Arthroplasty最新文献

Background: It is important to adhere to the pertinent guidelines to ensure evidence-based rehabilitation of patients with total knee arthroplasty (TKA); however, studies have suggested that pre- and post-TKA rehabilitation provided in Japan may not be adequately evidence-based. Quality indicators (QIs) translate practice guidelines into actionable and measurable statements by identifying the clinical context, timing, and target population. This study aimed to develop QIs for pre- and post-TKA rehabilitation in Japan. Additionally, a pilot practice test was conducted to assess the feasibility and applicability of the developed QIs prior to their actual clinical application.

Methods: This study used a modified Delphi technique (RAND/UCLA Appropriateness Method). A nine-member panel of clinicians and researchers evaluated the 49 proposed QIs related to rehabilitation before and after TKA. Panelists independently rated the 49 candidate QIs on a 9-point Likert scale and discussed these QIs in an online meeting. After the meeting, the panelists independently re-rated the QIs, and QIs with a median score of 7 or higher and score of less than 3 by two or fewer panelists were adopted as the final QIs. In addition, a pilot practice test was conducted to assess the feasibility and applicability of the developed QIs by retrospectively analyzing the medical records at two hospitals.

Results: Forty-nine candidate QIs were developed based on one set of QIs, nine practice guidelines, eight best practice recommendations, and 162 systematic reviews. Finally, 36 indicators, including two new ones, were adopted consensually by nine panelists. Among these 36 indicators, some had overlapping elements, so they were consolidated and organized into 24 indicators. The pilot test (n = 352) revealed a median QI performance of 86.1 (IQR, 56.1-100), with six QIs demonstrating performance levels below 10%. This low performance indicated that the proportion of patients receiving rehabilitation in accordance with the indicators was actually low.

Conclusions: This study developed 36 QIs for patients undergoing rehabilitation before and after TKA in Japan. Although their feasibility was confirmed at two facilities, future studies are warranted to measure the quality of care more comprehensively.

Background: While the role of chronic preoperative steroid use in orthopedic outcomes has been studied, particularly in hip, knee, and lumbar surgeries, its impact on total shoulder arthroplasty (TSA) outcomes is not well understood. This study aimed to evaluate the impact of chronic preoperative steroid use on early-onset postoperative infectious outcomes and readmission within 30 days following TSA compared to patients without chronic steroid use.

Methods: A retrospective analysis was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) spanning from 2010-2018. Clinical data including preoperative demographics, operative variables, and 30-day post-TSA outcomes were collected. Groups were balanced using propensity score matching based on gender, age, race, ethnicity, BMI, functional status, ASA, smoking status, alcohol use, year of operation, and comorbidities. A conditional logistic regression model was used to calculate odds ratios for each outcome measure.

Results: A total of 3,445 identified cases were included in this analysis after propensity score matching, with 1,157 exhibiting chronic steroid use. The steroid group demonstrated significantly greater rates of readmission (OR: 1.86; 95% CI: 1.22-2.81; P = 0.004). No significant differences were observed between groups in all other adverse outcomes, including reoperation, specific infectious outcomes, and combined infectious outcomes.

Conclusions: Preoperative chronic steroid use is an independent predictor of readmission but not infection following TSA. While the surgeon should be aware of the increased risk of readmission associated with chronic steroid use, the role of steroid use as a risk factor for postoperative infections following TSA may be less pronounced, particularly compared to surgeries of other joints. Further investigation of infectious outcomes and readmissions with longer follow-up is needed to clarify the specific role of chronic preoperative steroid use in adverse outcomes following TSA.

Revision total joint arthroplasty (TJA) is widely performed, and its incidence is increasing exponentially over time. Morbidity, mortality, as well as cost, both to the patient and the healthcare system, are significantly greater with revision TJA than primary TJA. Thus, efforts to minimize all-cause revision surgery are essential. In this special issue, we present articles on revision TJA epidemiology, surgical techniques, novel technology, implant design, and outcome optimization.

Background: As the population ages, the number of total joint arthroplasty (TJA) performed is rising, making early identification of patients at risk for adverse events essential to improving care and reducing healthcare costs. The aim of this study was to evaluate the association between Clinical Frailty Scale (CFS) and postoperative outcomes in elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods: We conducted a retrospective study of prospectively collected data regarding 328 TKAs and 294 THAs at a single institution from February 2019 to February 2020. Patient demographic data were harvested, and the preoperative CFS scores were calculated for all patients and analyzed to identify their associations with the length of stay (LOS), the need for admission to an inpatient rehabilitation unit (IPRU), postoperative complications and patient-reported outcome measures (PROMs).

Results: Robust patients (CFS < 3) had a significantly shorter LOS than their non-robust (CFS > 3) counterparts in both the TKA and THA groups (3.7 vs. 5.2 days, P < 0.001, and 3.8 vs. 5.8 days, P < 0.001, respectively). IPRU admission rates were significantly higher in non-robust than in robust patients. Specifically, none of the robust TKA patients required IPRU admission, whereas up to 39 non-robust patients (11.9%) did (P < 0.001). Similarly, for THA, 9 robust (5.7%) and 30 non-robust (21.9%) patients were admitted to an IPRU (P < 0.001). Non-robust patients had a significantly higher complication rate for both THA (11.0% vs. 6.4%, P = 0.03) and TKA (8.7% vs. 2.6%, P = 0.11). Both cohorts showed significant improvements in PROMs post-surgery, with non-robust patients experiencing greater relative gains than robust patients.

Conclusions: CFS is a strong predictor of the hospital length of stay, IPRU admission, and complication rates following TJA. This study also highlighted the link between frailty and PROMs in joint replacement patients. The CFS may be a valuable tool in the preoperative assessment of elective THA and TKA.

Background: Precise implant positioning during total hip arthroplasty (THA) is an important factor influencing dislocation rate and long-term implant survival. Although a special carbon fiber traction table for THA improves the accuracy of implant positioning, it is too expensive. We aimed to report the accuracy of cup positioning and complication rate in patients undergoing THA via the direct anterior approach using a conventional noncarbon fiber traction table, which is generally used for osteosynthesis of femoral fractures.

Methods: This retrospective study included 101 patients who received primary THA via the direct anterior approach using a conventional traction table with fluoroscopy between July 2022 and October 2024. Two observers evaluated radiological outcomes using postoperative anteroposterior X-rays. The intraclass correlation coefficients of cup positioning angles were calculated (inclination: 0.92, anteversion: 0.89 for intra-observer agreement; inclination: 0.91, anteversion: 0.85 for inter-observer agreement). Complications were defined as dislocation, periprosthetic fracture, ankle fracture, implant loosening, nerve injury, surgical site infection, deep vein thrombosis, and revision surgery for any reason.

Results: Radiographic analysis showed an average cup inclination of 38.1° ± 4.1° (99.0% within Lewinnek's safe zone). The average cup anteversion was 12.0° ± 4.7° (97.0% within Lewinnek's safe zone). None of the patients experienced any complications.

Conclusion: The use of a conventional traction table to perform THA using fluoroscopy may not interfere with precise cup positioning. This technique, which does not require a special carbon fiber traction table for THA, could be a feasible alternative for performing THA at general hospitals.

Background: Septic arthritis is a debilitating condition that results in joint destruction and irreversible loss of joint function. Surgical treatment options include arthroscopy, resection arthroplasty, and total hip replacement (THR). Current literature on the treatment of septic arthritis of various joints includes periprosthetic or native joints. However, to our knowledge, a consolidated review that focuses solely on THR outcomes in a previously infected native hip is still lacking. This systematic review, for the first time, examined the clinical outcomes of THR, specifically in adults with septic arthritis of the native hip joint.

Methods: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, Cochrane Library, grey literature, and bibliographic references were searched from inception to October 2023. Only case series or cohort studies published within the last 20 years assessing the outcomes of THR for native hip septic arthritis were included. Literature retrieval and data extraction were conducted by three independent reviewers. Re-infection rate and various functional outcomes, measured in terms of the Harris Hip Score (HHS), Visual Analogue Scale (VAS), Merle D'Aubigne and Postel (MAP), Western Ontario, McMaster Universities Arthritis Index (WOMAC) Short Form 12-Item (SF-12) scores, were analyzed. Range of motion (ROM) and limb length discrepancy (LLD) were also examined.

Results: Against the relevant criteria, seven studies (six case series, one cohort study) involving 1243 patients were included. The patients aged from 18 to 78 years old. The reinfection rate ranged from 0 to 22.8%, with a mean rate of 19.6%. With regards to functional outcomes, the mean increase in HHS was from 39.5 to 48.92 and the increase in MAP ranged from 7.3 to 10.9. Improvement in LLD ranged from 2.28 to 3.52 cm, with all studies reporting < 1 cm of LLD postoperatively.

Conclusion: THR, both single and two-staged, is an effective treatment option for septic arthritis of the native hip joint that and yields good functional outcomes and acceptable reinfection rates. However, more prospective and randomized trials are needed to establish clear protocols on antibiotic regimes, clinical criteria clearance, and optimal time from infection to joint replacement.

Introduction: Unicompartmental knee arthroplasty (UKA) is one of the treatment options for patients whose osteoarthritis involves one out of the 3 compartments. Patients who underwent UKA benefited from shorter hospital stays, better range of motion, and lower risk of postoperative complications compared with patients who underwent total knee arthroplasty (TKA). Hydrotherapy is being introduced complementary to conventional postoperative rehabilitation programs. No report on the use of hydrotherapy evaluating physical functions on patients who underwent UKA leads us to carry out the present study. This is a feasibility study to investigate the effects of hydrotherapy on physical functions in patients after primary unilateral UKA.

Methods: A retrospective cohort study recruited 68 patients who underwent primary unilateral UKA. Nineteen patients were allocated to the hydrotherapy group and 49 patients were in the convention group. Patients in the hydrotherapy group received hydrotherapy and conventional physiotherapy, and the convention group was given conventional physiotherapy only. The primary outcome was Knee Society Function Score (KFS) measured before surgery, six months, and one year after UKA. Self-reported walking tolerance, Timed Up and Go Test (TUGT), and 30-s Chair Stand Test (30CST) were conducted before and after the completion of rehabilitation. Pain and range of motion were also covered.

Results: Hydrotherapy group showed significantly higher KFS at 6 months (P = 0.038) and one year (P = 0.030) after operation. Range of motion flexion and extension in the hydrotherapy group were significantly improved at postoperative 4 weeks and the last session of rehabilitation. Self-reported walking tolerance in the hydrotherapy group was significantly longer at the last session (P = 0.011). No significant difference was found in TUGT, 30CST, and pain between the two groups after rehabilitation. In both groups, all outcomes were significantly better as compared to preoperative findings.

Conclusion: Patients who underwent UKA after hydrotherapy complementary to conventional physiotherapy showed significant improvements in functions, range of motion, and time to tolerating walking before rest. Pain, mobility, balance, leg strength, and endurance were comparable between the two groups. Combination of hydrotherapy with conventional postoperative physiotherapy rehabilitation yielded even better outcomes than conventional physiotherapy alone. Further research with advanced study design, larger sample size and longer follow-up periods for patients who underwent UKA is recommended.

Trial registration: NCT06459960, retrospectively registered on 13.06.2024 (ClinicalTrials.gov).

Background: High-offset stems in cementless primary total hip arthroplasty (THA) have been potentially associated with early aseptic femoral loosening. This study aimed to evaluate the primary and secondary stability of a cementless high-offset femoral component under full weight-bearing conditions using model-based RSA, comparing it with a standard offset stem in patients undergoing THA.

Methods: In this prospective, observational, single-center study, 42 patients with end-stage hip osteoarthritis underwent cementless primary THA using either a standard (SL-PLUS Standard) or a high-offset (SL-PLUS Lateral) cementless stem. Radiostereometric analysis (RSA) was employed to monitor stem migration at six weeks and three, six, twelve, and twenty-four months. Clinical outcomes were assessed using the modified Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Results: There were no significant differences in mean stem subsidence between the groups at any follow-up interval, indicating comparable primary and secondary stability. After minimal initial subsidence (SL-PLUS Standard: up to -0.54 mm; SL-PLUS Lateral: up to -0.73 mm), no further progressive migration was observed. A significant difference in stem anteversion was noted between the groups at six months (P = 0.021) and two years (P = 0.001). The SL-PLUS Lateral group had significantly better WOMAC scores at the two-year follow-up (P = 0.027).

Conclusions: This RSA study demonstrated similar migration patterns for the high-offset and standard-offset cementless stems within the first two years after operation. Both groups exhibited initial subsidence followed by high secondary stability. Based on the results of this study, the SL-PLUS Lateral is a safe alternative for patients with high femoral offset undergoing cementless THA.

Background: With robotic advancements in UKA technology, we sought to explore if robotic-assisted UKA could translate to clinical benefits such as reduced hospital stays and lowered emergency readmissions. Also, current utilization trends of UKA and choice of procedure timing (unilateral [uUKA] vs. one-staged bilateral UKA [biUKA]) could be explored.

Methods: This was a retrospective study utilizing the Clinical Data Analysis and Reporting System (CDARS) for data retrieval. All patients who had undergone primary UKA in all Hospital Authority (HA) hospitals in HK from 2021-2023 were included. Primary outcomes included utilization of UKA compared to TKA and percentage utilization of different UKA systems, namely, conventional, Mako, and Cori/Navio systems, from 2021-2023. Secondary outcomes involved: (1) patient demographics, (2) postoperative average length of stay (ALOS), (3) 30-day and 90-day postoperative Accident and Emergency Department (AED) attendance, (4) surgical times (skin-to-skin) and (5) 90-day mortality and reoperation. Differences in outcomes between uUKA and biUKA and between different robotic systems were examined. Regression analysis was performed to study if utilization of robotic-assisted systems could contribute to reduced hospital stays.

Results: UKA accounted for 15.2% of primary knee arthroplasties throughout 2021-2023. Robotic-assisted UKA (Mako and Navio/Cori) has shown an increasing utilization since 2022 in both unilateral (16.0% to 25.9%) and bilateral operations (17.8% to 29.0%). Mako had shorter ALOS than Navio/Cori (2.9 ± 1.6 vs. 3.6 ± 2.6 days; P = 0.006) and significantly shorter ALOS than conventional UKA (2.9 ± 1.6 vs. 3.6 ± 2.6 days; P = 0.004). Utilization of Mako was predictive of shortened ALOS on multi-linear regression (β = - 0.056; P = 0.049). Interestingly, biUKAs, especially conventional ones, showed a lower attendance rate than uUKAs at 30-day (2.9% VS 6.9%; P = 0.036) and 90-days (7.8% VS 15.7%; P = 0.004). Robotic-assisted surgery was associated with a prolonged surgical time of 16.4 min in uUKA and 29.1 min in biUKA compared to conventional operations.

Conclusion: UKA utilization has dropped since 2021 but the percentage of robotic-assisted UKA has risen. Mako yielded promising results in reducing hospital stays compared to conventional operations. Sub-group analysis (Mako versus Cori/Navio) highlighted the importance of distinguishing between different robotic platforms. For patients with bilateral unicompartmental OA, biUKA was shown to be a safe and effective alternative to unilateral operations.

Trial registration: Registered (HKU/ HA HKW IRB; Ref No: 24-373).

Purpose: The study aimed to compare the infection control rates, mechanical complications, and functional outcomes between prosthetic and cement spacers in two-stage revision arthroplasty for chronic periprosthetic joint infection (PJI).

Patients and methods: Data from patients treated for chronic PJI in our center from 2014 to 2023 were retrospectively collected and the patients were divided into the prosthetic spacer (PS) and cement spacer (CS) groups based on the type of spacer used for the first-stage surgeries. Data on patients' demographics and clinical scores were harvested. Infection control rates and mechanical complications were compared between the two groups by using chi-square tests and log-rank analysis.

Results: The study involved 113 cases, with a mean age of 64 ± 11.45 years (range, 31-88 years), with 48 cases in the PS group, 65 in the CS group, and all patients were followed up for at least 1 year (average 52.68 ± 26.07 months). Five patients in the PS group (10.42%) and six in the CS group (9.23%) developed recurrent infections, with no significant difference found in infection control rates (P = 0.833). The joint function score after the first-stage surgeries was higher in the PS group than in the CS group (P = 0.021). The incidence of mechanical complications, including dislocation, spacer fracture, and periprosthetic fracture, was significantly lower in the PS group than in the CS group (P = 0.024). The proportion of patients who underwent second-stage surgeries was lower in the PS group than in the CS group (58.3% vs 70.77%, P = 0.169).

Conclusion: For most patients with chronic PJI, PS can be used as the preferred option for two-stage revision arthroplasty.