Acetabuli","authors":"Narayan Hulse FRCS (Tr&Orth), MCh, MRCS, MS, DNB","doi":"10.1016/j.artd.2025.101849","DOIUrl":"10.1016/j.artd.2025.101849","url":null,"abstract":"<div><div>We describe a robotic-assisted triple reaming technique during total hip arthroplasty in protrusio acetabuli. This technique uses computerized tomography–based 3-dimensional preoperative planning and intraoperative dynamic referencing to prepare the acetabulum. Two separate surgical plans are created using the robotic workflow. Using the first plan, the protrusio defect is prepared utilizing a reamer that matches the size and location of the defect. Using the second plan, the true acetabulum is reamed, using a reamer that restores the hip center and provides an adequate rim fit. Thirdly, the impacted bone grafts are also reverse reamed using the second plan. The 3-step sequential reaming as well as final insertion of the acetabular component are performed with real-time robotic feedback. The robotic-assisted triple reaming technique can facilitate restoring the hip biomechanics in protrusio acetabuli.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101849"},"PeriodicalIF":2.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104765","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 : 2025-09-17DOI: 10.1016/j.artd.2025.101833
Joshua C. Rozell MD
{"title":"How to Wow From the Podium: Creating and Delivering a Great Presentation in Orthopedic Surgery","authors":"Joshua C. Rozell MD","doi":"10.1016/j.artd.2025.101833","DOIUrl":"10.1016/j.artd.2025.101833","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101833"},"PeriodicalIF":2.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105371","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 : 2025-09-17DOI: 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.
{"title":"Primary Care Patient Engagement With Patient-Reported Outcomes to Assess Osteoarthritis Symptoms","authors":"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","doi":"10.1016/j.artd.2025.101850","DOIUrl":"10.1016/j.artd.2025.101850","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101850"},"PeriodicalIF":2.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104758","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}
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.
{"title":"Euglycemic Diabetic Ketoacidosis and Its Prevention in Elective Surgical Patients Taking Sodium-Glucose Linked Transporter 2 Inhibitors: An International Perspective","authors":"James H.J. Selbie MbCHb , Shuhei Hiyama MD , Hemant Pandit FRCS, DPhil","doi":"10.1016/j.artd.2025.101840","DOIUrl":"10.1016/j.artd.2025.101840","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101840"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104764","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 : 2025-09-14DOI: 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.
{"title":"A Single-Reamer Technique is an Effective Strategy for Acetabular Preparation in Primary Total Hip Arthroplasty","authors":"Catelyn A. Woelfle BA, Geordie C. Lonza MD, Alexander L. Neuwirth MD, H. John Cooper MD","doi":"10.1016/j.artd.2025.101841","DOIUrl":"10.1016/j.artd.2025.101841","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101841"},"PeriodicalIF":2.1,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057407","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 : 2025-09-08DOI: 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.
{"title":"Fracture of Dual-Mobility Polyethylene Liner in a Primary Total Hip Arthroplasty: A New Complication to a Modern Design: A Case Report","authors":"Evan P. Bailey MD , Bryce T. Hrudka BS , Bailey J. Ross MD , Ajay Premkumar MD, MPH , Jacob M. Wilson MD , Galen E. Berdis MD","doi":"10.1016/j.artd.2025.101800","DOIUrl":"10.1016/j.artd.2025.101800","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101800"},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010534","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 : 2025-09-04DOI: 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.
{"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}
Pub Date : 2025-09-03DOI: 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.
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