Arthroplasty最新文献

Introduction: Total hip arthroplasty (THA) is a common surgical procedure that aims to relieve pain, improve function, and increase mobility in patients with hip joint pathology. One of the most challenging aspects of THA is to determine the correct angle of the acetabular component's placement. Intraoperative inclinometers have emerged as a promising tool to obtain accurate measurements of the acetabular component's inclination. The primary objective of this study was to evaluate the accuracy and efficacy of using intraoperative inclinometers for THA.

Methods: This non-randomized control trial evaluated patients undergoing primary THA. Patients in the inclinometer group had an inclinometer used intraoperatively to measure acetabular component inclination, and patients in the control group had no inclinometer. Inclination and anteversion of the acetabular component were measured on postoperative radiographs.

Results: A total of 223 patients were included in the study. The mean inclination angle of the acetabular cup was significantly higher in the inclinometer group (43.9° vs. 41.5°, P < 0.001). This difference was not clinically significant. There was no significant difference in anteversion. There were no significant differences in the number of patients within the safe zones for inclination or anteversion, or in the number of patients experiencing a dislocation. No correlation was found between inclinometer measurement and measured acetabular component inclination. Inclinometer use and body mass index (BMI) were the sole statistically significant factors in determining acetabular component inclination.

Conclusions: This study indicated no current benefit to inclinometer use during primary THA, as measured by inclination, anteversion, and dislocation rate. However, this might be confounded by subtle variations in patient positioning, which may be a strong area of study in the future.

Background: Both kinematically-aligned (KA) total knee arthroplasty (TKA) and bicruciate stabilized (BCS) TKA aim to reproduce the physiological knee kinematics. In this study, we compared the femoro-tibial component rotational mismatch between patients who underwent modified KA-TKA and those who received guided-motion BCS-TKA, and its influence on the clinical outcomes.

Methods: In this retrospective study, 77 consecutive patients were included and divided into two groups: subjects who underwent modified KA-TKA with Persona (KA Group; n = 42) and those who received BCS-TKA with JOURNEY II (BCS group; n = 35). Range of motion, the 2011 Knee Society Score (KSS), the rotational alignment of the femoral and tibial components, and the correlations between the rotational mismatch and the 2011 KSS subscales were examined.

Results: The postoperative objective knee indicators (P = 0.0157), patient satisfaction (P = 0.0039) and functional activity scores (P = 0.0013) in the KA group were significantly superior to those in the BCS group 1 year postoperatively. There was no significant difference between the two groups observed in the rotational mismatch. In the BCS group, significant negative correlations were identified between the rotational mismatch and objective indicators, patient satisfaction, and functional activity scores but not in the KA group.

Conclusions: The short-term clinical results following KA-TKA showed superior objective knee indicators, patient satisfaction and functional activity scores. A negative correlation was observed between component rotational mismatch and the 2011 KSS subscales in the BCS group, compared to no relationship found between the two in the KA group. These findings suggested that KA-TKA has a relatively higher tolerance for rotational mismatch than BCS-TKA.

Background: The second-generation metaphyseal cone was useful in managing bone defects in revision knee arthroplasty. However, due to the anatomical constraints in Asian osteometry, the authors utilized a novel free-hand burring technique instead of cannulated reaming for bone preparation. We reported the short-term outcomes of our surgical techniques specific to Asian osteometry.

Methods: We conducted a case series by consecutively recruiting 13 female and 12 male patients (involving 25 knees), with a mean age of 71 years (range, 54-88 years). The patients underwent revision total knee arthroplasty during the period from April 2017 to June 2022. Twenty-three tibial cones and 4 femoral cones using free-hand burring technique were implanted. The mean follow-up duration was 51 months (range 18-80 months). Due to the relatively small bone size and meta-diaphyseal center mismatch in the Asian knees, the free-hand burring technique instead of the cannulated reaming technique was adopted in preparing for cone implantation. The clinical outcomes were knee ranges of motion, the Knee Society Knee scores (KSS), end-of-stem pain, infection, and the need for revision surgery. The radiological outcomes included osteointegration, fracture, and loosening.

Results: Mean knee range of motion improved from 83 degrees (range 0°-120°) preoperatively to 106 degrees (range 60°-125°) postoperatively (P < 0.001). Mean KSS improved significantly from 29 (range 0-70) to 69 (range 5-100) (P < 0.001). All cones were osteointegrated. One case had transient end-of-stem pain, two developed intraoperative minor femoral fractures and one suffered from recurrent infection that did not require cone revision. Cone revision-free survivorship was 100%. There was no aseptic loosening.

Conclusions: The second-generation cone implanted with free-hand burring bone preparation yielded promising short-term outcomes in Asian knees.

Purpose: Mid-flexion instability has been identified as a cause for dissatisfaction following total knee arthroplasty (TKA). Robotic-assisted surgery using the Mako robot only allows for assessment of stability at 10° and 90°. This study aimed to investigate any evidence of mid-flexion instability in Mako-assisted TKA.

Methods: Data from 72 TKA in 59 patients from 2018 to 2022 were collected. All patients underwent an RA (Mako, Stryker, Fort Lauderdale, FL, USA), single-radius design, cruciate-retaining TKA. Intraoperatively, medial, and lateral pressures were measured at 10°, 45° and 90° of flexion using a pressure sensor (Verasense, OrthoSensor, 59 Inc., Dania Beach, FL, USA). The knee was considered balanced if the difference in pressures between compartments was less than 15 pounds-force (lbf).

Results: There was no significant difference between the pressures measured in the medial compartment at 10°, 45° and 90° of flexion (P = 0.696). A statistically significant difference was found between the pressures measured in the lateral compartment at 10°, 45° and 90° of flexion, with the 10° value being significantly higher (P < 0.001), but this did not exceed the threshold of 15 lbf. None of the patients had a pressure difference of more than 15 lbf when pressures at 45° were compared to that at 10° and 90°, medially or laterally.

Conclusion: This study showed no evidence of mid-flexion instability in Mako-assisted TKA, using a single radius, cruciate-retaining prosthesis whilst maintaining the joint height.

Level of evidence: Level III retrospective cohort study.

Background: The use of long stems for severe femoral bone defects is suggested by many scholars, but it is associated with further bone loss, intraoperative fracture, increased surgical trauma, and complications. With better bone retention, simple and quick surgical procedures, and minimal complications, the short cementless stems with a tapered rectangular shape may be an alternative for femoral revision. This study aimed to evaluate the results of this type of stem in treating selected Paprosky II-IV bone defects.

Methods: This retrospective study included 73 patients (76 hips involved) who underwent conservative femoral revision using the short cementless stems with a tapered rectangular shape between January 2012 and December 2020. The preoperative femoral bone defects were identified as follows: 54 cases of type II, 11 cases of type IIIA, 7 cases of type IIIB, and 4 cases of type IV. Indications for revision included aseptic loosening (76.3%) and prosthetic joint infection (23.7%). Six cementless stems with a tapered rectangular shape from three companies were used in all patients. Among them, SLR-Plus, SL-Plus MIA, and Corail stems were employed in most patients (40.8%, 23.7%, and 17.1%, respectively). The average length of these stems measured 171.7 mm (SD 27 mm; 122-215 mm). Radiographic results, Harris hip scores (HHS), complications, and survivorship were analyzed. The follow-up lasted for 7 years on average (range 3-11 years).

Results: The subsidence was observed in three hips (3.9%), and all stems achieved stable bone ingrowth. Proximal femoral bone restoration in the residual osteolytic area was found in 67 hips (88.2%), constant defects in nine hips (11.8%), and increasing defects in 0 cases. There was no evidence of stem fractures and stem loosening in this series. The mean HHS significantly improved from 32 (range 15-50) preoperatively to 82 (range 68-94) at the last follow-up (t = - 36.297, P < 0.001). Five hips developed prosthesis-related complications, including three infection and two dislocation cases. The mean 5- and 10-year revision-free survivorships for any revision or removal of an implant and reoperation for any reason were 94.6% and 93.3%, respectively. Both mean 5- and 10-year revision-free survivorships for aseptic femoral loosening were 100%.

Conclusion: Conservative femoral revision using short cementless stems with a tapered rectangular shape can provide favorable radiographic outcomes, joint function, and mid-term survivorship with minimal complications. Of note, a sclerotic proximal femoral bone shell with continued and intact structure and enough support strength is the indication for using these stems.

Background: The functional integrity of the anterior cruciate ligament (ACL) influences surgical decision-making in patients with knee osteoarthritis (KOA). This study aimed to compare the diagnostic value of radiography and magnetic resonance imaging (MRI) in determining the functional status of ACL.

Methods: We analyzed 306 knees retrospectively using preoperative hip-to-ankle anteroposterior standing (APS) radiographs, anteroposterior (AP) and lateral knee radiographs, AP valgus stress (VS) force radiographs, and standard orthogonal MRI. Based on the intraoperative visualization, the knees were grouped into ACL functionally-intact and ACL functionally-deficient (ACLD) groups. The diagnostic validity and reliability were calculated based on the radiograph parameters such as hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), posterior tibial slope (PTS), sagittal tibiofemoral subluxation (STFS), coronal tibiofemoral subluxation (CTFS), joint line convergence angle (JLCA), the maximum wear point of the proximal tibia plateau (MWPPT%), and MRI parameters including ACL grades and MWPPT%.

Results: HKA, MPTA, PTS, STFS, JLCA, and CTFS on APS and AP radiographs, and MWPPT% on radiographs and MRI showed a significant diagnostic value (P < 0.05). There were no statistically significant differences in the single parameters from radiographs and MRI. After constructing the logistic regression models, MRI showed higher sensitivity, specificity, and accuracy, reaching 96.8%, 79.9%, and 83.3%, respectively (P < 0.001).

Conclusions: In patients with KOA, the diagnostic value of single radiographic or MRI parameter in assessing the functional integrity of the ACL are equivalent. However, by constructing predictive models, MRI could significantly improve diagnostic validity compared with radiography.

Objective: In total knee arthroplasty (TKA), achieving soft-tissue balance while retaining acceptable lower limb alignment is sometimes difficult and may lead to patient dissatisfaction. Theoretically, patient-specific implants can bring great benefits, while the lack of precise surgical tools may hinder the improvement of outcomes. The objective of this study was to illustrate surgical techniques and evaluate kinematics and early clinical outcomes of robotic-assisted TKA using patient-specific implants.

Methods: Based on preoperative CT scan, femoral and tibial components were 3D printed. Medial and lateral tibial liners were separate with different thicknesses, posterior slopes and conformity. TiRobot Recon Robot was used for surgery, and was armed with smart tools that quantify gap, force and femoral-tibial track. We collected data on demographics, intraoperative gap balance and femoral-tibial motion. In the follow-up, we evaluated the range of motion, Visual Analogue Scale (VAS), forgotten joint score (FJS), Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR) score. Radiological data were also harvested.

Results: Fifteen patients (17 knees) were enrolled with a mean age of 64.6 ± 6.4 (53-76) years. In 5 knees, we used symmetric tibial liners, the rest were asymmetric. After surgery, the average alignment was 1.6 ± 2.0 (-3-5) degrees varus. The average follow-up lasted 6.7 ± 4.2 (1-14) months. The mean visual analogue scale was 0.8 ± 0.7 (0-2), FJS was 62.4 ± 25.3 (0-87), KOOS was 86.5 ± 9.4 (57-97). 11 patients were "very satisfied", 3 were "satisfied" with the result, and one patient was neutral due to restricted extension and unsatisfactory rehabilitation at five months' follow-up.

Conclusions: With patient-specific implants and robotics, TKA could be performed by a mathematical way, which was dubbed a "differential" TKA. Intraoperative kinematics was excellent in terms of gap-force balancing and femoral-tibial relative motion. Preliminary clinical outcomes were overall satisfactory.

Introduction: Hip hemiarthroplasty (HHA) is one of the most common types of orthopedic surgery. With the prevalence and utilization of the surgery increasing year after year, this procedure is found to be associated with severe postoperative complications and eventually mortality. Thus, it is crucial to understand the factors that increase the risk of mortality following HHA.

Methods: Using the Nationwide Inpatient Sample (NIS) database, patients undergoing HHA from 2016 to 2019 were identified. This sample was stratified into a mortality group and a control group. The data regarding patients' demographics, co-morbidities, and associated complications were compared between the groups.

Results: Of the 84,067 patients who underwent the HHA procedures, 1,327 (1.6%) patients died. Additionally, the mortality group had a higher percentage of patients who were non-electively admitted (P < 0.001) and diabetic patients with complications (P < 0.001), but lower incidences of tobacco-related disorders (P < 0.001). Significant differences were also seen in age (P < 0.001), length of stay (P < 0.001), and total charges (P < 0.001) between the two groups. Preoperatively, those aged > 70 years (OR: 2.11, 95% CI [1.74, 2.56], P < 0.001) had diabetes without complications (OR: 0.32, 95% CI [0.23, 0.44], P < 0.001), tobacco-related disorders (OR: 0.24, 95% CI [0.17, 0.34], P < 0.001) and increased rates of mortality after HHA. Postoperatively, conditions, such as pulmonary embolisms (OR: 6.62, 95% CI [5.07, 8.65], P < 0.001), acute renal failure (OR: 4.58 95% CI [4.09, 5.13], P < 0.001), pneumonia (95% CI [2.72, 3.83], P < 0.001), and myocardial infarctions (OR: 2.65, 95% CI [1.80, 3.92], P < 0.001) increased likelihood of death after undergoing HHA. Patients who were electively admitted (OR: 0.46 95% CI [0.35, 0.61], P < 0.001) had preoperative obesity (OR: 0.67, 95% CI [0.44, 0.84], P = 0.002), and a periprosthetic dislocation (OR: 0.51, 95% CI [0.31, 0.83], P = 0.007) and were found to have a decreased risk of mortality following THA.

Conclusions: Analysis of pre- and postoperative complications relating to HHA revealed that several comorbidities and postoperative complications increased the odds of mortality. Old age, pulmonary embolisms, acute renal failure, pneumonia, and myocardial infraction enhanced the odds of post-HHA mortality.

The management of periprosthetic joint infection (PJI) and surgical site infection (SSI) after joint arthroplasty poses a major challenge in orthopedic surgery. This Editorial provides an overview of the studies published in the special issue "Management of PJI/SSI after Joint Arthroplasty", summarizing the key findings from these studies, which cover a wide range of topics, including stringent preventive strategies, comprehensive diagnostic methods, and personalized treatment modalities. The authors concluded the editorial with their perspectives regarding the status quo of research in this field and future directions for research, such as the development of novel antibiotics, biofilm research, patient-specific risk factors, and the integration of technological advancements (such as machine learning and artificial intelligence) into clinical practice. The authors emphasized the need for continued research, interdisciplinary collaboration, and the application of innovative technologies to enhance patient outcomes and mitigate the burden of these infections on healthcare systems.

Background: Survivorship of medial unicompartmental knee arthroplasty (UKA) is technique-dependent. Correct femoral-tibial component positioning associates with improved survivorship. Image-free robotic-assisted unicompartmental knee arthroplasty enables preoperative and intraoperative planning of alignment and assessment of positioning prior to execution. This study aimed to compare the radiological outcomes between robotic-assisted UKA (R-UKA) and conventional UKA (C-UKA).

Methods: This retrospective case control study involved 140 UKA (82 C-UKA and 58 R-UKA) performed at an academic institution between March 2016 to November 2020, with a mean follow-up of 3 years. Postoperative radiographs were evaluated for mechanical axis and femoral-tibial component position. Component position was measured by two methods: (1) femoral-tibial component contact point with reference to four medial-to-lateral quadrants of the tibial tray and (2) femoral-tibial component contact point deviation from the center of the tibial tray as a percentage of the tibial tray width. Baseline demographics and complications were recorded.

Results: There was a higher mean component deviation in C-UKA compared with R-UKA using method 2 (17.2% vs. 12.8%; P = 0.007), but no difference in proportion of zonal outliers using method 1 (4 outliers in C-UKA, 5.1% vs. 1 outlier in R-UKA, 1.8%; P = 0.403). R-UKA showed no difference in mean mechanical alignment (C-UKA 5° vs. R-UKA 5°; P = 0.250). 2-year survivorship was 99% for C-UKA and 97% for R-UKA. Mean operative time was 18 min longer for R-UKA (P < 0.001).

Conclusion: Image-free robotic-assisted UKA had improved component medio-lateral alignment compared with conventional technique.