Arthroplasty最新文献

Background: This study compared transverse and longitudinal skin incisions in anterolateral supine (ALS) total hip arthroplasty (THA), focusing on cosmetic and sensory outcomes using the Patient Observer Scar Assessment Scale (POSAS).

Methods: A retrospective analysis was conducted on 132 hips that underwent primary ALS THA performed by a single surgeon between 2019 and 2024. Longitudinal incisions were used until December 2022, and transverse incisions aligned with relaxed skin tension lines were used thereafter. POSAS 3.0 was used to evaluate scar quality across satisfaction, appearance, and sensory domains.

Results: Baseline characteristics were similar between groups, except for follow-up duration and incision length. No significant differences were found in POSAS scores. However, regression analysis revealed that transverse incision significantly improved satisfaction (P = 0.04) and appearance (P < 0.05). Sensory scores were significantly affected by follow-up duration (P < 0.001).

Conclusion: Transverse incisions in ALS THA may enhance cosmetic satisfaction without compromising sensory outcomes. These findings support the potential role of personalized incision planning for improving patient-reported outcomes following THA. Video Abstract.

Objective: To review and synthesise the existing evidence on the effects of peripheral nerve block (PNB) compared with no nerve block on the incidence of postoperative delirium (POD) in adults undergoing hip fracture repair.

Methods: A systematic search of electronic databases (PubMed, Web of Science, EMBASE, and the Cochrane Library) for relevant literature published from database inception to 1st May 2025 was conducted. Randomised controlled trials with PNBs as an intervention in adults undergoing surgery for hip fractures were selected. Studies that excluded patients with preoperative cognitive dysfunction and observed POD as an outcome were eligible.

Results: Twelve randomised controlled trials, involving a total of 1157 participants, 602 in the control group and 555 in the intervention, were included for quantitative analysis. The meta-analysis revealed that PNBs significantly reduced the incidence of POD (RR: 0.68, 95% CI [0.50 to 0.91], P = 0.009, I² = 43%).

Conclusion: In patients without pre-existing cognitive impairment, the perioperative use of PNBs can reduce the occurrence of POD. However, substantial variation in study design and heterogeneity of PNB approaches limit the certainty of these findings. Future research calls for well-designed, standardised, and stratified clinical trials to compare the efficacy of each PNB approach and to evaluate their potential benefits in those at greater risk of POD, including those with baseline cognitive impairment and preoperative delirium. Video Abstract.

Purpose: Accurate prediction of postoperative coronal alignment is essential for successful outcomes following medial unicompartmental knee arthroplasty (UKA). Traditionally, valgus stress femorotibial angle (FTA) has been used to estimate the correctability of varus deformity; however, its reliability is limited by dependence on soft tissue behavior and examiner technique. In contrast, the arithmetic hip-knee-ankle angle (aHKA), calculated from bony anatomy, offers an objective and reproducible measure of constitutional limb alignment. While early studies suggest aHKA correlates well with postoperative alignment, direct comparison with valgus stress FTA has been lacking. This study aimed to compare the predictive accuracy of aHKA and valgus stress FTA for postoperative alignment and alignment correction (ΔHKA) in medial UKA.

Methods: This retrospective study included 125 knees undergoing medial fixed-bearing UKA. Preoperative aHKA was calculated from long-leg radiographs, and valgus stress FTA was measured using a Telos arthrometer. Postoperative hip-knee-ankle angle (HKA) was obtained from standardized radiographs. Correlation analyses were performed between postoperative HKA and both aHKA and 360°-valgus stress FTA. Similarly, correlations were assessed between ΔHKA and (aHKA-preoperative HKA) as well as (360°-valgus stress FTA-preoperative HKA). Fisher's Z-test was used to assess differences in correlation strengths.

Results: Postoperative HKA showed stronger correlation with aHKA (R² = 0.5003, P < 0.001) than with 360°-valgus stress FTA (R² = 0.1157, P < 0.001), with a statistically significant difference (Z = -4.12, P < 0.001). ΔHKA was more strongly associated with aHKA-preoperative HKA (R² = 0.3805, P < 0.001) than with 360°-valgus stress FTA-preoperative HKA (R² = 0.1111, P < 0.001) (Z = -2.92, P = 0.0036).

Conclusion: aHKA demonstrated superior predictive accuracy for both postoperative alignment and alignment correction compared to valgus stress FTA. As a bone-based and examiner-independent parameter, aHKA is a valuable tool for preoperative planning in medial UKA and may reduce the need for stress radiography. Video Abstract.

The implantation of total knee replacements is an effective treatment for advanced degenerative knee joint diseases. Implant positioning relative to the bones affects the loads occurring in the artificial joint, joint stability, and postoperative functionality. Variance in implant positioning during the surgical implantation of a total knee replacement cannot be entirely ruled out. By simulating implant malpositioning in an experimental setting, particularly critical cases of malalignment can be identified, from which guidelines for orthopedic surgeons can be derived. The AMTI VIVO™ six degree of freedom joint simulator allows reproducible preclinical testing of joint endoprostheses under specific kinematic and loading conditions. It features a virtual ligament model that defines up to 100 ligament fibers between the articulating components. This paper presents a method to investigate the effect of different implant positions on the biomechanics of the knee after total knee arthroplasty. For this, the VIVO joint simulator requires no modification of the physical setup by moving virtual ligament insertion points relative to the bone. As a proof of concept, exemplary shifts and rotations of the femoral and tibial implant components are performed, and dynamic results are compared to a musculoskeletal multibody digital twin and findings from the literature. Video Abstract.

Background: Vertebral compression fractures (VCFs) can impair posture, gait, and daily activities in patients undergoing total hip arthroplasty (THA). However, limited data are available regarding the incidence, risk factors, and impact of VCFs on sagittal spinal alignment following THA. Therefore, the purpose of this study was to investigate the incidence and risk factors of VCFs after THA, and to evaluate their impact on sagittal spinal alignment and clinical outcomes.

Methods: This retrospective cohort study included 220 patients (243 hips) who underwent primary THA, with a mean follow-up period of 6.1 years. Data collected included patient demographics, Fracture Risk Assessment Tool (FRAX) scores, lumbar bone mineral density measured before THA, sagittal spinal alignment parameters, Harris Hip Score (HHS), and the occurrence of new VCFs. We analyzed changes in spinal alignment and identified risk factors associated with incident VCFs.

Results: VCFs occurred in 20% of hips during the follow-up period. Patients who developed VCFs demonstrated a significantly increased sagittal vertical axis, reduced lumbar lordosis angle, and lower postoperative HHS compared to those without VCFs. Preexisting VCF and higher preoperative FRAX scores were significantly associated with the development of new VCFs. Multivariate logistic regression analysis identified the FRAX score as an independent predictor of incident VCFs.

Conclusions: In this 6.1-year retrospective cohort study, 20% of hips developed new VCFs after THA, which were associated with worsened spinal alignment and hip function. The higher FRAX score, calculated prior to THA surgery, is a useful predictor of VCF risk and may help identify individuals who require closer monitoring or preventive interventions during follow-up after surgery. Video Abstract.

Background: The management of retro-acetabular osteolysis in revision hip arthroplasty with acetabular component retention remains controversial and challenging due to limited access to the area.

Surgical technique and methods: Fourteen patients with well-fixed and well-aligned acetabular components underwent revision surgery and a retained shell. A vinyl urinary catheter and syringe were used to deliver demineralized bone matrix putty to the bone defect after debridement. Clinical outcome and radiographic follow-up were scheduled at a minimum of 2 years.

Results: The revision arthroplasty survivorship rate with this technique was 85.7% (12 of 14 patients) at a median follow-up of 6 years. One cup failed due to an aseptically loosening cup, and another from late septic loosening. Significant improvement of the University of California Los Angeles (UCLA) score, Harris Hip Score (HHS) pain subscale, and Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) were observed at a median 6-year follow-up.

Conclusions: Management of retro-acetabular osteolysis with injected demineralized bone matrix using a syringe and vinyl urinary catheter is a reliable, easy, low-cost method with satisfactory mid-term clinical outcome improvement. Video Abstract.

Background: Hemophilia A (HA) arthropathy poses a significant clinical challenge, particularly in achieving perioperative hemostasis and surgical precision. Accounting for the majority of hemophilia cases, HA frequently leads to severe secondary joint damage. Although gene therapy holds promise, its clinical application in HA remains limited by challenges to durable efficacy. Crucially, the transient efficacy and unpredictable pharmacokinetics of gene therapy have not been evaluated in major orthopedic surgeries with a high potential for bleeding, such as total hip arthroplasty (THA).

Case presentation: To our knowledge, this is the first documented case of robot-assisted (RA)-THA performed after gene therapy for severe HA-associated hip arthropathy, including a detailed surgical protocol and a postoperative follow-up of over six months. The patient received hemophilia gene therapy 56 weeks prior to surgery. Crucially, no exogenous FVIII supplementation was required preoperatively or intraoperatively. A minimal amount of FVIII was administered postoperatively. No abnormal bleeding events occurred throughout the perioperative period. The patient maintained normal coagulation status, achieved excellent wound healing, and demonstrated excellent functional recovery.

Conclusion: This pioneering case demonstrates the potential safety and efficacy of combining gene therapy with minimally invasive RA-THA for HA hip arthropathy. The integrated approach significantly reduced dependence on exogenous FVIII and enabled precise anatomical reconstruction.

Background: Precise implant positioning is critical for optimizing outcomes and implant longevity in total knee arthroplasty (TKA). Although body mass index (BMI) has been linked to postoperative complications, its association with implant malalignment remains inconclusive. As local soft tissue thickness (LSTT) may serve as a more relevant risk factor, this study aimed to evaluate the relationship between LSTT and implant alignment deviation and to compare its predictive value to BMI in conventional, manual TKA.

Methods: A total of 122 consecutive patients who underwent primary TKA using the ATTUNE Knee System were retrospectively analyzed. Preoperative local soft tissue thickness was assessed at three anatomical levels: the ankle (ankle-adipose-index [AAI]), pretubercular region (pretibial subcutaneous fat [PSF]), and knee joint (knee-adipose-index [KAI]) using standardized radiographs. Postoperative implant positioning was measured by assessing coronal and sagittal alignment parameters. Group comparisons, correlation analyses, and receiver operating characteristic (ROC) curve analysis were performed to investigate associations between LSTT, BMI, and alignment deviations.

Results: PSF showed a statistically significant moderate positive correlation with deviation from target proximal tibial angle (PTA) (r = 0.422, P = 0.043) and sagittal femoral angle (SFA) (r = 0.431, P = 0.041). Patients classified as outliers with alignment deviations greater than 3° had significantly higher PSF values for PTA and posterior slope angle (PSA) (P < 0.001). ROC analysis of pooled data identified an optimal PSF threshold of 10.9 mm to predict outliers (AUC = 0.59, sensitivity 66.7%, specificity 50.4%). No significant associations were found between AAI, KAI, or BMI and implant positioning.

Conclusion: PSF is a significant risk factor for component malalignment in both coronal and sagittal planes and provides a simple, radiograph-based measure that outperforms BMI in predicting alignment accuracy in conventional TKA. A PSF threshold of approximately 11 mm may help preoperatively identify patients at risk for malalignment, in whom navigation, robotics, or patient-specific instrumentation may be considered. Further prospective studies with larger cohorts and clinical outcomes are warranted to validate these findings. Video Abstract.

Background: There is no consensus on the antibiotic course or type of surgical treatment in streptococcal periprosthetic-joint infections (PJIs). We aimed to compare the treatment failure rate at 2 years of PJIs caused by streptococci to PJIs caused by other pathogens and identify factors associated with failure.

Methods: It was a single-center retrospective cohort study conducted between 2009 and 2019. We included all patients aged ≥ 18 years undergoing treatment for hip or knee PJI with a 2-year follow-up. We analyzed the treatment failure rate at 2 years of streptococcal PJIs versus PJIs caused by other pathogens with failure defined as a non-successful treatment using the Delphi-based international multidisciplinary consensus of success. We also analyzed factors associated with failure including streptococcal etiology and type of treatment.

Results: We included 404 patients; 62 (15%) had a streptococcal PJI, of which 14 (23%) exhibited treatment failure at 2 years. The treatment failure rate was similar to that for PJIs caused by other pathogens (21%, 71/342) (P = 0.78). Streptococci were not associated with failure (OR = 1.55, 95% CI 0.62-3.89, P = 0.35). However, Streptococcus dysgalactiae (OR = 9.45, 95% CI 1.37-65.46, P = 0.02) and debridement, antibiotics and implant retention (DAIR) (OR = 9.31, 95% CI 1.80-48.20, P = 0.008) were associated with failure among patients with a streptococcal PJI.

Conclusions: The treatment failure rate of streptococcal PJIs was similar to that for PJIs caused by other pathogens. However, Streptococcus dysgalactiae and DAIR were factors associated with failure among patients with a streptococcal PJI. Our results suggest that streptococcal PJIs, especially Streptococcus dysgalactiae PJIs, should be surgically treated more aggressively with an implant exchange.

Objective: Limited research exists on factors influencing early postoperative swelling after total knee arthroplasty (TKA). This prospective observational cohort study aims to analyze patterns and predictors of early postoperative inflammatory swelling following TKA, informing high-risk screening and interventions.

Methods: This study measured 110 TKA patients' (76.4% female, mean age 69.51 ± 7.46 years) lower limb circumference (10 cm/5 cm above patella, patella, calf, ankle) preoperatively and postoperatively 1-5 days. Variables of interest included body mass index (BMI), preoperative joint pain, postoperative joint and thigh pain, cryotherapy duration, and inflammatory biomarkers.

Results: Swelling peaked proximally at 5 cm above the patella on day 3 (4.16 ± 2.90 cm). Multivariable regression analysis identified BMI as a core predictor of lower limb swelling (P < 0.05), with a 1-unit increase in BMI corresponding to a 0.18-0.24 cm increase in proximal leg circumference. Pain timing was site-specific: swelling 10 cm above the patella was associated with preoperative joint pain on touch (β = 0.184, P = 0.052), calf swelling with postoperative joint pain at rest (β = 0.213, P = 0.022), and ankle swelling with postoperative thigh pain at rest (β = 0.228, P = 0.017). Other factors and inflammatory markers were not significantly associated with swelling (P > 0.05). However, preoperative joint pain during activity correlated with higher white blood cell (WBC) counts (P = 0.012), and postoperative thigh resting pain with elevated C-reactive protein (CRP) levels (P = 0.035).

Conclusion: Early postoperative proximal swelling following TKA warrants attention, as chronic pro-inflammatory states in obese patients and the progression of knee osteoarthritis lead to elevated inflammatory levels, exacerbating postoperative swelling. Focus should be placed on high-risk patients with obesity and preoperative joint pain on touch.

Trial registration: ChiCTR2500098167. Video Abstract.