Journal of Arthroplasty最新文献

Background: Total knee arthroplasty (TKA) is a common procedure for end-stage knee osteoarthritis. The comparative safety and functional outcomes of simultaneous bilateral TKA (SBTKA) versus unilateral TKA (UTKA) remain uncertain. This systematic review evaluated the complication rate, range of motion (ROM), functional recovery, and health-related quality of life (HRQoL) in patients who underwent SBTKA or UTKA.

Methods: We performed a comprehensive literature search identifying 52 studies, including 5,859,125 patients who underwent SBTKA or UTKA. Outcomes assessed included complications, mortality, and readmission rates from the in-hospital period to 90 days, as well as lengths of stay (LOS), ROM, Knee Society Score (KSS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and physical and mental HRQoL scores. Meta-analyses were conducted using random-effects models. Risk ratios (RR) and mean differences (MD) were calculated for dichotomous and continuous outcomes, respectively.

Results: Patients who underwent SBTKA had a longer LOS (mean 0.8 days; 95% confidence interval [CI]: 0.3 to 1.3; P = 0.003) and higher complication rates (RR 1.42; 95% CI: 1.21 to 1.67; P < 0.001) compared with patients who underwent UTKA. Mortality (RR 1.12; 95% CI: 0.79 to 1.59; P = 0.55) and readmission (RR 1.13; 95% CI: 0.91 to 1.41; P = 0.29) were similar between groups. Functional outcomes, including ROM, KSS, and OKS, as well as HRQoL scores, were broadly comparable, with possible improvements in two-year KSS favoring SBTKA.

Conclusions: Compared with UTKA, SBTKA is associated with a higher risk of complications and a longer LOS, while functional outcomes, range of motion, and health-related quality of life appear comparable between the two groups. Further high-quality studies are needed to clarify long-term outcomes and guide patient selection.

Background: As total hip arthroplasty (THA) continues to grow in the United States, so does patients' body mass index (BMI). This study evaluated links between BMI, operative times, complications, and radiographic parameters in THA using anterior (DAA) and postero-lateral (PL) approaches.

Methods: Of 2,088 THAs performed between 2017 and 2021 at a single academic institution, 998 met inclusion criteria: DAA (n = 640) and PL (n = 358). Operative times, complications, and radiographic parameters were analyzed. The mean BMI was 29.5 for DAA and 31.1 for PL, and 38 had a BMI greater than 40.

Results: Body mass index was not associated with postoperative fractures or dislocations. Each point increase in BMI was linked to the addition of 0.42 minutes to operative times for PL (CI [confidence interval]: 0.16 to 0.67, P = 0.001) and a 19% increase in the odds of infection for DAA (OR [odds ratio]: 1.19, CI: 1.03 to 1.38, P = 0.02). Radiographic measurement showed no relationship with complications.

Conclusions: Elevated BMI was associated with increased risk of infection for DAA and longer operative times for PL. Radiographic parameters were not predictive of postoperative outcomes. These results demonstrate positive outcomes across approaches, though tradeoffs were evident in patients who had elevated BMIs.

Background: The prosthetic design landscape for total knee arthroplasty (TKA) is extensive. Modified surface geometries aim to replicate native kinematics for superior outcomes, yet evidence remains conflicting regarding optimal design efficacy based on patient-reported and objective metrics. The primary aim of this study was to compare the patient satisfaction between UC (ultra- congruent) and CR (cruciate- retaining) insert designs in bilateral simultaneous TKA, and the secondary aim was to study the parameters validating potential reasons behind any differences in the outcomes between these two design philosophies.

Methods: In this Institutional Review Board (IRB)-approved, prospective, randomized, double-blinded (patient/assessor), Level I trial, 53 patients (mean age 63 years [range, 54.8 to 66.6] and 45 women). Patients had bilateral end-stage osteoarthritis underwent bilateral simultaneous TKA by a single surgeon. Each patient received a randomly assigned UC insert in one knee and the contralateral knee received a CR insert. The primary outcome was the Forgotten Joint Score (FJS). The secondary outcomes included clinical and radiological parameters, including Oxford Knee Score (OKS), Knee Society Score (KSS), and gait analysis. Patients were assessed preoperatively and at three, 12, and 24 months postoperatively. Intraoperative static stability and post-operative (six months) dynamic stability was assessed.

Results: The UC group demonstrated significantly superior FJS at all postoperative intervals (P < 0.05), with the largest difference at one year (UC: 73.2 ± 6.0 versus CR: 67.5 ± 16.6; P = 0.007). There were no statistically significant differences found in other parameters at any time point between the two groups.

Conclusion: The UC inserts provide significantly better patient-reported joint awareness (FJS) compared to CR inserts at 2-year follow-up in bilateral simultaneous TKA. This subjective advantage was not validated by differences in objective parameters. The UC design represents a viable Posterior Cruciate Ligament (PCL) sacrificing alternative with enhanced patient-perceived outcomes.

Background: The Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) is a composite patient-reported outcome measure intended to represent overall knee health. Limited investigations exist to determine the validity of KOOS JR as a marker of joint function among total knee arthroplasty (TKA) patients. The goal of this study was to evaluate the underlying construct of KOOS JR.

Methods: Data were collected from 156 patients (94 women; mean age 68 years (range, 39 to 83)) who were scheduled to undergo primary elective TKA. The KOOS JR and eight physical performance measures (PPMs) were postoperatively administered at two, six, and 12 weeks. Spearman's rank correlation coefficients (rho) were used to assess the association among our variables. Principal component analyses (PCAs) were performed to determine the relative contribution of each KOOS JR domain score (i.e., stiffness, pain, and function) to the total score.

Results: The KOOS JR total score showed the strongest correlation (P < 0.001) with the pain score (rho = 0.94 to 0.96), followed by the function (rho = 0.80 to 0.85) and stiffness (rho = 0.59 to 0.65) scores. The PCA indicated that one dominant component explained 69 to 74% of the total variance across the three domain scores, with the pain score contributing the most. There were no PPMs that were correlated with the KOOS JR function score (P ≥ 0.059), except the Step Up measure that was weakly correlated at six weeks (rho = -0.33, P = 0.003).

Conclusions: The KOOS JR appears to be a unidimensional construct that largely reflects perceived pain, despite its intention to represent overall knee health. Appropriate outcome metrics should be selected based on the specific goals of assessment and tailored to reflect what matters most to patients, whether that is reducing pain, addressing stiffness, or achieving functional recovery.