Journal of Arthroplasty最新文献

Background: Reflecting advancements in surgical techniques and postoperative care, total knee arthroplasty (TKA) is being performed increasingly as an outpatient procedure. This study aimed to report the frequency and timing of unplanned readmission after outpatient TKA with updated data, identify risk factors for readmission after outpatient TKA, and identify common causes for readmission after outpatient TKA with a much larger cohort compared to previous studies.

Methods: This study retrospectively analyzed data from 31,347 patients who underwent outpatient TKA between 2012 and 2021. Adverse events and unplanned readmissions were identified. Timing and reason for readmission were recorded. Statistical analysis involved multivariate logistic regression to identify patient risk factors for readmission.

Results: Following surgery, 1.86% of cases reported an unplanned readmission within 30 days. Multivariate analysis demonstrated that age (Odds ratio (OR): 1.042; P < 0.001), body mass index (BMI) (OR: 1.023; P = 0.002), operative time (OR: 1.003; P = 0.017), congestive heart failure (CHF) (OR: 3.079; P < 0.001), chronic obstructive pulmonary disease (OR: 2.577; P < 0.001), bleeding disorders (OR: 1.706; P = 0.025), hypertension (1.436; P < 0.001), and partially dependent functional status (OR: 2.486; P = 0.036) significantly increased the risk of 30-day readmission. Reasons unrelated to the surgical site contributed the most to readmission at 68.3%, while reasons related to the surgical site made up 27.3%, followed by knee-related complaints (4.40%). The most common days on which readmissions occurred were postoperative days two, four, and one.

Conclusion: Our analysis revealed a low readmission risk (1.86%) after outpatient TKA. Readmission rates were found to decrease over the observed time, despite a dramatic increase in outpatient cases. The most common reason for 30-day readmission was an organ/space surgical site infection. Identified risk factors for readmission highlight areas for targeted mitigation to enhance patient outcomes and healthcare efficiency.

Background: Periprosthetic knee fracture (PPKF) following total knee arthroplasty (TKA) can be difficult to treat. A PPKF can be treated both operatively and non-operatively, and the treatment varies between fracture sites. This study aimed to assess the risk of reoperation according to the fracture site and treatment of the PPKF.

Method: This study is a nationwide cohort study using register data from 1997 to 2022. Cruciate-retaining or posterior-stabilized primary TKA were identified from the Danish Knee Arthroplasty Register (DKR). Subsequent PPKFs, fracture treatments, and later reoperations were identified through the International Classification of Diseases (ICD-10) diagnosis and procedure codes in the Danish National Patient Register. Additionally, indications for revision TKA (rTKA) in the DKR were used to identify PPKFs and the reason for reoperation.

Results: We included 1,931 PPKFs (1,494 femoral, 207 patellae, and 230 tibial) with an overall two-year reoperation risk of 20% (95% CI [confidence interval]: 18 to 23). Femoral PPKFs had a two-year reoperation risk of 16% (12 to 22) after non-operative treatment and 21% (18 to 24) after operative treatment. Patellar PPKFs had a two-year reoperation risk in five to 17 after non-operative treatment and 46% (30 to 69) after operative treatment. Tibial PPKFs had a two-year reoperation risk of 17% (11 to 27) after non-operative treatment, and 36% (25 to 53) after operative treatment.

Conclusion: The overall two-year reoperation risk was 20% (18 to 23). Operative-treated PPKFs had a higher risk of reoperation across all fracture locations. The highest reoperation risk was found after operatively treated patella and tibial PPKFs (46 and 36%, respectively), and the lowest reoperation risk was found after non-operative treated patella PPKFs.

Background: Periprosthetic joint infections (PJIs) are common and serious complications following knee and hip arthroplasty. Our previous retrospective study suggested extended antibiotics following debridement, antibiotics, and implant retention (DAIR) decreased failure rates and were not associated with increased adverse events (AEs) as compared to a standard 6 weeks of antibiotic therapy. Further, extended antibiotics beyond one year did not provide additional benefits. These observations were tested in this prospective cohort study.

Methods: A prospective cohort of patients who underwent DAIR for total knee arthroplasty PJI and received primary antibiotics were compared to patients who received primary antibiotics combined with extended antibiotics for one year. Participants had a minimum of 2-year follow-up after the final dose of antibiotics.

Results: A prospective cohort of 79 patients was followed, where 39 participants (52.7%) received primary antibiotics and 35 participants (47.3%) received both primary and extended antibiotics following DAIR. Multivariable time-to-event analyses revealed that extended antibiotic use was an independent predictor of treatment success. Infection-free survival differed significantly between the two treatment regimens, as the hazard of PJI failure was significantly lower for extended antibiotics as compared to primary antibiotics alone (adjusted hazard ratio [HR] = 0.46 [0.24 to 0.87], P = 0.017). The AE rates did not significantly differ between patients treated with primary antibiotics only versus primary combined with extended antibiotics.

Conclusions: This prospective cohort study supports our previous observations that extended antibiotics for one year were associated with lower failure rates as compared to primary antibiotics alone. Extended antibiotics after primary antibiotics were not found to be associated with increased AEs as compared to only primary antibiotics.

Response/Recommendation The literature delineates distinct differences between modular and monoblock femoral stems in revision total hip arthroplasty (rTHA), each presenting unique advantages and limitations. Modular stems offer intraoperative flexibility, enabling precise restoration of leg length and offset. However, they are associated with complications such as junctional fatigue, corrosion, and implant breakage, and they incur much higher costs compared to monoblock stems. In contrast, monoblock stems provide enhanced mechanical stability and no risk of modular junction complications, though their implantation is technically more challenging. Both modular and monoblock femoral stem designs perform well in revision THA, exhibiting no significant differences in long-term (3-5 years) clinical outcomes or subsidence rates. The choice between modular and monoblock stems should be tailored to individual patient needs and specific clinical scenarios. LEVEL OF EVIDENCE: Moderate. DELEGATES VOTE: 92.7% Agree, 5.7% Disagree, 1.7% Abstain.

Background: As total hip arthroplasty (THA) has become more common and widely available, candidates now often present with multiple risk factors that increase the risk of complications, directly impacting the cost of surgery and provider compensation. The present study was designed to better understand the impact of these factors and the perceptions of hip surgeons in Brazil.

Methods: All 880 full members of the Brazilian Hip Society (SBQ) were invited to complete an online questionnaire on preoperative risk factors, adapted from the previous American Association of Hip and Knee Surgeons (AAHKS) survey. Statistical analyses of survey response data were performed.

Results: A total of 398 responses were received (45.2% of SBQ members). Most (81.7%) work in high-complexity hospitals; 46% have more than 15 years of experience in THA; and 30.2% perform more than 100 THAs/year (47% perform 40 to 100/year). Overall, 56.5% restrict THA eligibility based on modifiable risk factors: 76.6% view malnutrition and 65.8% view poorly controlled diabetes as factors precluding THA; most (89.2%) recommend waiting 6 to 24 months after bariatric surgery. Although 59.5% of respondents turn down candidates who abuse alcohol, 80.9% are willing to operate on smokers and 75.6%, on opioid users. Advanced age was not a relevant factor for 87.2, and 71.1% perceive risk as equal in men and women. Among respondents who restrict THA eligibility, 78% do so based on personal experience or literature, while 32.6% follow the opinion of the patient's primary clinician. 90.4% believe risk-based compensation would expand access to THA.

Conclusion: Compared to their peers in Latin America, Asia, Europe, and the United States, SBQ members have a largely similar perception of restrictions to performing THA, but are more willing to operate on smokers and more likely to defer THA in post-bariatric patients. Nearly all favor adjusting surgeon compensation to take patient risk factors into account.

Objective: To investigate the relationship between the distance from the medial tibial osteotomy point to the medial tibial edge and the development of lateral tibial hinge fracture (type II) and intra-articular tibial plateau fracture (type III) in patients who have degenerative disease undergoing open wedge high tibial osteotomy (OWHTO). This information will aid surgeons in avoiding the occurrence of fractures.

Methods: This retrospective study analyzed 304 patients who underwent OWHTO from January 2018 to January 2024 in the Affiliated Hospital of Qingdao University. The distance from the tibial osteotomy point to the medial tibial edge on imaging was analyzed to determine its association with fracture. A one-way analysis of variance was used to compare the differences in height, weight, body mass index (BMI), the distance from the medial tibial osteotomy point to the medial tibial edge, sex, left and right sides of the knee, and osteoporosis in the occurrence of type II and type III fractures. Receiver operating characteristic curves were used to identify the critical distances associated with type II and type III fractures. Logistic regression analysis was used to obtain the odds ratio (OR) of the critical distance adjusted for age, sex, left and right sides, BMI, and T value.

Results: There were 40 fractures (13.3%) in 304 patients after OWHTO, comprising 21 type II fractures (7.0%) and 19 type III fractures (6.3%). A single-factor variance analysis showed that the tibial bone cutting distance to the medial tibial edge (P = 0.02) and osteoporosis (P = 0.01) were significantly different from the fracture. Receiver operating characteristic curves showed that the critical distances for type II and type III fractures were 40.5 and 47.1 mm, respectively. Logistic regression analysis showed that the ORs of type II and type III fractures were 1.061 (95% CI [confidence interval] = 1.010 to 1.115) and 1.064 (95% CI = 1.011 to 1.119), respectively.

Conclusion: In patients undergoing OWHTO, the risk factors for type II and III fractures are osteoporosis and the distance from the tibial bone cutting point to the medial tibial edge. This distance should be minimized during OWHTO to avoid type II and III fractures.

Background: The purpose of this study was to evaluate the effect of preoperative bisphosphonate use in patients who have osteoporosis on the risk of complications following primary total knee arthroplasty (TKA).

Methods: An administrative claims database was queried for patients who have osteoporosis undergoing primary TKA between 2010 and 2019 with a minimum of 2-year follow-up. Bisphosphonate naïve patients and bisphosphonate users, defined as patients who had a continuous prescription for bisphosphonates for a minimum of six months preoperatively, were matched 1:1 based on age, sex, and comorbidity burden. Patients undergoing non-elective TKA on chronic glucocorticoid therapy or receiving any other pharmacologic treatment for osteoporosis were excluded. The final cohort included 21,058 matched pairs of patients. The incidence of postoperative complications was identified via International Classification of Disease (ICD) coding and compared between matched groups. A subgroup analysis was performed to examine outcomes amongst patients who underwent cemented and cementless TKA.

Results: There was no difference in the incidence of periprosthetic fracture on univariate (0.7 versus 0.8%, P = 0.068) or multivariate testing (OR [odds ratio]: 1.24, 95% CI [confidence interval] [0.99 to 1.56]; P = 0.060). Bisphosphonate users were statistically less likely to undergo all-cause revision TKA at 2 years (OR: 0.84 [0.72 to 0.97]; P = 0.021). Patients who had osteoporosis were found to have an increased risk of periprosthetic fracture when TKA was performed with cementless implants (1.6 versus 0.4%; P = 0.033). However, when treated with bisphosphonates, patients who have osteoporosis demonstrated equivalent fracture rates regardless of implant type (1.3 versus 1.0%; P = 1.000).

Conclusions: While bisphosphonate use in patients who have osteoporosis did not decrease the risk of periprosthetic fracture, it did significantly lower the incidence of all-cause revision at 2 years although the difference identified was small. Consideration should be given to performing cemented TKA in patients who have untreated osteoporosis, given the higher rate of periprosthetic fracture when cementless implants were utilized.

Background: A long cementless monobloc stem is widely used for aseptic loosening, with satisfactory five-to-ten-year outcomes reported. Nonetheless, related studies on chronic periprosthetic joint infection (PJI) are scant. This study evaluated the clinical and radiographic outcomes of the stem in two-stage revisions due to PJI.

Methods: This prospective multicenter cohort study consisted of patients from three medical centers who were enrolled in a single arm from January 2017 to May 2022. All patients were diagnosed with chronic PJI based on International Consensus Meeting (ICM) criteria and underwent two-stage revisions using a long monobloc cementless revision stem. Among 44 patients, 37 (12 women and 25 men) completed an average follow-up of 35.6 months (range, 14 to 75). The primary outcome was the stability of the stem; secondary outcomes included infection eradication, Harris hip score, leg length discrepancy, major complications, and isolated pathogens at intraoperative cultures.

Results: At one year after revision, the infection-free prosthesis survival rate was 97.3% (95% CI [confidence interval]: 96.4 to 98.2%). At the last follow-up, the mean subsidence was 2.9 ± 2.1 mm (range, 0.8 to 4.8). Postoperative leg length discrepancy averaged -4.6 ± 4.9 mm (range, -16 to 0). The Engh score averaged 14.1 ± 6.9 (range, 0 to 22). The Harris hip score improved from a preoperative average of 35.7 ± 8.5 (range, 12 to 50) to 80.4 ± 9.3 (range, 58 to 92) at the 1-year postoperative follow-up (P < 0.01).

Conclusion: The long cementless monobloc stem used in the current study presents a feasible option for two-stage revision in cases of chronic PJI. The bone ingrowth and stability could be observed within the short follow-up time.