Journal of Arthroplasty最新文献_第10页

Ipsilateral Lower-Limb Alignment after Total Hip Arthroplasty for Dysplastic Hip Osteoarthritis 发育不良髋关节骨关节炎全髋关节置换术后同侧下肢对齐。

IF 3.8 2区医学 Q1 ORTHOPEDICS

Journal of Arthroplasty

Pub Date : 2026-03-01 Epub Date: 2025-08-06 DOI: 10.1016/j.arth.2025.07.068

Shinya Tanaka MD, Yusuke Osawa MD, PhD, Yasuhiko Takegami MD, PhD, Hiroto Funahashi MD, PhD, Shiro Imagama MD, PhD

Background

Total hip arthroplasty (THA) is an effective treatment for dysplastic hip osteoarthritis (DHOA); however, factors associated with lower limb alignment changes after THA remain unclear. This study investigated factors associated with these changes in patients undergoing THA for DHOA.

Methods

We analyzed 121 patients undergoing THA for unilateral DHOA between 2018 and 2022. Based on the hip–knee–ankle angle (HKAA) changes, patients were divided into neutral (HKAA change <3°), varus (HKAA change ≥3° varus), and valgus (HKAA change ≥3° valgus) change groups. We compared their backgrounds, pelvic and femoral morphology, spinal alignment, and functional outcomes.

Results

The neutral, varus, and valgus groups included 88, 18, and 15 patients, with mean ages of 64 ± 9.9, 60 ± 7.5, and 69 ± 7.6 years, respectively. Patients in the valgus group were significantly older than those in the neutral group (P = 0.018). Preoperative femoral offset was significantly smaller in the varus group (neutral, 29.6 ± 6.3; varus, 23.9 ± 6.1; valgus, 30.7 ± 4.3 mm; P < 0.001). The ΔFemoral length was significantly larger in the valgus group (neutral, 8.1 ± 6.9; varus, 6.3 ± 7.1; valgus, 13.1 ± 6.9 mm; P = 0.014). The ΔFemoral offset was significantly larger in the varus group (neutral, 4.1 ± 5.4; varus, 10.2 ± 5.6; valgus, 1.9 ± 4.0 mm; P < 0.001). Multivariate analysis found that ΔFemoral offset is associated with varus change (odds ratio [OR], 1.25; P = 0.005). Age (OR, 1.10; P = 0.037), ΔFemoral length (OR, 1.15; P = 0.005), and ΔFemoral offset (OR, 0.84; P = 0.043) were associated with valgus change.

Conclusions

In unilateral DHOA, an increase in femoral offset was associated with varus changes in lower limb alignment after THA. Conversely, valgus changes were associated with older age, reduced femoral offset, and increased femoral length.

导言：全髋关节置换术（THA）是治疗发育不良髋关节骨关节炎（DHOA）的有效方法；然而，与THA术后下肢对齐改变相关的因素尚不清楚。本研究调查了因DHOA而行THA的患者下肢排列改变的相关因素。方法：我们分析了2018年至2022年间121例接受THA治疗单侧DHOA的患者。根据髋关节-膝关节-踝关节角度（HKAA）变化将患者分为中性（HKAA变化≤3°）、内翻（HKAA变化> 3°）和外翻（HKAA变化> 3°）变化组。我们比较了这些组的背景、骨盆和股骨形态、脊柱对齐和功能结果。结果：中性组、内翻组和外翻组分别有88例、18例和15例，平均年龄分别为64±9.9岁、60±7.5岁和69±7.6岁。外翻组患者年龄明显大于中性组（P = 0.018）。内翻组术前股骨偏移量明显减小(中性，29.6±6.3；内翻，23.9±6.1；外翻30.7±4.3 mm；P < 0.001)。外翻组ΔFemoral长度明显大于外翻组(中性，8.1±6.9；内翻，6.3±7.1；外翻：13.1±6.9 mm；P = 0.014)。内翻组ΔFemoral偏移量明显更大(中性，4.1±5.4；内翻，10.2±5.6；外翻1.9±4.0 mm；P < 0.001)。多因素分析发现ΔFemoral偏移与内翻改变相关(优势比[OR]， 1.25；95%置信区间[CI]: 1.07- 1.46；P = 0.005)。年龄(OR, 1.10；95% CI: 1.01 ~ 1.19；P = 0.037)， ΔFemoral长度(OR, 1.15；95% CI: 1.04 ~ 1.27；P = 0.005)， ΔFemoral偏移(OR, 0.84；95% CI: 0.71 ~ 1.00；P = 0.043)与外翻改变有关。结论：在单侧DHOA中，股骨偏置增加与THA后下肢直线内翻改变有关。相反，外翻变化与年龄较大、股骨偏移减小和股骨长度增加有关。

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引用次数: 0

Outcomes of Cemented versus Cementless Total Hip Arthroplasty Following Displaced Femoral Neck Fracture in Patients Under 65 Years of Age 65岁以下患者移位性股骨颈骨折后行骨水泥与无骨水泥全髋关节置换术的疗效比较

IF 3.8 2区医学 Q1 ORTHOPEDICS

Journal of Arthroplasty

Pub Date : 2026-03-01 Epub Date: 2025-07-16 DOI: 10.1016/j.arth.2025.07.013

Xiao T. Chen MD, Brian D. Wahlig MD, Lionel F. Kamga, Charles P. Hannon MD, MBA, Brandon J. Yuan MD, Nicholas A. Bedard MD

Background

Cemented femoral fixation is recommended for total hip arthroplasty (THA) performed in elderly patients who have displaced femoral neck fractures (FNFs). However, the optimal choice of femoral fixation is unknown for younger patients who have this injury. The purpose of this study was to compare outcomes of cemented versus cementless femoral fixation in THA performed in FNF patients younger than 65 years of age.

Methods

We identified 139 patients under 65 years of age treated with primary THA for FNF from 1970 to 2020. Of these, 70 received cemented and 69 received cementless femoral fixation. The mean age of the entire cohort was 59 years, and 68% were women. There were six Dorr A (4%), 97 Dorr B (70%), and 16 Dorr C (13%) femora. Gray’s tests were used to compare the cumulative incidence of any revision of the femoral component, any reoperation, revision for femoral component aseptic loosening, and periprosthetic femoral fracture between cemented and cementless groups, with mortality as a competing risk. The mean follow-up was 10 years.

Results

There were no differences in the 10-years cumulative incidence of any revision of the femoral component (3 versus 9%), any reoperation (10 versus 14%), or revision for femoral aseptic loosening (3 versus 2%) when comparing cemented versus cementless femoral components. The 10-years cumulative incidence of periprosthetic femoral fracture was significantly higher in the cementless cohort compared to the cemented cohort (18 versus 2%).

Conclusions

Selective use of cementless femoral fixation in patients younger than 65 years who had an FNF did not result in increased risk of revision or reoperation at 10 years compared to cemented fixation. However, the significantly increased risk of periprosthetic fracture in cementless femora must be considered when choosing femoral fixation in this population and warrants future study.

导论：对于移位型股骨颈骨折（FNF）的老年患者，推荐采用全髋关节置换术（THA）进行骨水泥股骨固定。然而，对于患有这种损伤的年轻患者，股骨固定的最佳选择尚不清楚。本研究的目的是比较65岁以下FNF患者行THA的骨水泥与非骨水泥股骨固定的结果。方法：从1970年到2020年，139例65岁以下的FNF患者接受了原发性THA治疗。其中70例接受骨水泥固定，69例接受无骨水泥股骨固定。整个队列的平均年龄为59岁，其中68%是女性。A门6例（4%），B门97例（70%），C门16例（13%）。Gray试验用于比较骨水泥组和非骨水泥组股骨假体翻修、再手术、股骨假体无菌性松动翻修和假体周围股骨骨折的累积发生率，并将死亡率作为竞争风险。平均随访时间为10年。结果：与非骨水泥股骨假体相比，在10年累积发生率中，任何股骨假体翻修（3比9%）、任何再手术（10比14%）或股骨无菌性松动翻修（3比2%）的发生率均无差异。无骨水泥组10年股骨假体周围骨折的累计发生率明显高于骨水泥组（18% vs 2%）。结论：与骨水泥固定相比，65岁以下有FNF的患者选择性使用无骨水泥股骨固定不会导致10年翻修或再手术的风险增加。然而，在这一人群中，选择股骨固定时必须考虑到无骨水泥股骨假体周围骨折风险的显著增加，这值得未来的研究。

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引用次数: 0

Letter Regarding “Patients Who Have Limited English Proficiency Are More Likely to Receive Elective Total Joint Arthroplasty” 关于“英语水平有限的患者更有可能接受选择性全关节置换术”的信函

IF 3.8 2区医学 Q1 ORTHOPEDICS

Journal of Arthroplasty

Pub Date : 2026-03-01 Epub Date: 2026-02-09 DOI: 10.1016/j.arth.2025.09.004

Zirvecan Güneş MD

引用次数: 0

Reply to Letter Regarding “Can a Large Language Model Interpret Data in the Electronic Health Record to Infer Minimum Clinically Important Difference Achievement of Knee Osteoarthritis Outcome Score Joint Replacement Score Following Total Total Knee Arthroplasty?” 回复关于“大型语言模型能否解释电子健康记录中的数据以推断膝关节骨性关节炎预后评分和全膝关节置换术后关节置换术评分的最小临床重要差异成就？”

IF 3.8 2区医学 Q1 ORTHOPEDICS

Journal of Arthroplasty

Pub Date : 2026-03-01 Epub Date: 2026-02-09 DOI: 10.1016/j.arth.2025.07.059

Abdul K. Zalikha MD, Thomas S. Hong MD, Easton A. Small, Michael Constant MD, Alex H.S. Harris PhD, Nicholas J. Giori MD, PhD

引用次数: 0

Complications Following Total Hip Arthroplasty in Patients Who Have Acetabular Fracture Versus Primary Osteoarthritis: A Retrospective Cohort Analysis 髋臼骨折与原发性骨关节炎患者全髋关节置换术后的并发症：回顾性队列分析。

IF 3.8 2区医学 Q1 ORTHOPEDICS

Journal of Arthroplasty

Pub Date : 2026-03-01 Epub Date: 2025-08-06 DOI: 10.1016/j.arth.2025.07.066

Alexander N. Berk MD , Cyrus F. Eghtedari , Logan M. Good MD , Robert J. Burkhart MD , Samuel A. Florentino MD , Harkirat Jawanda MD , George Ochenjele MD , Robert J. Wetzel MD , Joshua K. Napora MD

Background

Total hip arthroplasty (THA) following geriatric acetabular fractures provides benefits including early weight-bearing and accelerated rehabilitation; however, it involves a technically complex procedure with potentially high complication rates. This study aimed to evaluate the frequency of complications in patients undergoing acute THA (aTHA) after an acetabular fracture.

Methods

A collaborative network database was queried to identify patients aged 65 years and older who underwent THA between 2004 and 2024 following an acetabular fracture. The control cohort consisted of patients who underwent THA for primary osteoarthritis. Cohorts were propensity-matched based on age, sex, and comorbidities. Medical and surgical complications were analyzed during both the early (seven, 14, and 30 days) and delayed (90 days, 180 days, one year, and two years) postoperative periods. After 1:1 propensity score matching, both cohorts included 799 patients.

Results

Patients in the aTHA group demonstrated a higher risk of pneumonia, stroke, opioid use, rehospitalization, and urinary tract infections in both the early and delayed postoperative periods (P ≤ 0.05). Additionally, acute kidney injury and blood loss anemia were more common among the aTHA group in the early postoperative period, while deep infection/periprosthetic joint infection, sepsis, deep vein thrombosis, pulmonary embolism, emergency department visits, and death were more common in the delayed period (P ≤ 0.05). At 2-year follow-up, the aTHA group had higher rates of prosthetic hip dislocation (10.4 versus 1.3%; relative risk [RR] 8.30, P < 0.001), periprosthetic fracture (3.1 versus 1.3%; RR 2.50, P = 0.010), and revision THA (6.4 versus 2.5%; RR 2.55, P < 0.001) compared to the control group.

Conclusions

Patients undergoing aTHA following an acetabular fracture experience higher rates of complications, including prosthetic hip dislocation, periprosthetic fracture, and revision THA, compared to those undergoing THA for primary osteoarthritis.

Level of Evidence

Prognostic level III.

背景：老年髋臼骨折后全髋关节置换术（THA）的益处包括早期负重和加速康复；然而，它涉及一个技术复杂的过程，潜在的高并发症率。本研究旨在评估髋臼骨折后急性THA （aTHA）患者并发症的发生率。方法：查询一个协作网络数据库，以确定2004年至2024年间髋臼骨折后接受全髋关节置换术（THA）的65岁及以上患者。对照组包括因原发性骨关节炎（OA）接受THA治疗的患者。队列根据年龄、性别和合并症进行倾向匹配。分析了术后早期（7天、14天和30天）和延迟（90天、180天、1年和2年）的内科和外科并发症。在1:1的倾向评分匹配后，两个队列都包括799名患者。结果：tha组患者在术后早期和延迟期出现肺炎、卒中、阿片类药物使用、再住院和尿路感染的风险均较高（P≤0.05）。术后早期急性肾损伤、失血性贫血多见于tha组，术后迟发期深度感染/假体周围关节感染、脓毒症、深静脉血栓形成、肺栓塞、急诊就诊、死亡多见于tha组（P≤0.05）。在2年的随访中，tha组的假髋关节脱位率更高(10.4%比1.3%；RR[相对危险度]8.30,P < 0.001)，假体周围骨折(3.1比1.3%；RR 2.50, P = 0.010)，修正THA (6.4 vs 2.5%；RR 2.55, P < 0.001)。结论：与原发性骨关节炎患者相比，髋臼骨折后接受THA的患者并发症发生率更高，包括髋关节假体脱位、假体周围骨折和翻修THA。

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引用次数: 0

The Effect of Component Design and Tibial Tray Orientation on Weight-Bearing Postoperative Kinematics for Total Knee Arthroplasty: A Parametric Analysis of Multiple Variables 全膝关节置换术中构件设计和胫骨托盘定位对术后负重运动学的影响：多变量参数分析。

IF 3.8 2区医学 Q1 ORTHOPEDICS

Journal of Arthroplasty

Pub Date : 2026-03-01 Epub Date: 2025-07-18 DOI: 10.1016/j.arth.2025.07.024

Caleb D. Chesney BS, Michael T. LaCour PhD, Richard D. Komistek PhD

Background

Considerable work has been done to improve outcomes in total knee arthroplasty (TKA), yet there remains a lack of consensus for proper target component alignments and design, particularly of the tibial tray. Furthermore, isolation of variables is difficult to do clinically. This study used a preoperative planning tool and a validated forward mathematical model of the knee to examine the effects of different TKA design features and tibial tray orientations (posterior tibial slope [PTS] and axial orientation) on femorotibial kinematics.

Methods

The three-dimensional tool contains reconstructed bone and soft-tissue geometry for 10 unique subjects, each implanted with three different cruciate-retaining TKAs. Mechanical alignment with PTS of 6° was the control group, 5° internal/external rotation, and 0, 3, and 9° PTS of the tibial tray were experimental groups. Each subject underwent a deep knee bend from full extension to 120° flexion. Examined parameters include femorotibial condylar motion, medial collateral ligament forces, lateral collateral ligament forces, posterior cruciate ligament forces, and femorotibial contact mechanics (force, area, and stress).

Results

The PTS had no effect on kinematics, whereas internal/external rotation did (P < 0.001). More bearing conformity resulted in greater sensitivity to malalignment in contact mechanics and had the highest ligament forces, while less bearing conformity resulted in greater paradoxical anterior motion of the lateral condyle, with the least conforming system experiencing 8.6 ± 4.8 mm of motion.

Conclusions

Component design plays a critical role in producing desirable clinical outcomes, and there exists a balance between conformity and nonconformity that is optimal. Internal/external rotation of the tibial tray must be further standardized and studied to ensure stability and natural knee mechanics.

导言：为了改善全膝关节置换术（TKA）的疗效，已经做了大量的工作，但是对于正确的目标部件对齐和设计，特别是胫骨托盘的设计，仍然缺乏共识。此外，临床很难分离变量。本研究使用术前规划工具和经过验证的膝关节正演数学模型来研究不同TKA设计特征和胫骨托盘方向（胫骨后斜率（PTS）和轴向）对股胫骨运动学的影响。方法：三维工具包含10个独特受试者的骨和软组织几何形状重建，每个受试者植入三种不同的保留十字架的tka。机械对准6ºPTS为对照组，内/外旋转5º，胫骨托架0、3、9ºPTS为实验组。每位受试者均进行膝关节深度弯曲，从完全伸直至120º屈曲。检查参数包括股胫髁运动、内侧副韧带（MCL）力、外侧副韧带（LCL）力、后交叉韧带（PCL）力和股胫接触力学（力、面积和应力）。结果：PTS对运动学没有影响，而内/外旋转有影响（P < 0.001）。在接触力学中，更多的轴承一致性导致对错位更敏感，韧带力最高，而较少的轴承一致性导致外侧髁更大的矛盾前运动，最不一致的系统经历8.6±4.8 mm的运动。结论：组件设计在产生理想的临床结果中起着至关重要的作用，并且在符合和不符合之间存在最佳平衡。胫骨托盘的内/外旋转必须进一步标准化和研究，以确保稳定性和自然的膝关节力学。

{"title":"The Effect of Component Design and Tibial Tray Orientation on Weight-Bearing Postoperative Kinematics for Total Knee Arthroplasty: A Parametric Analysis of Multiple Variables","authors":"Caleb D. Chesney BS, Michael T. LaCour PhD, Richard D. Komistek PhD","doi":"10.1016/j.arth.2025.07.024","DOIUrl":"10.1016/j.arth.2025.07.024","url":null,"abstract":"<div><h3>Background</h3><div>Considerable work has been done to improve outcomes in total knee arthroplasty (TKA), yet there remains a lack of consensus for proper target component alignments and design, particularly of the tibial tray. Furthermore, isolation of variables is difficult to do clinically. This study used a preoperative planning tool and a validated forward mathematical model of the knee to examine the effects of different TKA design features and tibial tray orientations (posterior tibial slope [PTS] and axial orientation) on femorotibial kinematics.</div></div><div><h3>Methods</h3><div>The three-dimensional tool contains reconstructed bone and soft-tissue geometry for 10 unique subjects, each implanted with three different cruciate-retaining TKAs. Mechanical alignment with PTS of 6° was the control group, 5° internal/external rotation, and 0, 3, and 9° PTS of the tibial tray were experimental groups. Each subject underwent a deep knee bend from full extension to 120° flexion. Examined parameters include femorotibial condylar motion, medial collateral ligament forces, lateral collateral ligament forces, posterior cruciate ligament forces, and femorotibial contact mechanics (force, area, and stress).</div></div><div><h3>Results</h3><div>The PTS had no effect on kinematics, whereas internal/external rotation did (<em>P</em> < 0.001). More bearing conformity resulted in greater sensitivity to malalignment in contact mechanics and had the highest ligament forces, while less bearing conformity resulted in greater paradoxical anterior motion of the lateral condyle, with the least conforming system experiencing 8.6 ± 4.8 mm of motion.</div></div><div><h3>Conclusions</h3><div>Component design plays a critical role in producing desirable clinical outcomes, and there exists a balance between conformity and nonconformity that is optimal. Internal/external rotation of the tibial tray must be further standardized and studied to ensure stability and natural knee mechanics.</div></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"41 3","pages":"Pages 938-947"},"PeriodicalIF":3.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Does Previous Coronary Angiography Influence Complications in Total Joint Arthroplasty, and Should the Surgery Be Postponed? 以前的冠状动脉造影是否影响全关节置换术的并发症？是否应该推迟手术？

IF 3.8 2区医学 Q1 ORTHOPEDICS

Journal of Arthroplasty

Pub Date : 2026-03-01 Epub Date: 2025-07-08 DOI: 10.1016/j.arth.2025.07.002

Amir Human Hoveidaei MD , Kasra Pirahesh MD , Mohammad Poursalehian MD , Seyed Ali Mansouri MD , Mehrdad Mahalleh MD , Parham Dastjerdi MD , Sukrit Suresh MD , Jakob Adolf MD , Janet D. Conway MD

Background

Cardiovascular diseases are common in total joint arthroplasty (TJA) patients, many of whom undergo coronary angiography (CAG) before total hip (THA) or knee (TKA) arthroplasty. This study evaluated whether a history of CAG increases postoperative complications and how its timing affects outcomes.

Methods

Using a national database, we analyzed patients undergoing THA or TKA between 2012 and 2020. Patients were grouped by CAG history (with and without stent placement) and timing intervals (within six, six to 12, 12 to 18, 18 to 24, and 24 to 36 months). Outcomes included readmission, myocardial infarction (MI), cerebrovascular accident (CVA), venous thromboembolism (VTE), surgical site infection, prosthetic joint infection (PJI), acute renal failure (ARF), revision surgery, and blood transfusion. Analysis used propensity score-matching and multivariate logistic regression.

Results

Patients who underwent TKA with prior CAG (n = 4,602 with stent; n = 25,514 without stent) had significantly higher rates of MI, CVA, and blood transfusion compared to controls. These risks remained elevated across all CAG-to-TKA intervals. Acute renal failure, VTE, and readmission were significantly increased in earlier time intervals, but generally normalized with delays beyond 12 months, except in the stented subgroup, where elevated risks persisted up to 18 months. No significant differences were observed in 2-years PJI or revision rates. Patients who had a THA and a prior CAG (n = 3,422 with stent; n = 14,728 without stent) also experienced higher rates of MI, CVA, and blood transfusions. These risks did not decline with longer CAG-to-THA intervals. Readmission, VTE, and ARF were elevated in early time intervals, but normalized with delays beyond 12 months. Both PJI and revision rates were similar between groups.

Conclusions

A history of CAG, especially with stent placement, is linked to higher postoperative complications, with MI and CVA risks remaining elevated regardless of surgery timing in both THA and TKA groups. Strategic TJA delay for other complications is recommended for patients with prior CAG undergoing arthroplasty.

Level of Evidence

III.

背景：心血管疾病在全关节置换术（TJA）患者中很常见，其中许多患者在全髋关节（THA）或膝关节（TKA）置换术前接受冠状动脉造影（CAG）。本研究评估CAG病史是否会增加术后并发症，以及CAG发生的时机如何影响预后。方法：使用国家数据库，我们分析了2012年至2020年期间接受THA或TKA的患者。根据患者的CAG病史（有和没有放置支架）和时间间隔（6个月、6至12个月、12至18个月、18至24个月和24至36个月）对患者进行分组。结果包括再入院、心肌梗死（MI）、脑血管意外（CVA）、静脉血栓栓塞（VTE）、手术部位感染、假体关节感染（PJI）、急性肾功能衰竭（ARF）、翻修手术和输血。分析采用倾向评分匹配和多元逻辑回归。结果：有CAG病史的TKA患者(n = 4602例支架；n = 25,514（未使用支架）的患者心肌梗死、CVA和输血的发生率明显高于对照组。这些风险在cag - tka的所有时间间隔都保持升高。急性肾衰竭、静脉血栓栓塞和再入院在较早的时间间隔内显著增加，但通常延迟超过12个月后恢复正常，除了支架亚组，其风险升高持续至18个月。2年PJI或修订率无显著差异。有THA和既往CAG的患者（n = 3,422）；n = 14,728（未使用支架）也经历了更高的心肌梗死、CVA和输血率。这些风险并没有随着cag - tha间隔时间的延长而下降。再入院率、VTE和ARF在早期时间间隔升高，但延迟超过12个月后恢复正常。两组间PJI和修订率相似。结论：CAG病史，特别是支架置入术，与较高的术后并发症有关，无论THA组和TKA组的手术时间如何，心肌梗死和CVA的风险仍然升高。对于既往CAG患者进行关节置换术，建议延迟TJA治疗其他并发症。

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引用次数: 0

Reply to: "Letter to the Editor Commenting on: 'Current Evidence Does Not Support the Use of Tibial Stem Extension in Total Knee Arthroplasty of Obese Patients: A Systematic Review'" 回复：“致编辑的信，评论：‘目前的证据不支持在肥胖患者全膝关节置换术中使用胫骨干延伸：一项系统综述’”

IF 3.8 2区医学 Q1 ORTHOPEDICS

Journal of Arthroplasty

Pub Date : 2026-03-01 Epub Date: 2026-02-09 DOI: 10.1016/j.arth.2025.11.056

Seyed Mohammad Javad Mortazavi MD , Mohammad Poursalehian MD , Ali Soltani Farsani MD , Mohammad Amin Habibi MD , Mohammadreza Razzaghof MD, MPH , Maziar Nafisi MD , Mohammad Ayati Firoozabadi MD

引用次数: 0

Evidence-Based Outcomes Should Propel Innovation in Total Joint Arthroplasty 循证结果应推动全关节置换术的创新

IF 3.8 2区医学 Q1 ORTHOPEDICS

Journal of Arthroplasty

Pub Date : 2026-03-01 Epub Date: 2026-02-09 DOI: 10.1016/j.arth.2026.01.058

R. Michael Meneghini MD, James A. Browne MD, Giles R. Scuderi MD, Michael A. Mont MD

引用次数: 0

Satisfactory and Similar Outcomes After Knee Arthroplasty Revisions in One or Two Stages for Infection, Following a Surgical Strategy Based on Robust Guidelines 膝关节置换术后的满意和相似的结果在一个或两个阶段的感染，遵循基于健全指南的手术策略。

IF 3.8 2区医学 Q1 ORTHOPEDICS

Journal of Arthroplasty

Pub Date : 2026-03-01 Epub Date: 2025-07-16 DOI: 10.1016/j.arth.2025.07.019

Jean Baltzer MD , Timothy Lording MBBS, FRACS , Tomas Pineda MD , Tristan Ferry MD, PhD , Elvire Servien MD, PhD , Sébastien Lustig MD, PhD , Cécile Batailler MD, PhD

Background

This study aimed to assess the outcomes of a one-stage or two-stage strategy after revision total knee arthroplasty for periprosthetic joint infection.

Methods

This single-center retrospective study included all TKA revisions for chronic infection operated on between 2010 and 2021, with at least two years of follow-up. The surgical strategy was based on the recommendations from the Philadelphia Consensus 2018. Patients were classified into five overlapping groups: mechanical failure, septic failure, controlled infection, cure of infection, and complete healing. Revision was defined as the need for further surgery with implant removal. There were 218 revision total knee arthroplasties included, with 182 two-stage revisions (83.5%) and 36 one-stage revisions (16.5%). The mean follow-up was 56.9 ± 30.8 months. At the last follow-up, 135 patients (61.9%) were classified as “complete healing,” 30 as “septic failure” (13.8%), 12 as “mechanical failure” (5.5%), 147 (67.4%) as “infection-cured,” and 41 (18.8%) as “controlled infection.”

Results

There were 27 patients (14.8%) who had septic failure, and 11 (6.1%) had mechanical failure in the two-stage group, versus three (8.3%) and one (2.8%), respectively, in the one-stage group (P = 0.36). There were 128 “R2” or “complex revision cases” (58.7%) and 90 “R3” or “salvage cases” (41.3%) according to the revision knee complexity classification. In multivariate analysis, the requirement of a flap (odds ratio [OR] = 0.28, [0.11 to 0.72]), revision knee complexity classification grade of R3 (OR = 0.37, [0.21 to 0.68]), and an American Society of Anesthesiologists score >2 (OR = 0.51, [0.28 to 0.93]) were associated with lower rates of infection healing.

Conclusions

Following a surgical strategy based on robust guidelines, one- or two-stage TKA revision for periprosthetic joint infection achieved satisfactory rates of complete healing and cure of infection despite 41% of very complex cases. Patients classified as R3, those requiring a flap, and those who had an American Society of Anesthesiologists score greater than 2 were at higher risk of failure.

Level of Evidence

III.

背景：本研究旨在评估全膝关节置换术翻修（RTKA）后一期或两期策略治疗假体周围关节感染（PJI）的结果。方法：这项单中心回顾性研究纳入了2010年至2021年间所有治疗慢性感染的TKA修订患者，并进行了至少两年的随访。手术策略是基于2018年费城共识的建议。将患者分为机械性失败、脓毒性失败、感染控制、感染治愈和完全愈合五组。修复被定义为需要进一步手术切除种植体。包括218个rtka， 182个两阶段修订（83.5%）和36个一阶段修订（16.5%）。平均随访时间56.9±30.8个月。在最后一次随访中，135例（61.9%）患者被分类为“完全愈合”，30例为“脓毒性衰竭”（13.8%），12例为“机械故障”（5.5%），147例（67.4%）为“感染治愈”，41例（18.8%）为“感染控制”。结果：两期组发生脓毒性衰竭27例（14.8%），机械衰竭11例（6.1%），而一期组分别为3例（8.3%）和1例（2.8%）（P = 0.36）。根据膝关节修复复杂性分类（RKCC）， R2型或复杂型翻修病例128例（58.7%），R3型或挽救型翻修病例90例（41.3%）。在多因素分析中，皮瓣的需求（OR[比值比]= 0.28,[0.11至0.72]），RKCC等级R3 （OR = 0.37,[0.21至0.68]）和ASA（美国麻醉医师协会）评分bbb1 2 （OR = 0.51,[0.28至0.93]）与较低的感染愈合率相关。结论：在严格指导的手术策略下，尽管41%的非常复杂的病例，一期或两期TKA修正PJI获得了令人满意的完全愈合和感染治愈率。被分类为R3的患者，需要皮瓣的患者，以及ASA评分大于2的患者失败的风险更高。

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引用次数: 0