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Rapid Return to Braking After Anterior and Posterior Approach Total Hip Arthroplasty. 前路和后路全髋关节置换术后快速恢复制动。
IF 1.5 Q3 Medicine Pub Date : 2024-04-03 eCollection Date: 2024-04-01 DOI: 10.5435/JAAOSGlobal-D-23-00093
John T Richards, Sean E Slaven, Bobby G Yow, Robert W Tracey, Andrew W Mack, John P Cody

Background: Little is known about the effect of surgical approach on return to braking after total hip arthroplasty (THA), and few studies have investigated braking after THA with modern surgical techniques and rehabilitation protocols.

Methods: In a prospective comparative design, we enrolled 65 patients who received right-sided primary THA at our institution from April 2018 through March 2020, 34 with a direct anterior approach (DAA) and 31 with a posterior approach (PA). Braking tests measuring brake reaction time (BRT) and brake pedal depression (BPD) were administered to patients preoperatively and at 1, 2, and 4 weeks postoperatively using a realistic driving simulator. BRT and BPD were compared between groups and preoperatively versus postoperatively using mixed-effects models.

Results: Preoperative BRT averaged 638 msec in the DAA group and 604 msec in the PA group (P = 0.31). At 1 week postoperatively, the DAA group had significantly prolonged BRT compared with preoperatively (694 msec, P = 0.02). No significant difference was observed in the PA group (633 msec, P = 0.31). Both groups had returned to baseline by 2 weeks, and both had significantly faster BRT at 4 weeks compared with preoperatively (583 msec for DAA, P = 0.01; 537 msec for PA, P < 0.001). BPD was similar between groups, and there were no significant differences between preoperative and postoperative BPD at any time point.

Conclusions: With modern surgical techniques, BRT after right-sided THA returns to baseline levels approximately 2 weeks after surgery. There seems to be a quicker return to preoperative BRT observed in patients with a PA.

背景:人们对手术方式对全髋关节置换术(THA)后恢复制动的影响知之甚少,很少有研究调查了采用现代手术技术和康复方案进行THA后的制动情况:在前瞻性比较设计中,我们纳入了 2018 年 4 月至 2020 年 3 月期间在我院接受右侧初次 THA 的 65 例患者,其中 34 例采用直接前路(DAA),31 例采用后路(PA)。在术前、术后 1 周、2 周和 4 周,使用逼真的驾驶模拟器对患者进行了制动测试,测量制动反应时间(BRT)和制动踏板压陷(BPD)。使用混合效应模型对各组之间以及术前与术后的制动反应时间和制动踏板抑制进行比较:结果:DAA 组术前 BRT 平均为 638 毫秒,PA 组为 604 毫秒(P = 0.31)。术后 1 周,DAA 组的 BRT 与术前相比明显延长(694 毫秒,P = 0.02)。PA 组则无明显差异(633 毫秒,P = 0.31)。两组患者在 2 周时均已恢复至基线,4 周时的 BRT 与术前相比均明显加快(DAA 组为 583 毫秒,P = 0.01;PA 组为 537 毫秒,P < 0.001)。各组间的BPD相似,术前和术后任何时间点的BPD均无明显差异:结论:采用现代手术技术,右侧 THA 术后 BRT 可在术后 2 周左右恢复到基线水平。结论:采用现代手术技术,右侧 THA 术后 BRT 在术后 2 周左右恢复到基线水平,PA 患者的 BRT 似乎恢复得更快。
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引用次数: 0
The Use of Biomarkers to Quantify Clinical Response to Total Knee Arthroplasty Interventions: A Systematic Review. 使用生物标志物量化全膝关节置换术干预的临床反应:系统回顾。
IF 1.5 Q3 Medicine Pub Date : 2024-03-28 eCollection Date: 2024-04-01 DOI: 10.5435/JAAOSGlobal-D-23-00202
Mark Mackie, Kristen I Barton, Darek Sokol-Randell, Brent Lanting

The primary objective of this review was to determine whether the attenuation of the postoperative inflammatory response (PIR) after total knee arthroplasty (TKA) leads to a notable improvement in clinical outcome scores. The secondary objective of this review was to determine the optimal approach in using inflammatory biomarkers, clinical inflammatory assessments, and imaging to quantify the PIR. A systematic literature search of eight major databases was conducted using a predetermined search strategy. C-reactive protein (CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), knee surface temperature (KST), and clinical outcome data were collected and graphically displayed. Eighty-six percent of the studies that reported a statistically significant decrease in inflammatory biomarkers in their treatment group demonstrated a concordant notable improvement in clinical outcome scores. Mean CRP, IL-6, ESR, and KST values peaked on postoperative day (POD) 2, POD1, POD7, and POD 1-3, respectively. The PIR is correlated with early pain and function recovery outcomes. Future studies comparing TKA surgical methodologies and perioperative protocols should assess PIR by incorporating inflammatory biomarkers, such as CRP and IL-6, and clinical inflammatory assessment adjuncts, to provide a more comprehensive comparison.

本综述的主要目的是确定全膝关节置换术(TKA)后炎症反应(PIR)的减轻是否会明显改善临床结果评分。本综述的次要目的是确定使用炎症生物标记物、临床炎症评估和成像来量化 PIR 的最佳方法。我们采用预先确定的检索策略对八个主要数据库进行了系统性文献检索。收集了 C 反应蛋白 (CRP)、白细胞介素-6 (IL-6)、红细胞沉降率 (ESR)、膝关节表面温度 (KST) 和临床结果数据,并以图表形式显示。有 86% 的研究报告称,其治疗组的炎症生物标志物出现了统计学意义上的显著下降,同时临床结果评分也有明显改善。CRP、IL-6、ESR 和 KST 的平均值分别在术后第 2 天、第 1 天、第 7 天和第 1-3 天达到峰值。PIR 与早期疼痛和功能恢复结果相关。未来比较 TKA 手术方法和围手术期方案的研究应结合 CRP 和 IL-6 等炎症生物标志物以及临床炎症评估辅助指标来评估 PIR,以提供更全面的比较。
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引用次数: 0
Bilateral Flexion-Type Supracondylar Humerus Fracture. 双侧屈曲型肱骨髁上骨折。
IF 1.5 Q3 Medicine Pub Date : 2024-03-28 eCollection Date: 2024-04-01 DOI: 10.5435/JAAOSGlobal-D-23-00239
Muhammed Uslu, Mahsum Solmaz, Mustafa Fatih Daşcı, Ozan Beytemür

Supracondylar humerus fractures are common in the pediatric population, but flexion fractures are very rare in this population. The need for open reduction in these fractures is high and can be challenging for orthopaedic surgeons. In this article, we report a 9-year-old patient with bilateral flexion-type humeral fracture treated with closed reduction, which, to our knowledge, is the first report in the literature. We concluded that the first step in the treatment of flexion-type supracondylar fractures should be closed reduction with the help of an experienced assistant surgeon and that successful results can be obtained even in bilateral flexion-type fractures with appropriate treatment and follow-up.

肱骨髁上骨折在儿科人群中很常见,但屈曲骨折在儿科人群中却非常罕见。这些骨折需要进行开放复位,这对骨科医生来说具有挑战性。本文报告了一名 9 岁双侧屈曲型肱骨骨折患者的闭合复位治疗情况,据我们所知,这是文献中的首例报告。我们的结论是,治疗屈曲型肱骨髁上骨折的第一步应该是在经验丰富的助理外科医生的帮助下进行闭合复位,即使是双侧屈曲型骨折,通过适当的治疗和随访也能获得成功的结果。
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引用次数: 0
Value-Driven Pediatric Supracondylar Humerus Fracture Care: Implementing Evidence-Based Practices. 以价值为导向的小儿肱骨髁上骨折护理:实施循证实践。
IF 1.5 Q3 Medicine Pub Date : 2024-03-28 eCollection Date: 2024-04-01 DOI: 10.5435/JAAOSGlobal-D-24-00058
Sonia Chaudhry

Supracondylar humerus fractures are high-volume injuries in children; therefore, value-driven treatment has far-reaching implications for patients and families as well as healthcare systems. Children younger than 5 years can remodel posterior angulation. Most Type IIa fractures will maintain alignment after closed reduction. Many patients with surgical fractures can safely wait for nonemergent fixation. Outpatient surgery is associated with shorter surgical time, lower costs, and fewer return visits to the emergency department with no increase in adverse events. Type III fractures treated the following day do not have higher rates of open reduction, and patients with associated nerve injuries have no difference in recovery time compared with those treated more urgently. Pediatric-trained surgeons generally provide more efficient care (shorter surgical time and less after-hours surgery); however, their outcomes are equivalent to non-pediatric orthopaedic surgeons. Community hospitals have lower costs compared with teaching hospitals; therefore, transferring patients should be avoided when feasible. Postoperative care can be streamlined in uncomplicated cases to minimize radiographs, therapy referrals, and multiple visits. Splinting offers safer, lower cost immobilization over casting. With staffing shortages and an increasingly burdened healthcare system, it is imperative to maximize nonsurgical care, use outpatient facilities, and minimize postoperative requirements without negatively affecting patient outcomes.

肱骨髁上骨折是儿童的高发伤;因此,以价值为导向的治疗对患者和家庭以及医疗保健系统具有深远影响。5 岁以下的儿童可以重塑后方成角。大多数 IIa 型骨折在闭合复位后可保持对位。许多手术骨折患者可以安全地等待非急诊固定。门诊手术具有手术时间短、费用低、急诊科复诊次数少且不良反应不增加等优点。次日治疗的 III 型骨折的切开复位率并不高,与急诊治疗相比,伴有神经损伤的患者在恢复时间上没有差异。受过儿科培训的外科医生通常能提供更高效的治疗(手术时间更短、下班后手术更少);但他们的治疗效果与非儿科骨科医生相当。与教学医院相比,社区医院的成本较低;因此,在可行的情况下应避免转院。对于不复杂的病例,可以简化术后护理,以尽量减少拍片、治疗转诊和多次就诊。夹板固定比石膏固定更安全、成本更低。随着人员短缺和医疗保健系统负担日益加重,当务之急是最大限度地利用非手术治疗、使用门诊设施和尽量减少术后需求,同时不对患者的治疗效果产生负面影响。
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引用次数: 0
Pelvic Pseudotumor Associated With a Ceramic Bearing Total Hip. 与陶瓷轴承全髋关节相关的骨盆假瘤
IF 1.5 Q3 Medicine Pub Date : 2024-03-21 eCollection Date: 2024-03-01 DOI: 10.5435/JAAOSGlobal-D-23-00184
Jaskaran Singh, Arash Panahifar, Roman Chernikov, William N Dust

Pseudotumors have been well documented to occur most frequently in metal-metal bearing total hip arthroplasties and less frequently in metal-polyethylene bearings. There are few cases in the literature of pseudotumors occurring in ceramic-ceramic articulations. We report a case of a large pelvic pseudotumor in a patient with a ceramic-ceramic bearing articulation in a 67-year-old man. In addition to the usual investigations, we did a detailed wear analysis of the ceramic implants and an examination of the soft tissues for particulate debris. The detailed wear analysis did show evidence of stripe wear; however, the volumetric wear was within the expected range. Synchrotron imaging identified strontium and zirconium debris arising from the ceramic surfaces. Although association does not mean causation, no other cause for the large pseudotumor could be identified and presumably represents an idiosyncratic reaction to ceramic debris.

有大量文献证明,假瘤最常发生在金属-金属轴承全髋关节置换术中,而较少发生在金属-聚乙烯轴承中。在文献中,陶瓷-陶瓷关节发生假瘤的病例很少。我们报告了一例骨盆假瘤病例,患者为一名 67 岁的男性,使用的是陶瓷轴承关节。除了常规检查外,我们还对陶瓷植入物进行了详细的磨损分析,并检查了软组织中的颗粒碎片。详细的磨损分析确实显示了条纹磨损的迹象,但体积磨损在预期范围内。同步加速器成像确定了陶瓷表面产生的锶和锆碎片。虽然相关性并不意味着因果关系,但无法确定造成巨大假瘤的其他原因,这可能是对陶瓷碎片的一种特殊反应。
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引用次数: 0
The Effect of Concomitant Biceps Tenodesis on Revision Surgery Rates After Primary Rotator Cuff Repair. 同时进行肱二头肌腱膜切除术对初次肩袖修复术后翻修手术率的影响
IF 1.5 Q3 Medicine Pub Date : 2024-03-20 eCollection Date: 2024-03-01 DOI: 10.5435/JAAOSGlobal-D-24-00046
Zachary C Pearson, Mark Haft, Amil R Agarwal, Marco-Christopher Rupp, Jacob D Mikula, Uzoma Ahiarakwe, Matthew J Best, Uma Srikumaran

Introduction: We aimed to use a national database to compare the 4-year revision surgery rates after rotator cuff repair (RCR) in patients with concomitant biceps tenodesis (BT) versus those without BT.

Methods: A retrospective cohort analysis was conducted using the PearlDiver database from 2015 to 2017. Patients undergoing primary open and arthroscopic RCR with and without BT were identified. Demographic variables, 90-day complications, and 2- and 4-year revision surgery rates were analyzed, and a multivariable logistic regression was conducted.

Results: Of the 131,155 patients undergoing RCR, 24,487 (18.7%) underwent concomitant BT and 106,668 (81.3%) did not. After controlling for comorbidities and demographics, patients with concomitant BT were associated with lower odds of all-cause revision (OR; P-value [0.77; P < 0.001]), revision BT (0.65; P < 0.001), revision RCR (0.72; P < 0.001), and shoulder arthroplasty (0.81; P = 0.001) within 4 years when compared with those without concomitant BT.

Discussion: In our analysis, patients undergoing primary RCR with concomitant BT had 35% reduced odds of revision BT and 23% reduced odds of any all-cause revision within 4 years when compared with those without concomitant BT. This suggests that tenodesis at the time of primary RCR may be associated with a reduction in the utilization of ipsilateral shoulder revision surgery rates.

简介:我们旨在利用国家数据库,比较同时进行肱二头肌腱膜切除术(BT)与未进行BT的患者在肩袖修复术(RCR)后4年的翻修手术率:利用PearlDiver数据库对2015年至2017年进行了回顾性队列分析。确定了接受初治开放式和关节镜 RCR(伴有或不伴有 BT)的患者。分析了人口统计学变量、90 天并发症、2 年和 4 年翻修手术率,并进行了多变量逻辑回归:结果:在131,155名接受RCR手术的患者中,24,487人(18.7%)同时接受了BT,106,668人(81.3%)未接受BT。在控制了合并症和人口统计学因素后,与未同时接受BT治疗的患者相比,同时接受BT治疗的患者在4年内发生全因翻修(OR;P值[0.77;P<0.001])、BT翻修(0.65;P<0.001)、RCR翻修(0.72;P<0.001)和肩关节置换术(0.81;P=0.001)的几率较低:讨论:在我们的分析中,与未同时进行 BT 的患者相比,接受初级 RCR 并同时进行 BT 的患者在 4 年内进行 BT 翻修的几率降低了 35%,进行各种原因的翻修的几率降低了 23%。这表明,在进行初次 RCR 时进行腱鞘切除术可能会降低同侧肩关节翻修手术的使用率。
{"title":"The Effect of Concomitant Biceps Tenodesis on Revision Surgery Rates After Primary Rotator Cuff Repair.","authors":"Zachary C Pearson, Mark Haft, Amil R Agarwal, Marco-Christopher Rupp, Jacob D Mikula, Uzoma Ahiarakwe, Matthew J Best, Uma Srikumaran","doi":"10.5435/JAAOSGlobal-D-24-00046","DOIUrl":"10.5435/JAAOSGlobal-D-24-00046","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to use a national database to compare the 4-year revision surgery rates after rotator cuff repair (RCR) in patients with concomitant biceps tenodesis (BT) versus those without BT.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted using the PearlDiver database from 2015 to 2017. Patients undergoing primary open and arthroscopic RCR with and without BT were identified. Demographic variables, 90-day complications, and 2- and 4-year revision surgery rates were analyzed, and a multivariable logistic regression was conducted.</p><p><strong>Results: </strong>Of the 131,155 patients undergoing RCR, 24,487 (18.7%) underwent concomitant BT and 106,668 (81.3%) did not. After controlling for comorbidities and demographics, patients with concomitant BT were associated with lower odds of all-cause revision (OR; P-value [0.77; P < 0.001]), revision BT (0.65; P < 0.001), revision RCR (0.72; P < 0.001), and shoulder arthroplasty (0.81; P = 0.001) within 4 years when compared with those without concomitant BT.</p><p><strong>Discussion: </strong>In our analysis, patients undergoing primary RCR with concomitant BT had 35% reduced odds of revision BT and 23% reduced odds of any all-cause revision within 4 years when compared with those without concomitant BT. This suggests that tenodesis at the time of primary RCR may be associated with a reduction in the utilization of ipsilateral shoulder revision surgery rates.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Limb Fractures Treated With the Novel Plate Osteosynthesis Application Technique: Second to Minimally Invasive Plates osteosynthesis. 用新型钢板骨结合应用技术治疗肢体骨折:仅次于微创钢板骨结合。
IF 1.5 Q3 Medicine Pub Date : 2024-03-11 eCollection Date: 2024-03-01 DOI: 10.5435/JAAOSGlobal-D-24-00017
Wei Li, Yaowei Zhao, Lian Liu, Haiyang Yu, Zhao Xie, Quankui Zhuang

Background: The main aim of this article was to propose a new concept of minimally invasive surgery for treating limb fractures, named as second to minimally invasive plates osteosynthesis (STMIPO).

Methods: We have described the STMIPO technique in a step-wise and standardized manner based on our findings from a study involving six patients treated at our institution. All patients with fracture achieved satisfactory outcomes.

Results: Ours clinical trials have shown that the STMIPO technique can be successfully applied in various limb fractures, including fibula fractures, tibial fractures, femur fractures, humerus fractures, ulna fractures, and radius fractures. All fracture patients achieved satisfactory outcomes.

Conclusion: As a new minimally invasive technology, the STMIPO technique can serve as an alternative solution for fractures that are difficult to reduce with minimally invasive plates osteosynthesis (MIPO).

背景:本文的主要目的是提出一种治疗四肢骨折的微创手术新概念,即第二至微创钢板骨合成术(STMIPO):方法:我们根据在本院治疗的六名患者的研究结果,以循序渐进和标准化的方式描述了 STMIPO 技术。所有骨折患者都获得了满意的结果:我们的临床试验表明,STMIPO 技术可成功应用于各种四肢骨折,包括腓骨骨折、胫骨骨折、股骨骨折、肱骨骨折、尺骨骨折和桡骨骨折。所有骨折患者都获得了满意的疗效:结论:作为一种新的微创技术,STMIPO技术可作为微创钢板骨合成术(MIPO)难以缩小的骨折的替代解决方案。
{"title":"Limb Fractures Treated With the Novel Plate Osteosynthesis Application Technique: Second to Minimally Invasive Plates osteosynthesis.","authors":"Wei Li, Yaowei Zhao, Lian Liu, Haiyang Yu, Zhao Xie, Quankui Zhuang","doi":"10.5435/JAAOSGlobal-D-24-00017","DOIUrl":"10.5435/JAAOSGlobal-D-24-00017","url":null,"abstract":"<p><strong>Background: </strong>The main aim of this article was to propose a new concept of minimally invasive surgery for treating limb fractures, named as second to minimally invasive plates osteosynthesis (STMIPO).</p><p><strong>Methods: </strong>We have described the STMIPO technique in a step-wise and standardized manner based on our findings from a study involving six patients treated at our institution. All patients with fracture achieved satisfactory outcomes.</p><p><strong>Results: </strong>Ours clinical trials have shown that the STMIPO technique can be successfully applied in various limb fractures, including fibula fractures, tibial fractures, femur fractures, humerus fractures, ulna fractures, and radius fractures. All fracture patients achieved satisfactory outcomes.</p><p><strong>Conclusion: </strong>As a new minimally invasive technology, the STMIPO technique can serve as an alternative solution for fractures that are difficult to reduce with minimally invasive plates osteosynthesis (MIPO).</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10927324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Extrapulmonary, Chronic Septic Arthritis From Mycobacterium tuberculosis in the Ankle and Subtalar Joints. 踝关节和跗关节结核分枝杆菌引起的肺外慢性化脓性关节炎
IF 1.5 Q3 Medicine Pub Date : 2024-03-11 eCollection Date: 2024-03-01 DOI: 10.5435/JAAOSGlobal-D-23-00273
Tyson Compton, Nicholas Andrew Ferguson, Laura Certain, Devon Nixon

In the United States, rates of Mycobacterium tuberculosis infection have been declining for decades. Osteoarticular tuberculosis of the ankle is rarely observed. We present the case of a 65-year-old man who immigrated to the United States from India 24 years before the onset of symptoms. The patient initially reported atraumatic swelling and pain of the left ankle and foot and was treated for venous insufficiency. Later, the patient was referred to a nonsurgical orthopaedic clinic for additional workup and was found to have elevated inflammatory markers. MRI showed septic arthritis and osteomyelitis of the talus, distal tibia, and calcaneus. Joint aspiration revealed elevated white blood cell counts with predominately PMNs. The patient was then referred to an orthopaedic foot and ankle surgeon and underwent extensive irrigation and débridement. The patient was discharged on empiric antibiotics. Culture results from the original joint aspirate returned 14 days after surgery as positive for acid-fast bacillus, later identified as M tuberculosis by sequencing. Empiric antibiotics were discontinued, and the patient was started on appropriate antituberculotic therapy. This case report illustrates the challenge in the diagnosis of skeletal tuberculosis and the importance of including this condition on the differential for patients with atypical foot and ankle presentations.

几十年来,美国的结核分枝杆菌感染率一直在下降。踝关节骨关节结核很少见。我们介绍的病例是一名 65 岁的男性,在出现症状 24 年前从印度移民到美国。患者最初报告左脚踝和足部有创伤性肿胀和疼痛,并因静脉功能不全接受了治疗。后来,患者被转诊到一家非手术骨科诊所做进一步检查,发现炎症指标升高。核磁共振成像显示,患者的距骨、胫骨远端和方骨出现化脓性关节炎和骨髓炎。关节抽吸术发现白细胞计数升高,其中主要是 PMNs。随后,患者被转诊至足踝矫形外科医生处,接受了大面积冲洗和清创术。患者出院时使用了经验性抗生素。术后 14 天,原始关节抽吸物的培养结果显示耐酸杆菌阳性,后经测序确定为结核杆菌。患者停用了经验性抗生素,并开始接受适当的抗结核治疗。本病例报告说明了骨骼结核诊断的挑战性,以及将这种疾病纳入非典型足踝表现患者的鉴别诊断中的重要性。
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引用次数: 0
Individualizing a Total Knee Arthroplasty with Three-Dimensional Planning. 通过三维规划实现全膝关节置换术的个性化。
IF 1.5 Q3 Medicine Pub Date : 2024-03-08 eCollection Date: 2024-03-01 DOI: 10.5435/JAAOSGlobal-D-24-00023
Harold Gene Dossett, David G Deckey, Henry D Clarke, Mark J Spangehl

Total knee arthroplasty (TKA) is evolving from mechanical alignment to more individualized alignment options in an attempt to improve patient satisfaction. Thirteen-year survival of kinematically aligned prostheses has recently been shown to be similar to mechanically aligned TKA, allaying concerns of long-term failure of this newer individualized technique. There is a complex inter-relationship of three-dimensional knee and limb alignment for a TKA. This article will review planning parameters necessary to individualize each knee, along with a discussion of how these parameters are related in three dimensions. Future use of computer software and machine learning has the potential to identify the ideal surgical plan for each patient. In the meantime, the material presented here can assist surgeons as newer individual alignment planning becomes a reality.

为了提高患者的满意度,全膝关节置换术(TKA)正从机械对位向更个性化的对位方案发展。最近的研究表明,运动学对位假体的13年存活率与机械对位TKA相似,这消除了人们对这种较新的个性化技术长期失败的担忧。TKA的三维膝关节和肢体对位有着复杂的相互关系。本文将回顾个性化膝关节所需的规划参数,并讨论这些参数在三维空间中的关系。未来计算机软件和机器学习的使用有可能为每位患者确定理想的手术方案。在此期间,本文介绍的材料可以帮助外科医生实现更新的个体化对位规划。
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引用次数: 0
Use of The Risk Assessment and Prediction Tool to Predict Same-day Discharge After Primary Hip and Knee Arthroplasty. 使用风险评估和预测工具预测初次髋关节和膝关节置换术后当天出院情况。
IF 1.5 Q3 Medicine Pub Date : 2024-03-08 eCollection Date: 2024-03-01 DOI: 10.5435/JAAOSGlobal-D-22-00269
Marcel M Dupont, Michael B Held, Roshan P Shah, H John Cooper, Alexander L Neuwirth, Thomas R Hickernell

Introduction: The Risk Assessment and Prediction Tool (RAPT) is a preoperative screening tool developed to predict discharge disposition after total hip arthroplasty (THA) and total knee arthroplasty (TKA), but its predictive value for same-day discharge (SDD) has not been investigated. The aims of this study were (1) to assess RAPT's ability to predict SDD after primary THA and TKA and (2) to determine a cutoff RAPT score that may recognize patients appropriate for SDD.

Methods: Data were retrospectively collected from patients undergoing primary THA and TKA at a single tertiary care center between February 2020 and May 2021. A receiver operating characteristic curve was generated to choose a cutoff value to screen for SDD. Logistic regression analysis was done to identify factors including age, BMI, or RAPT score that may be associated with SDD.

Results: Three hundred sixty-one patients with preoperative RAPT scores were included in the analysis of whom 147 (42.6%) underwent SDD. A cutoff of ≥9 was identified for TKA and ≥11 for THA. RAPT had a predictive accuracy of only 66.7% for SDD, whereas the discharge plan documented in the preoperative note was 91.7% accurate.

Discussion: Although there is a positive association between RAPT and SDD, it is not a useful screening tool given its low predictive accuracy.

导言:风险评估和预测工具 (RAPT) 是一种术前筛查工具,用于预测全髋关节置换术 (THA) 和全膝关节置换术 (TKA) 后的出院处置,但其对当日出院 (SDD) 的预测价值尚未得到研究。本研究的目的是:(1) 评估 RAPT 预测初次 THA 和 TKA 术后 SDD 的能力;(2) 确定可识别适合 SDD 患者的 RAPT 临界分数:回顾性收集了2020年2月至2021年5月期间在一家三级医疗中心接受初级THA和TKA手术患者的数据。生成接收者操作特征曲线,以选择筛查 SDD 的临界值。进行了逻辑回归分析,以确定可能与 SDD 相关的因素,包括年龄、体重指数或 RAPT 评分:分析纳入了361名术前有RAPT评分的患者,其中147人(42.6%)接受了SDD。TKA的临界值为≥9分,THA的临界值为≥11分。RAPT对SDD的预测准确率仅为66.7%,而术前病历中记录的出院计划的准确率为91.7%:讨论:尽管RAPT与SDD之间存在正相关,但由于其预测准确性较低,因此并非有用的筛查工具。
{"title":"Use of The Risk Assessment and Prediction Tool to Predict Same-day Discharge After Primary Hip and Knee Arthroplasty.","authors":"Marcel M Dupont, Michael B Held, Roshan P Shah, H John Cooper, Alexander L Neuwirth, Thomas R Hickernell","doi":"10.5435/JAAOSGlobal-D-22-00269","DOIUrl":"10.5435/JAAOSGlobal-D-22-00269","url":null,"abstract":"<p><strong>Introduction: </strong>The Risk Assessment and Prediction Tool (RAPT) is a preoperative screening tool developed to predict discharge disposition after total hip arthroplasty (THA) and total knee arthroplasty (TKA), but its predictive value for same-day discharge (SDD) has not been investigated. The aims of this study were (1) to assess RAPT's ability to predict SDD after primary THA and TKA and (2) to determine a cutoff RAPT score that may recognize patients appropriate for SDD.</p><p><strong>Methods: </strong>Data were retrospectively collected from patients undergoing primary THA and TKA at a single tertiary care center between February 2020 and May 2021. A receiver operating characteristic curve was generated to choose a cutoff value to screen for SDD. Logistic regression analysis was done to identify factors including age, BMI, or RAPT score that may be associated with SDD.</p><p><strong>Results: </strong>Three hundred sixty-one patients with preoperative RAPT scores were included in the analysis of whom 147 (42.6%) underwent SDD. A cutoff of ≥9 was identified for TKA and ≥11 for THA. RAPT had a predictive accuracy of only 66.7% for SDD, whereas the discharge plan documented in the preoperative note was 91.7% accurate.</p><p><strong>Discussion: </strong>Although there is a positive association between RAPT and SDD, it is not a useful screening tool given its low predictive accuracy.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10923310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140060711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews
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