Journal of Arthroplasty最新文献

Background: The applicability of the coronal plane alignment of the knee (CPAK) classification for unicompartmental knee arthroplasty (UKA) is not yet clear. The current study aimed to address the following questions: 1) What is the distribution of the CPAK classification among patients who underwent medial UKA? and 2) What would be the clinical outcomes for patients whose coronal alignment and joint line obliquity have either changed or been maintained postoperatively?

Methods: This retrospective study involved 325 patients treated with fixed-bearing medial UKA between 2017 and 2019 following a kinematic alignment strategy and using cemented resurfacing implants. Long-leg standing radiographs were utilized for all pre- and postoperative measurements. There were two independent observers who measured the alignment parameters. The patient's CPAK classification diagram was subsequently created. At the last follow-up, patients' outcomes were assessed using the clinical scores.

Results: The CPAK type 1 was the most prevalent type among 150 (46.1%) patients. Postoperatively, the most common CPAK type was type 2. In comparison to the preoperative distribution, there was a decrease in the prevalence of Types 1 and 4 in the postoperative distribution, whereas an increase in the distribution of all other types was noted. A total of 203 patients (62.4%) experienced CPAK classification change postoperatively, of which 122 patients (37.5%) maintained their original preoperative CPAK classification (P = 0.003). At a mean follow-up of 66.1 months (range, 54 to 75), implant survival (P = 0.9) and all clinical scores were similar between the CPAK Maintained and Changed groups (P > 0.05 for all).

Conclusion: The use of UKA may alter the preoperative CPAK distribution in more than half of the patients. Following UKA, a maintained coronal alignment and joint line obliquity do not have an impact on either patient-reported outcomes or implant survival.

Introduction: Trabecular metal is being increasingly used in primary total hip arthroplasty. This study compared medium-term (< 15 years) outcomes of fiber mesh titanium and trabecular metal acetabular components.

Methods: This study included 6,563 patients who underwent primary THA with either fiber mesh titanium or trabecular metal-backed acetabular components. Data was sourced from a prospectively maintained local arthroplasty database and linked with the National Joint Registry.

Results: There were 5,603 fiber mesh and 960 trabecular metal acetabular components that were included with a mean follow-up of 6.5 and 7.1 years, respectively. The above highlighted should be moved to Methods. The 10-year survivorship was 97.3% for fiber mesh and 98.9% for porous tantalum groups (P = 0.009). Multivariate analysis showed no significant variable associated with reduced revision rates.

Conclusion: Both fiber mesh titanium and trabecular metal acetabular components demonstrated high survivorship in THA, with trabecular metal showing statistically significant though marginally better survival. Despite the increased cost associated with trabecular metal, its use may be justified in complex primary and revision cases where increased primary stability may be required. Future research should focus on cost analysis and include patient-reported outcomes to guide implant selection further.

Background: Anterior knee pain (AKP) after total knee arthroplasty (TKA) results in dissatisfaction with the surgical outcomes. This study aimed to investigate risk factors for AKP after TKA using radiographic assessments.

Methods: This retrospective matched-pair, case-control study included 284 patients who underwent primary fixed-bearing, posterior-stabilized TKA from 2016 to 2020, with a minimum follow-up of two years. The inclusion criterion was varus osteoarthritis in the knees without patellar resurfacing. The exclusion criteria were the use of bone graft or metal block, valgus knees, and patellar resurfacing. The patellar tilt angle, lateral patello-femoral angle, length of the tibial tuberosity to the trochlear groove (TT-TG), hip-knee-ankle (HKA) angle, patellar height, and trochlear dysplasia index were measured. Patients were divided into two groups according to the presence of AKP based on the Feller score (≤ 20 points) at a 2-year follow-up, then a 1:2 propensity matching was performed. Risk factors for AKP were identified through a logistic regression analysis.

Results: A total of 135 patients were enrolled in this study after matching. The preoperative patellar tilt angle, lateral patello-femoral angle, TT-TG, and trochlear dysplasia index significantly differed between the groups (P < 0.05), but not the postoperative parameters (P > 0.05). The Western Ontario and McMaster Universities total score and Feller score were significantly different postoperatively. (P < 0.05) Logistic regression analysis revealed that the preoperative patellar tilt angle, preoperative trochlear dysplasia index, and preoperative lateral patello-femoral angle were significant risk factors.

Conclusion: Care should be exercised when performing TKA in patients who have a large patellar tilt angle, a small lateral patello-femoral angle, and a small trochlear dysplasia index preoperatively, as there can be an increased risk of postoperative anterior knee pain in TKA with unresurfaced patellae. Surgeons may consider counseling patients about their increased risk of AKP if these factors are present preoperatively.

Background: Total knee arthroplasty (TKA) is frequently performed to reduce pain and improve quality of life. Patient satisfaction following TKA is commonly reported at 80%. However, given recent advancements in perioperative management, implants, and operative techniques, new assessments on patient satisfaction are warranted.

Methods: Patients who underwent unilateral or bilateral TKA between November 2018 and December 2023 and used a web-based home therapy program were included. In total, 1,702 patients, with 1,527 (89.7%) reporting satisfaction following TKA, were included. Patients were stratified by satisfaction with postoperative outcomes. Univariate analyses were performed on demographics and patient-reported outcomes. Multivariate logistic regression analyses were performed to identify parameters predictive of postoperative satisfaction with TKA.

Results: Satisfied patients had higher mean age (69 versus 66 years, P = 0.001), body mass index (BMI) (31.7 versus 30.5, P = 0.046), and hypertension (32.8 versus 22.3%, P = 0.005). Across the entire cohort, Patient-Reported Outcomes Measurement Information System (PROMIS), Knee Injury and Osteoarthritis Outcome Score Junior (KOOS Jr), and Visual Analog Scale (VAS) pain scores improved from preoperatively to one year postoperatively (P < 0.001). Preoperatively, satisfied patients reported higher PROMIS Overall (34.3 versus 33.1), PROMIS Mental (50.7 versus 49.0), and KOOS Jr (51.4 versus 48.9) scores (all P < 0.05). At one year postoperatively, satisfied patients noted larger improvements in all functional outcomes, thus resulting in better PROMIS Overall (39.0 versus 35.2), PROMIS Physical (50.7 versus 45.3), PROMIS Mental (53.7 versus 50.2), KOOS Jr (77.9 versus 63.9), and VAS pain (2.5 versus 3.6) scores (all P < 0.001). Multivariate logistic regression analyses revealed that only age (OR [odds ratio] = 1.0, 95% CI [confidence interval] = 1.0 to 1.1, P = 0.005) and BMI (OR = 1.0, 95% CI = 1.0 to 1.1, P = 0.006) were predictive of satisfaction after TKA procedure.

Conclusions: In a modern cohort of TKA patients, nearly 90% reported satisfaction following surgery. Satisfied patients had higher preoperative and postoperative functional outcome scores. Older age and BMI were strongly predictive of postoperative satisfaction. While careful preoperative selection of patients should still be employed, patient satisfaction following TKA may be higher than commonly reported.

Value-based care models are healthcare economic frameworks that aim to prioritize and financially incentivize quality of care, provider performance, and patient experience. The focus on value-based care metrics will undoubtedly lead to a greater weight placed on economic analyses in arthroplasty. Authors of cost analyses in arthroplasty often use the term "cost" in ways that have vastly different underlying meanings. It is imperative that surgeons understand the different characteristics of cost data, where they come from, and how to interpret them. There are three types of costs: 1) costs to the healthcare providers; 2) costs to the payer; and 3) costs to society. In this review, we evaluate where each type of cost data comes from, what are the appropriate conclusions to be drawn from them, and examples of how they are used in the literature.

Purpose: This retrospective case series aimed to assess the clinical and radiographic outcomes of revision total hip arthroplasty with trabecular metal (TM) augments associated with cementless TM acetabular components for the management of Paprosky type IIIA and IIIB defects without pelvic discontinuity.

Methods: There were 83 hips (82 patients) enrolled. There were 53 patients who completed the clinical and radiological follow-up (64% of the total) who had a mean follow-up of 11 years (range, seven to 16.6). There were seven patients who died during the follow-up period without undergoing further revision, and 23 were lost to follow-up. A Paprosky type IIIA defect was found in 42 hips, whereas a Paprosky type IIIB defect was present in 11 hips. We previously reported short-term outcomes for 55 hips that underwent acetabular reconstruction using TM cups associated with TM augments with a mean follow-up of 53.7 months. Here, we followed the clinical and radiological outcomes of the aforementioned patients and 28 more hips. We retrospectively collected the clinical and radiological data of all the patients operated on in our tertiary referral center between 2005 and 2016.

Results: The average Harris Hip Score (HHS) increased from 36.4 (range, 24 to 53) preoperatively to 87.4 (range, 63 to 100) at the last follow-up. The cumulative survival of the acetabular construct at seven years of follow-up was 90.6% (95% CI [confidence interval]: 78.8 to 95.9) considering revision for any reason, and at 10 years of follow-up was 86.3% (95% CI: 73.4 to 93.2). The cumulative survival of the acetabular construct at seven years of follow-up was 94.2% (95% CI: 83.2 to 98.1) considering revision for aseptic loosening, and at 10 years of follow-up was 92.1% (95% CI: 80.4 to 97).

Conclusion: The use of TM cups and augments could be considered an effective management of Paprosky type III defects without pelvic discontinuity. The present technique provides an anatomical reconstruction of the defect with the restoration of the hip center of rotation (COR) associated with good clinical and radiographic outcomes in the mid-term.

Healthcare delivery systems throughout the United States have transitioned to a value-based care model, shifting away from a fee-for-service model to instead emphasize patient health outcomes and the quality of medical care. Social determinants of health (SDOH) have been shown to have a large impact on patient health outcomes and thus, must play an integral role in the implementation of a value-based model. This is of particular interest in the field of lower extremity joint arthroplasty, where demand is rising in conjunction with expanded access to care. This article intends to: 1) provide background on SDOH in the setting of value-based arthroplasty care; 2) explore the impact of SDOH on patient outcomes and costs following total joint arthroplasty (TJA); and 3) provide strategies for recognizing and addressing SDOH in practice.