Arthroplasty最新文献

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.

Background: Cryotherapy is a non-pharmacological option that complements drug therapy to achieve the most comprehensive multimodal analgesia. Various techniques are currently available, including the conventional gel cold pack, the cryo-cuff, and a novel mobile cold compression device (MCCD). This study aimed to evaluate and compare three cryotherapy techniques in terms of efficacy and patient satisfaction in patients undergoing total knee arthroplasty (TKA).

Methods: This prospective randomized study included 108 patients who were scheduled for primary unilateral TKA. The patients were allocated to 3 groups for postoperative cryotherapy techniques: gel cold pack, cryo-cuff, and MCCD. Scores on the visual analog scale (VAS) for pain intensity, morphine consumption, knee range of motion (ROM), knee swelling, length of hospital stay, and patient satisfaction were collected.

Results: Postoperative VAS scores showed a significant difference among the groups at 8 and 72 h after surgery (P = 0.002 and 0.026, respectively). At the earliest postoperative time point, post hoc analysis demonstrated that patients in the MCCD group had lower pain scores than those in the gel cold pack (P < 0.001) and the cryo-cuff group (P = 0.030). However, cryo-cuff reduced knee swelling significantly compared to gel cold pack (P = 0.028) and MCCD (P = 0.011) at postoperative 72 h. The total satisfaction score was 86.8, 82.8, and 89.1 with gel cold pack, cryo-cuff, and MCCD, respectively.

Conclusions: Cryotherapy is an adjunct to post-TKA pain control at the surgical site. MCCD has shown superior efficacy in pain reduction during the earliest postoperative period, and achieved high patient satisfaction.

Trial registration: This study was registered in the Thai Clinical Trials Registry database (no. TCTR20200517002).

Purpose: Swelling in the lower limbs after total knee arthroplasty (TKA) affects surgical outcomes. Prolonged swelling requires monitoring and remote management during home-based rehabilitation. Causes of swelling vary but, so far, no indicators are available to monitor and identify causes of lower limb swelling, making it difficult to implement targeted interventions. This study aimed to find the indicators to monitor and identify the causes of lower limb swelling during home-based rehabilitation after TKA by literature research and consulting experts from various disciplines.

Methods: The Delphi method was used. Based on literature research and analysis, a set of candidate indicators was developed. Fifteen experts from different disciplines evaluated the validity of the indicators and provided modification suggestions.

Results: After two rounds of Delphi consultations, consensus was reached. Agreement scores ranged from 4.40 to 5.00, with low variability (standard deviation 0.00-0.91) and high consistency (coefficient of variation 0.00-0.20). P was less than 0.05 in Kendall's W with an agreement rate of 80.00-100%. In the final set of indicators, there were five primary indicators (representing four swelling causes and a general category), along with 23 secondary indicators and 40 tertiary indicators.

Conclusions: This study preliminarily established indicators for at-home identification of post-TKA swelling caused by four distinct reasons. Further research is needed to validate the value of these indicators in distinguishing the causes of swelling.

Background: Proper positioning of a total hip arthroplasty (THA) plays a crucial role in the success and long-term survivorship of the implant. Cup positioning within the Lewinnek Safe Zone (LSZ) does not, however, avoid implant dislocation. Thus, the concept of a functional cup position has been introduced. The purpose of this study was to assess the discrepancy between LSZ and the acetabular cup position suggested by the patient's specific functional planning. The hypothesis was that a mismatch does exist.

Methods: One hundred consecutive patients with primary hip osteoarthritis undergoing primary THA with a personalized functional preoperative planning and patient-specific cup implantation system were enrolled. Anatomical and spino-pelvic functional parameters were recorded and, for each patient, a "safe cup orientation" was suggested. The suggested functional safe zone was compared to the LSZ.

Results: The mean suggested inclination was 39° ± 3° (range 32°-45°). The mean suggested anteversion was 21° ± 3° (range 12°-28°). The patient's functional acetabular inclination (AI) corresponded to the LSZ in one of the 100 patients, whereas the acetabular anteversion (AV) was outside the LSZ in 8 of the 100 patients. The mean pelvic tilt while standing and sitting were 0.5° ± 7° (range 21°-45°) and -6° ± 16.7° (range -63°-33°), respectively. The mean pelvic incidence was 52° ± 9.7° (range 33°-83°).

Conclusion: When a functional patient's specific preoperative planning is performed, the LZS does not correspond to the patient's functional safe zone in about 8% of patients. The concept of a universal safe zone should be revisited, and a functional personalized safe zone may have to be more widely considered.