Arthroplasty最新文献

Objective: To identify and characterise distinct post-operative physical activity profiles in joint arthroplasty patients.

Methods: This cohort study utilised wrist-worn accelerometer data from the UK Biobank, linked to hospital records, to identify patients who underwent primary unilateral hip or knee arthroplasty. Daily step counts from 4 to 12 months post-operatively were extracted using validated algorithms. Principal component analysis (PCA) was applied to demographic and clinical variables to reduce dimensionality, followed by clustering using k-means and Partitioning Around Medoids (PAM). The optimal number of clusters was determined using the elbow method and silhouette score. Clustering validity was assessed using the Rand Index and Adjusted Rand Index.

Results: 237 patients were included, the majority of whom were female, with a mean age of 66 years. Based on the elbow plot and the highest average silhouette width, a two-cluster solution was deemed optimal, consistently emerging across both clustering methods as distinct high-and low-performing physical activity profiles. High performers had significantly higher daily step counts (mean > 10,000 vs. < 6,000, P < 0.001), were younger, had a lower body mass index, fewer comorbidities, and were more likely to have undergone total hip replacement. Sociodemographic factors such as higher educational attainment and lower deprivation index were also associated with the high-performing group. The clustering methods demonstrated a weak-but-positive agreement (ARI = 0.224).

Conclusion: Unsupervised learning of accelerometer-derived physical activity data revealed two clinically meaningful recovery profiles following joint arthroplasty. These findings underscore the multifactorial nature of post-operative recovery and support the development of personalised rehabilitation strategies to improve outcomes in lower limb arthroplasty patients. Video Abstract.

Background: This systematic review and meta-analysis aimed to quantify risks of complications associated with total hip and knee arthroplasty (THA, TKA) in patients with solid organ transplants (SOT) compared to the general population.

Methods: The study was pre-registered on PROSPERO (CRD42023399043). Literature searches were performed looking for comparative studies reporting postoperative complication data of THA or TKA in patients with kidney, liver, pancreas, heart, or lung transplants versus controls. Outcomes of interest included incidence of blood transfusion, periprosthetic joint infection (PJI), periprosthetic fracture, deep venous thrombosis (DVT), pulmonary embolism (PE), mortality, hospital re-admission, and all-cause revision. The Newcastle Ottawa scale was used to assess study quality, and the GRADE for certainty of evidence.

Results: A total of 13 studies participated in meta-analyses (10 in THA, 3 in TKA). Compared to controls, SOT patients (mixed data from all transplant types) had a significantly higher incidence of blood transfusion [THA OR 1.57 (1.36-1.80), TKA OR 1.37 (1.15-1.63)], PJI [THA OR 1.78 (1.01-3.12), TKA 3.11 (1.16-8.35)], DVT [THA OR 1.32 (1.04-1.66), TKA OR 1.56 (1.36-1.78)], and all-cause revision [only TKA OR 1.37 (1.15-1.63)]. THA in kidney transplant patients was associated with higher early mortality [OR 2.12 (1.38-3.25)] and 30-day re-admission [OR 1.62 (1.31-2.00)] compared to the general population. SOT was not associated with a higher incidence of post-operative PE after either THA or TKA [OR 0.94 (0.66-1.34), OR 0.89 (0.55-1.43), respectively]. The incidence of THA dislocation in mixed analyses with all SOT types was not statistically significant despite the unfavourable OR [1.62 (0.94-2.78)], but it was in the kidney and heart transplant subgroup analyses (OR 1.41 (1.16-1.73), OR 2.17 (1.47-3.20), respectively). The incidence of periprosthetic fracture was not higher in SOT patients compared to controls in those undergoing a THA [OR 1.07 (0.84-1.36)], but it was after a TKA [OR 1.79 (1.36-2.36)].

Conclusion: THA and TKA are associated with an unfavourable complication profile in SOT patients compared to the general population. Decisions for or against arthroplasty surgery should be made on an individual basis with a multidisciplinary approach.

Background: Robotic TKA (rTKA) was developed to improve implant positioning and accuracy of bone cuts, potentially resulting in improved functional outcomes for the patient. The Depuy Synthes VELYS™ Robotic-Assisted Solution (VRAS) is one of the latest, imageless systems available and utilizes the ATTUNE™ primary knee system. Due to its recency, there is limited literature on the outcomes of VRAS compared to its conventional total knee arthroplasty (cTKA) counterpart. This paper aims to look at the differences between VRAS and cTKA regarding early postoperative and 6-month functional outcomes.

Methods: Registry data of all primary TKAs performed by 3 surgeons from January 2021 to December 2024 from a high-volume arthroplasty center were analysed. Patients who underwent VRAS or cTKA using ATTUNE™ implants were included. Propensity scores were estimated using logistic regression, followed by optimal matching in a 1:1 ratio to establish the VRAS and cTKA groups. Early postoperative outcomes (static/dynamic pain score, ambulation distance, length of stay), 6-month functional outcomes (Knee Society Score, Oxford Knee Score, SF-36, patient expectation/satisfaction scores), and proportion attaining a minimum clinically important difference (MCID) were analysed.

Results: Sixty-five VRAS patients were matched with 65 in the cTKA group. The VRAS showed significantly shorter surgical duration (78.2 vs. 85.5 min, P = 0.04), improved ambulation distance (22.2 vs. 11.3 m, P < 0.001), and shorter length of stay (2.48 vs. 3.66 days, P = 0.01). Both groups showed significant improvements in the majority of the functional outcome scores at 6 months. The VRAS displayed a trend towards higher SF-36 outcome measures, with significant differences in SF-36 vitality (P = 0.001), SF-36 mental component summary (P = 0.015), and a larger proportion of patients achieving SF-36 bodily pain MCID (76.9 vs 60.0%, P = 0.038). More patients reported satisfaction and expectation fulfillment (95.2% vs 92.3% and 92.1% vs 87.7%, respectively), albeit non-significantly (P = 0.718 and P = 0.413).

Conclusion: The VRAS TKA demonstrated superior immediate postoperative advantages and patient-reported functional outcomes at 6 months. Further studies are needed to determine long-term outcomes.

Trial registration: Centralized Institutional Review Board (CIRB: 2024-4046).

Background: Computer-assisted navigation has improved surgeons' ability to achieve accurate implant placement in total knee arthroplasty (TKA). As technology evolves and new systems are introduced, it is imperative to evaluate their accuracy for achieving desired goals.

Methods: This work evaluated the accuracy of a novel mixed reality surgical guidance platform that uses a head-mounted device to measure patient bony anatomy, quantify soft tissue balance, and provide quantitative resection guidance overlaid on the surgical field. Accuracy is evaluated in a cadaveric simulated use study and in a comprehensive evaluation of the tracking subsystem using the international ASTM standard F2554-22. Depth and angular errors are reported across eight knees for the proximal tibial, distal femoral, and posterior femoral resections by comparing platform-navigated resection metrics to caliper-measured resection depths and post-operative CT-measured angles. Analysis of the tracking subsystem investigated instrument localization error across the tracking volume, including rotational and positional extremes. Testing also extended the ASTM standard to include additional rotation tests and an evaluation procedure for planar accuracy metrics.

Results: All cadaveric simulated use depth and angular absolute errors were below 2 mm and 2°, with 83% less than or equal to 1 mm and 1°. Absolute resection errors averaged 0.7 ± 0.4 mm and 0.6 ± 0.4° for depths and angles, respectively. The tracking subsystem localized over 99.5% of points with positional accuracy better than ± 2 mm and localized over 99.5% of planes with angular accuracy better than ± 1°. Average absolute tracking errors were sub-millimeter and sub-degree.

Conclusion: This open and imageless platform for TKA surgical guidance requires only 13 landmarks with no additional equipment footprint, minimal tooling, and data overlaid holographically onto the surgical scene, while still providing a comprehensive set of metrics with state-of-the-art accuracy. Video Abstract.

Background: Although robot-assisted TKA improves alignment accuracy, the understanding of soft tissue stiffness remains limited. This study aimed to investigate the impact of preoperative and constitutional alignment on the stiffness of knee compartments during robot-assisted TKA.

Methods: We included 151 patients who underwent primary robot-assisted TKA between May 2021 and May 2022. A digital joint-tensioning device was used intraoperatively to apply stepwise increasing tension (30-90 N) to the medial and lateral knee compartments. The device measured corresponding gap changes at 0°, 10°, and 90° of flexion. Linear regression was used to analyze the relationship between gap changes and applied tension, and the regression slope (K value) was used to compare stiffness between compartments. Preoperative factors, including hip-knee-ankle angle and Coronal Plane Alignment of the Knee (CPAK) subtypes, were assessed for their influence on stiffness.

Results: There were significant differences in stiffness (K values) between medial and lateral compartments, particularly at higher flexion. The medial compartment generally showed greater stiffness. The medial-to-lateral stiffness ratio increased with greater varus alignment. Significant differences in K_M/K_L ratios were found among CPAK subtypes at 0° and 10° flexion.

Conclusion: This study introduced gap-tension regression for assessing soft tissue stiffness in robot-assisted TKA and showed that stiffness is influenced by preoperative and constitutional alignment. Varus alignment was associated with higher medial-to-lateral stiffness, and CPAK subtypes showed distinct stiffness patterns. These findings may help optimize soft tissue balancing and improve outcomes in TKA.

Background: Accurate and timely diagnosis of periprosthetic joint infection (PJI) is of utmost importance. Although synovial alpha-defensin has shown potential as a biomarker, recent studies have questioned its additional benefit over traditional synovial biomarkers and advised against its routine use. The primary objective is to evaluate the diagnostic accuracy of the alpha-defensin immunoassay in PJI. Secondary objectives include comparing its diagnostic accuracy against traditional biomarkers and assessing our results in the context of existing research to provide a solid perspective on its clinical utility.

Methods: This is a prospective cohort study. Synovial samples were obtained at the time of revision arthroplasty or from painful arthroplasties. A complete laboratory workup was performed, including CBC, ESR, CRP, WBCs count. Synovial samples were analyzed for leucocytic count, PMN percentage, leucocyte esterase, and alpha-defensin immunoassay. Culture and sensitivity, and histopathology were also done. Patients who met the inclusion criteria were classified into septic and aseptic according to MSIS criteria.

Results: Ninety joints met our inclusion criteria. Alpha-defensin immunoassay was positive in 36 joints and negative in 54 joints, with 1 false positive and 3 false negatives, resulting in a sensitivity of 92.11% (95% CI, 78.62-98.34%), a specificity of 98.08% (95% CI, 89.74-99.95%), positive predictive value (PPV) of 49.43% (95% CI, 12.28-87.22%), negative predictive value (NPV) of 99.84% (95% CI, 99.52-99.94%) and diagnostic accuracy of 97.96% (95% CI, 92.48-99.78%). The optimal cutoff was 9.2, and the area under the curve (AUC) was 0.945.

Conclusions: While the alpha defensin immunoassay is not recommended to be used routinely as a screening method for PJI, its high specificity and NPV make it a valuable addition to traditional blood and synovial parameters in the diagnosis of complex hip and knee PJI, particularly for ruling out infection.

Background: Preoperative radiographic templating plays an important role in optimizing total hip arthroplasty (THA). Digital templating software ensures precise implant selection, but can be costly and limited to select workstations. A new method using an iPhone/iPad with the picture archiving and communication system (PACS) offers comparable accuracy but is restricted by Apple's ecosystem. To improve accessibility, we adapted this method for Android smartphones and tablet computers, enabling broader use among surgeons. This study aimed to compare the accuracy and reproducibility of this novel method with a commercial digital templating software.

Methods: Radiographs of 124 hips were retrospectively templated by two independent assessors using three methods. The first used OrthoView® digital templating software. The other two, performed on an Android smartphone and tablet, utilized the PACS measurement tool. A circle was drawn on the acetabular radiograph to represent the cup, then a photograph of the display was imported into Microsoft PowerPoint 365®, where transparent femoral stem templates, scanned from plastic templates, were overlaid. Templating results were compared with implanted cementless THA components for accuracy. Intra-rater and inter-rater reliabilities were analyzed to assess consistency between and within assessors.

Results: Predicting the acetabular cup ± 1 Size could be achieved in 91.1% of cases (113 hips) by OrthoView® and 88.7% (110 hips) by the novel method (P = 0.674). The accuracies of three methods were comparable to predict ± 1 size of femoral stem [OrthoView® 90.3% (112 hips), smartphone 85.5% (106 hips), and tablet 87.9% (109hips), P = 0.526], and neck length [OrthoView® 94.4% (117 hips, smartphone 91.9% (114 hips), and tablet 93.5% (116 hips), P = 0.571]. The neck offset was correctly predicted using OrthoView® in 83.1% (103 hips), comparable with 81.4% (101 hips) using a smartphone and 85.5% (106 hips) using a tablet (P = 0.717). No different accuracy was found in each type of the 4 designs of the implanted femoral stems. All methods showed substantial and excellent agreement for intra- and inter-rater reliabilities.

Conclusions: Digital templating for THA using an Android smartphone, tablet, and PACS provides accuracy comparable to commercial software. It is reliable and reproducible for predicting cementless prosthetic size, neck length, and offset across femoral stem types.

Background: Implant malalignment in total knee arthroplasty (TKA) correlates with poor outcomes, and robotic-assisted systems aim to improve precision. While closed-platform robotic systems dominate the market, their restriction to proprietary implants limits surgical flexibility. This study evaluates the radiological accuracy of an open-platform robotic system (Yuanhua KUNWU) across four TKA implant designs.

Methods: A multi-centre retrospective analysis of 129 robotic-assisted TKAs (Zhengtian Irene, n = 60; DePuy Synthes Attune, n = 32; Zimmer Biomet Persona, n = 20; Smith & Nephew Legion, n = 17) was conducted. Patients with end-stage osteoarthritis (Kellgren-Lawrence grade 3-4) were included, while those with prior knee surgery or complex anatomy were excluded (n = 15). A total of 114 pre-operative and post-operative alignment (hip-knee-ankle angle [HKA], femoral and tibial component coronal angles [FCCA, TCCA], posterior tibial slope [PTS]) were measured on radiographs by two independent reviewers. Interobserver reliability (intra-class correlation [ICC], Cronbach's α) and deviations from planned alignment (paired t-tests) were analysed. Acceptability was defined as ≤ 3° deviation.

Results: Interobserver reliability was excellent (ICC > 0.77, Cronbach's α > 0.87 for all parameters). Mean post-operative deviations from planned alignment were clinically small: HKA (+1.32°, P < 0.001), FCCA (-0.55°, P < 0.001), TCCA (+0.19°, P = 0.097), and PTS (-0.42°, P = 0.018). All mean differences were within the 3° acceptability threshold. Subgroup analysis of pre- and post-operative alignment between implant types also showed deviations of < 3°.

Conclusions: The KUNWU open-platform robotic system achieved high radiological accuracy across four implant designs, with alignment deviations < 1.5°. This suggests open-platform robotics can provide implant versatility without compromising precision. Further studies regarding the assessment of long-term clinical and patient-reported outcomes and comparison with closed-platform systems are warranted.

Introduction: Intra-articular distal radius fractures (DRF) frequently result in post-traumatic cartilage defects, which can lead to early osteoarthritis, particularly when residual step-offs or gaps ≥ 2 mm remain after fracture reduction. While cartilage repair techniques are well established in large joints, options for small joints like the wrist remain limited. Chondrofiller liquid, a cell-free collagen type I hydrogel, has demonstrated regenerative potential in larger joints; however, its application in the wrist has not yet been studied.

Methods: In this prospective clinical study, 59 patients with intra-articular DRFs treated by arthroscopy-assisted open reduction and internal fixation (ORIF) were included. In 25 cases, residual chondral defects between 0.5 and ≤ 2 mm were filled with Chondrofiller. Technical feasibility, defect characteristics, and application parameters were recorded. A subgroup of 8 Chondrofiller-treated patients underwent follow-up arthroscopy and was compared to a matched control group (n = 7) that had received ORIF without Chondrofiller. Cartilage quality was assessed using Outerbridge and the International Cartilage Repair Society (ICRS) classifications.

Results: Chondrofiller was applied arthroscopically under dry conditions using G20-21 cannulas. Only 0.2-0.3 mL of the 1 mL preparation was required in most cases. At follow-up arthroscopy, patients treated with Chondrofiller showed significantly better cartilage quality (median Outerbridge 1.5 vs. 3, P = 0.006; ICRS 1 vs. 3, P = 0.002). Fibrous tissue formation (FTF) occurred only in overfilled defects, while flush applications were free of FTF. No significant differences were found in consolidation, complications, or associated injuries between groups.

Conclusion: Chondrofiller is technically feasible and safe for use in the wrist. When applied precisely and flush with the cartilage surface, it may improve cartilage quality after intra-articular DRF. Further long-term clinical and radiological studies are needed to assess its effectiveness in preventing post-traumatic osteoarthritis and to evaluate cost-effectiveness compared to standard treatment.

Background: This study aims to investigate whether individualized component positioning in robotic-assisted total hip arthroplasty (RTHA) using three-dimensional (3D) Functional Component Positioning Assessment (FCPA) reduces prosthetic and bone impingement and improves Patient-Reported Outcome Measures (PROMs).

Methods: This retrospective study includes 100 consecutive patients who underwent RTHA at a single center between May 2021 and March 2022 using the Mako THA system. Preoperative imaging and planning incorporated sacral slope (SS) measurements. SS values in standing and sitting positions were uploaded into the robotic software to simulate prosthetic hip motion during FCPA and guide component orientation. The primary outcome measures included intraoperative impingement analyses using FCPA and postoperative PROMs, including the Oxford Hip Score (OHS), Forgotten Joint Score (FJS-12), and Hip Disability and Osteoarthritis Outcome Score (HOOS).

Results: Impingement was detected in 46% of patients during daily living activities, with prosthesis-on-prosthesis being the most frequent impingement type. No statistically significant differences in PROMs were observed between patients with and without impingement. Nonetheless, overall PROMs were excellent, with a mean HOOS of 94.2 ± 8.3, mean FJS-12 of 87.8 ± 17.2, and mean OHS of 92.3 ± 10. Multivariate analysis revealed that higher BMI negatively impacted PROMs, and the SS difference correlated significantly with OHS and FJS-12 scores (P < 0.0001).

Conclusions: Individualized component positioning, even when aided by 3D FCPA, does not eliminate the risk of impingement. The concept of a universal "safe zone" may be inadequate to prevent impingement, emphasizing the need for patient-specific implant positioning strategies based on spinopelvic mobility. While impingement did not significantly impact PROMs, optimizing implant positioning through robotic-assisted techniques may contribute to improved long-term outcomes and reduced dislocation risk.