Arthroplasty最新文献

Background: Intraoperative periprosthetic femur fracture is a serious complication in hip arthroplasty, affecting patient outcomes. This study explored the biomechanical properties of the proximal femur, specifically comparing prophylactic cerclage wiring to non-wiring techniques using finite element analysis (FEA) and cadaveric biomechanical testing.

Method: A finite element model of the proximal femur was constructed using Ansys software, allowing systematic assessment of both wiring area and technique to identify biomechanically optimal locations and configurations for cerclage placement. Twenty fresh cadaveric femurs were prepared according to standard protocols; the left femurs received cerclage wiring, while the right served as controls. Each femur was fitted with a femoral stem and tested under axial loading until catastrophic failure. Outcomes measured included ultimate load, seating load, subsidence distance, and energy absorption. Statistical analysis included the Shapiro-Wilk test for normality and independent t-tests for group comparisons.

Results: The wiring group demonstrated comparable biomechanical performance to the non-wiring group across all measured parameters. Energy absorption was similar between groups (41.9 ± 18.1 Nm vs. 41.0 ± 19.1 Nm, P = 0.918). No significant differences were observed in ultimate load (7.6 ± 2.1 kN vs. 7.7 ± 2.0 kN, P = 0.901) or seating load (3.1 ± 0.7 kN vs. 3.4 ± 1.4 kN, P = 0.589). Similarly, subsidence distance showed no intergroup difference (7.7 ± 2.6 mm vs. 7.7 ± 3.8 mm, P = 0.978).

Conclusion: Cerclage femoral wiring for prophylactic purposes during hip arthroplasty does not confer a significant biomechanical advantage over non-wiring techniques.

Background: Periprosthetic joint infection (PJI) is a serious complication that necessitates a complex treatment strategy. Single-stage exchange arthroplasty, combined with intravenous and intra-articular antibiotic infusions, has shown high efficacy in treating complex PJIs. However, the impact of this approach on hematologic parameters remains underexplored. This study aims to evaluate the postoperative trends in blood platelet count, white blood cell (WBC) count, and neutrophil count in patients undergoing single-stage exchange arthroplasty.

Methods: A retrospective analysis was conducted on 313 patients who underwent single-stage revision for PJI between June 2010 and October 2022. Hematologic parameters were monitored for the first seven postoperative days. The delta between preoperative and lowest postoperative values for platelet, WBC, and neutrophil counts was calculated. Statistical analyses compared these changes between revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) groups.

Results: Platelet count significantly decreased postoperatively, reaching its nadir on day 2.5 for rTHA and day 2.8 for rTKA. The delta in platelet count was higher in rTHA patients (73.5 × 10⁹/L) compared to rTKA patients (46.0 × 10⁹/L). The incidence of thrombocytopenia was higher in the rTHA group (28.7%) compared to the rTKA group (12.3%). Multivariate regression analysis identified rTHA and preoperative platelet levels as independent risk factors for greater postoperative platelet decreases. WBC and neutrophil counts initially increased postoperatively, peaking on day 1, and then gradually declined, with nadirs around day 4-5.

Conclusion: Single-stage revision for PJI is associated with significant postoperative decreases in platelet count, particularly in patients undergoing rTHA. However, this hematologic change did not result in bleeding complications and may not represent a major clinical concern in most patients. Routine monitoring remains advisable to guide perioperative management.

Introduction: Major robotic systems for total knee replacements necessitate the use of array pins in the tibia and femur. These extra-incisional pins are placed away from the primary incision and may be associated with soft tissue complications and peri-prosthetic fractures. There is currently no standardized, reproducible method for reliably placing pins in the femur and tibia metaphyses. We have developed an all-intra-incisional pin method within the primary incision. This paper aims to describe our technique, analyse the proximity of the pins to the implants, and study complications arising from both techniques.

Methods: A total of 102 robotic-assisted total knee arthroplasties were performed using the ROSA, MAKO, and CORI systems. Patient charts were reviewed for their age, gender, body mass index, and ethnicity. Post-operative day zero radiographs of the operated knee were used for measurements in anteroposterior and lateral views, with X-ray magnifications taken into consideration.

Results: Our study demonstrates that intra-incisional pins can be placed 6.52 times closer to the tibial implant compared to extra-incisional pins on the anteroposterior X-ray view radiographs, with no observed significant difference between the complication rates. In anteroposterior view, it allows placement of tibia pins within 8.99 ± 1.21 mm (95% CI: 7.78, 10.2) of the tibial implant, within 5.93 ± 1.29 mm (95% CI: 4.64, 7.22) of the tibia-reamed-surface, and placement of the femoral pins within 6.01 ± 1.37 mm (95% CI: 4.64, 7.37) of the femoral implant. In the lateral X-ray view, it enables the placement of tibial pins within 9.40 ± 1.43 mm (95% CI: 7.97, 10.8) of the implant. Univariate analysis reveals that our technique and pin-distance from the implants are not influenced by patient demographics.

Conclusion: Our study has demonstrated that our technique is precise, not affected by patients' demographics, and eliminates the need for pin repositioning, potentially reducing the incidence of pin-site complications.

Background: A new non-invasive augmented reality-based portable navigation system was developed for accurate cup positioning during total hip arthroplasty in the supine position. This study aimed to clarify whether the navigation system supports cup positioning more accurately than a conventional goniometer during surgery.

Methods: In total, 60 patients who underwent total hip arthroplasty in the supine position between September 2021 and August 2022 were retrospectively investigated. The navigation system was used for 30 patients (navigation group), and a conventional goniometer was used for 30 patients (control group) to measure radiographic cup inclination and anteversion during surgery. The primary outcome was the absolute value of the difference in cup alignment measured during surgery and via postoperative radiography.

Results: An assessment of the primary outcome showed no significant difference in the radiographic cup inclination in the navigation and control groups (2.9° vs. 3.2°; mean difference, 0.3°; 95% confidence interval, - 1.4 to 0.9; P = 0.67); however, the positioning in the navigation group was significantly more accurate than that in the control group in terms of radiographic anteversion (3.4° vs. 5.4°; mean difference, 2.0°; 95% confidence interval, 0.4-3.8; P = 0.017).

Conclusions: A new non-invasive augmented reality-based portable navigation system resulted in more accurate cup anteversion than the conventional goniometer.

The treatment for an acute Periprosthetic Joint Infection (PJI) is historically described using the acronym DAIR (Debridement, Antibiotics, Implant Retention). However, this acronym, by intention, does not imply that the modular parts of an implant system are always exchanged. There are many circumstances where modular exchange is not possible. It is well known that DAIR procedures with modular exchange show improved results. To reduce heterogeneity in the published literature, we introduce the supplementary acronym DECRA (Debridement, Modular Exchange, Component Retention, Antibiotics) for the treatment of acute PJI. The DECRA acronym will identify studies where modular exchange is always performed and will be separate from DAIR, where modular exchange is not performed or is unclarified. This will reduce heterogeneity and provide fidelity in research analysis. Moving forward, we advocate that the orthopaedic community, reviewers, and journal editors mindfully reflect this distinction in publications.

Background: Proper coronal alignment plays a critical role in the effectiveness of medial unicompartmental knee arthroplasty (UKA). This research seeks to explore the connection between the arithmetic hip-knee-ankle angle (aHKA) and the actual postoperative (postop) HKA angle after undergoing medial UKA.

Methods: A retrospective analysis was conducted on individuals who received medial UKA at a specialized orthopedic hospital between January 1, 2024, and July 31, 2024. The aHKA was determined using the formula: medial proximal tibial angle (MPTA) minus lateral distal femoral angle (LDFA), plus 180°. The relationships between the postop HKA angle and the aHKA, MPTA, and LDFA were analyzed. Patients were further divided into three categories based on their postop HKA angle: greater than 180°, between 175° and 180°, and less than or equal to 175°. These groups were then compared in terms of aHKA, LDFA, MPTA, and preoperative HKA angle.

Results: A total of 242 patients (254 knees) were included in this study. The postop HKA was nearly equal to the preoperative aHKA (176.09° ± 2.86° vs. 176.23° ± 3.15°). Statistical analysis revealed a positive association between aHKA and postop HKA angle (R² = 0.4595, P < 0.05), as well as between MPTA and postop HKA angle (R² = 0.2072, P < 0.05). Conversely, a negative correlation was identified between LDFA and postop HKA angle (R² = 0.2448, P < 0.05). These patterns held true for both fixed-bearing and mobile-bearing UKA prostheses. Notable differences among the three HKA groups were found regarding aHKA, MPTA, LDFA, and preoperative HKA angle (P < 0.05).

Conclusion: The findings indicate that aHKA has a strong relationship with the postop HKA angle, suggesting its potential as an effective predictor for postop coronal alignment after medial UKA, irrespective of the type of prosthesis used.

Background: Periprosthetic joint infection (PJI) is a significant complication following total joint arthroplasty that demands rapid, accurate diagnosis. The leukocyte esterase (LE) test shows promise, but studies vary in cut-off values and omit the centrifugation's effect. In this study, we assessed the sensitivity and specificity of the LE test across different cut-off values, both with and without centrifugation. We aimed to identify the optimal threshold for diagnosing PJI and to compare its diagnostic odds ratio (DOR) to those of biomarkers recommended by the International Consensus Meeting (ICM).

Methods: A comprehensive literature search was performed in PubMed, Scopus, Web of Science, and Embase up to May 2024. Studies were included if they evaluated the diagnostic accuracy of LE for PJI in TJA and provided sufficient data for constructing 2 × 2 contingency tables. Data extraction and quality assessment were independently conducted by two reviewers using a standardized form and the QUADAS-2 tool. Statistical analysis involved pooling data using a bivariate random-effects model and constructing summarized receiver operating characteristic (sROC) curves.

Results: Out of 2195 records, 26 studies involving 4,206 joints (1,282 with PJI) were included. The optimal LE cut-off point without centrifugation was 3 + , yielding a sensitivity of 0.877, a specificity of 0.957, and a DOR of 159.2. With centrifugation, a 2 + cut-off provided a sensitivity of 0.899, a specificity of 0.924, and a DOR of 108.6. Direct comparison with other biomarkers indicated that polymorphonuclear neutrophils percentage (PMN%), white cell count (WCC), and alpha defensin (AD) had a slightly higher diagnostic odds ratio and Youden index than LE. Direct comparison with other biomarkers also indicated that erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), synovial CRP, and D-dimer had lower DOR and Youden index than LE.

Conclusions: The LE test is an effective diagnostic tool for PJI. Adopting a 3 + cut-off point without centrifugation and a 2 + one with centrifugation optimizes diagnostic accuracy.

Background and purpose: The design and coating of uncemented joint implants impact bone ingrowth and thereby the stability of the implant. This prospective randomized clinical trial aimed to compare early migration of two uncemented, similarly shaped femoral stems with either calcium phosphate or hydroxyapatite coating.

Patients and methods: 93 patients (102 hips) were randomized to either an intervention calcium phosphate or a conventional hydroxyapatite-coated stem. Migration measurements were performed postoperatively, and at 6 weeks, 3, 12 months, and 2 and 5 years after operation, and analyzed with radiostereometric analysis.

Results: There were no significant differences in migration between the two stems from postoperative to 5-year follow-up. With 6 weeks follow-up as baseline, the calcium phosphate coated stem showed a tendency towards migrating less with a maximum total point motion up to 2 years of 0.84 mm (0.68 to 1.00 95% CI) compared to the hydroxyapatite-coated stem which migrated 1.25 mm (0.99 to 1.52 95% CI) (P = 0.010).

Conclusions: Our data show that the calcium phosphate-coated stem is a safe implant in terms of ingrowth stability, and with migration patterns comparable to a hydroxyapatite-coated stem.

Background: Robotic Total Knee Arthroplasty (rTKA) has become increasingly popular. Intraoperative manual planning of femur and tibia implant positions in all degrees of freedom to achieve surgeon-defined targets and limits of bone cuts, gaps, and alignment is challenging. The final manually defined solution may not be optimal, and surgical duration increases significantly. We aim to demonstrate the effectiveness of our novel algorithm in terms of accuracy and surgical duration.

Methods: We developed a novel AI computational algorithm to optimize rTKA implant positioning in three-dimensional space. The initial parameters of 3D implant positioning and surgeon-defined target gaps and bone cuts are set. The algorithm determines permutations achieving ideal 3D implant positioning with ± 0.5 mm accuracy, ranking them by surgeon preference and evidence-based criteria. We compared accuracy in achieving surgeon-defined target gaps, intraoperative soft tissue balancing duration, and total surgical time.

Results: A prospective study of 67 consecutive rTKA patients at a tertiary institution (Nov 2021-Dec 2023) was conducted. 25 patients (mean age 70.4 ± 7.34 years) had our algorithm used intraoperatively, while 42 (mean age 70.5 ± 6.90 years) did not. 92% of rTKAs using our algorithm achieved target gaps ± 1.5 mm, vs. 52% of non-algorithm rTKAs (P = 0.003). The average difference between surgeon-defined target gaps and final achieved gaps was 1.1 ± 0.5 mm in the algorithm group vs. 1.8 ± 1.0 mm in the non-algorithm group (P = 0.003). Soft tissue balancing duration was significantly shorter: 1.16 min ± 0.11 with algorithm use vs. 14.5 min ± 8.3 (P < 0.0001). Total surgical duration was also significantly lower: 38.4 min ± 14.9 vs. 73.7 min ± 19.6 (P = 0.0002).

Conclusion: Our novel AI algorithm significantly improves accuracy in achieving surgeon-defined target extension and flexion gaps while reducing soft tissue balancing and total surgical duration. This is highly promising for achieving both reproducibility and efficiency in rTKAs. Video Abstract.

Background: Although reverse shoulder arthroplasty (RSA) is a popular treatment, its efficacy in patients with failed rotator cuff repair (ARCR) remains unclear. In this study, we aimed to evaluate the clinical results of RSA for following failed ARCR. We hypothesized that RSA after failed ARCR would lead to improved clinical outcomes comparable to those of RSA performed without prior surgeries.

Methods: Between January 2017 and December 2022, 143 patients underwent RSA at our institution. We included 85 patients who met the study criteria and followed them for a minimum of 2 years. The patients were divided into two groups: those who underwent RSA for failed ARCR (group A: 25 patients; mean age, 77.7 years) and those who underwent primary RSA (group B: 60 patients; mean age, 77.9 years). The University of California, Los Angeles (UCLA) scores, Japanese Orthopaedic Association (JOA) scores, range of motion (ROM), Numerical Rating Scale (NRS) scores, and complication rates were compared between the two groups.

Results: At the 2-year postoperative follow-up, both groups showed significant improvements in all items. Postoperative outcome or complication rate demonstrated no significant difference between group A and group B: UCLA scores (29.7 ± 3.9 vs 29.3 ± 3.6), JOA scores (87.4 ± 6.1 vs 87.4 ± 8.6), ROM forward elevation (129.1 ± 20.1 vs 133.9 ± 24.1), ROM external rotation (29.1 ± 12.7 vs 29.4 ± 10.7), ROM internal rotation (2.4 ± 1.0 points vs 2.3 ± 1.1 point), NRS scores (0.9 ± 1.2 vs 1.1 ± 1.3), and complication rates (4.0% vs 3.3%). Group A exhibited improvement in all items, and the results were comparable to those in group B.

Conclusions: RSA in patients with prior rotator cuff repair demonstrated similar functional outcomes and complication rates to those in patients who underwent RSA without prior surgeries. The study demonstrated that prior ARCR would not be a negative predictor. For patients who are afraid of or cannot consent to artificial joint surgery, recommending ARCR first may be an option.