Arthroplasty最新文献

Background: Inadequate gap balance during total knee arthroplasty (TKA) can result in postoperative pain, restricted range of motion, and suboptimal long-term outcomes. The sagittal alignment of the femoral and tibial components plays a pivotal role in determining both the flexion and extension gaps. This study systematically investigates how variations in femoral and tibial sagittal alignment affect knee gap dynamics during TKA, utilizing intraoperative data from a robotic-assisted surgical system.

Method: This retrospective study analyzed data from 40 robotic-assisted TKA procedures. Surgical planning data were obtained using the landmark registration process. The tibial posterior slope was fixed at 3°, while the femoral flexion angle was adjusted incrementally from 3° to 8° in 1° intervals. Medial and lateral flexion gaps were measured at each increment. To examine the effect of tibial posterior slope on knee gap dynamics, the femoral flexion angle was maintained at 3°, and the tibial posterior slope was varied from 3° to 7° in 1° increments. Medial and lateral extension and flexion gaps were recorded for each configuration.

Results: Both medial and lateral flexion gaps progressively increased as the femoral flexion angle was adjusted from 3° to 8°. Similarly, both flexion and extension gaps demonstrated a corresponding increase as the tibial posterior slope was elevated from 3° to 7°. Spearman correlation analysis showed that increasing femoral flexion and tibial slope significantly increased medial and lateral gaps (ρ > 0.99).

Conclusion: Increasing femoral flexion results in a larger flexion gap, while a higher tibial slope leads to proportional increases in both flexion and extension gaps. Future studies incorporating intraoperative validation will be crucial for refining surgical techniques and improving outcomes in TKA.

Background: Recent studies have demonstrated that tranexamic acid (TXA) effectively reduces postoperative blood loss after total hip arthroplasty (THA) and is a safe treatment option. However, the anti-inflammatory effect of using TXA without dexamethasone (DEX) in THA remains unclear. In this study, we evaluated the anti-inflammatory effects, postoperative pain reduction, hidden blood loss (HBL), and postoperative complications associated with the use of TXA in THA.

Methods: This retrospective cohort study included 126 patients who underwent primary THA via a direct anterior approach (DAA) between January 1, 2023, and February 29, 2024. Patients were divided into two groups based on the administration of TXA (1000 mg IV preoperatively): Group A (with TXA) and Group B (without TXA). The postoperative inflammatory response (C-reactive protein [CRP] levels) and pain (numerical rating scale [NRS]) were assessed on postoperative days (PODs) 1, 3, and 7. HBL was assessed on PODs 3 and 7. Postoperative complications were counted based on occurrences from the postoperative period until discharge.

Results: CRP levels were significantly lower on POD 1 in Group A than in Group B (P = 0.002). Postoperative pain levels in Group A peaked later, with a significant reduction in the NRS score on POD 3, compared with that in Group B (P = 0.031). HBL in Group A was significantly reduced on PODs 3 (P < 0.001) and 7 (P = 0.013) compared to that in Group B. Postoperative complications did not differ significantly between Groups A and B.

Conclusion: TXA can effectively reduce postoperative blood loss, inflammation, and pain in patients undergoing THA without postoperative complications. Using TXA alone remains a highly effective and practical approach for improving early postoperative outcomes in patients undergoing THA.

Background: Our surgical team has been performing bicruciate-retaining total knee arthroplasty (BCR-TKAs) with functional alignment (FA). This study aimed to investigate knee kinematics before and after FA BCR-TKA, as well as the influence of these changes on clinical outcomes.

Methods: Fifty cases of BCR-TKAs were included. Intraoperative rotational kinematics and anteroposterior translations between before (preinsertion group) and after (postinsertion group) BCR-TKA were compared. The relationship between clinical outcomes and intraoperative kinematic parameters between the two groups was evaluated.

Results: The tibial internal rotational angles of the preinsertion group were significantly larger than those of the postinsertion group at 0°, 60°, 90°, and maximum flexion angles. Anteroposterior (AP) translation of the femur center relative to the tibial center of the preinsertion group was significantly smaller than that of the postinsertion group at 60° and 90° of flexion angles. No difference was found between the two groups at 0°, 30°, and maximum flexion angle. A negative relationship was found between the difference in rotational angles at maximum flexion and knee injury, and osteoarthritis outcome score (KOOS) activity of daily living (ADL), and improvement of KOOS symptom and ADL subscale scores. A positive relationship was found between the difference in rotational angles at 0° and improvement of KOOS pain, sports, and quality of life subscale scores.

Conclusions: AP translation of the femur after BCR-TKA with respect to the tibia was similar to that of the preoperative knee. The change in rotational knee kinematics after BCR-TKA showed associations with clinical outcomes; however, the relationship remains multifactorial and should be interpreted with caution.

Background: Coronal Plane Alignment of the Knee (CPAK) phenotypes I, II, and IV can achieve favorable soft tissue balance following kinematic total knee arthroplasty (KA-TKA). Given that this classification was developed from a Caucasian population, limited studies have evaluated clinical outcomes following restricted vs unrestricted KA-TKA in South-East Asian patients, this study aimed to: (1) outline the prevalence of CPAK types in a South-East Asian population, (2) compare clinical outcomes of patients undergoing restricted versus unrestricted KA-TKA.

Methods: Prospectively collected data from 232 patients who underwent KA-TKA between 2015 and 2018 were reviewed. The prevalence of CPAK in our cohort was determined using preoperative medial proximal tibial (MPTA) and lateral distal femoral (LDFA) angles measured from long-limb radiographs. Unrestricted calipered KA-TKA targeted equal bone cuts while restricted KA-TKA utilized intraoperative navigation to restrict tibia varus to 4°. Patients were assessed preoperatively, at 6 months, and 2 years using the Knee Society Score, Oxford Knee Score, and Short-Form 36. Postoperative satisfaction and expectation fulfillment were recorded. Intra- and interclass correlation of all radiographic measurements and both parametric and non-parametric statistical analysis were used.

Results: The prevalence of CPAK in our cohort: I (47.8%), II (30.6%), III (9.1%), IV (7.8%), V (3.9%), VI (0.9%), VII (0%), VIII (0%) and IX (0%). Intra- and interclass correlation of radiographic measurements were excellent at 0.98 (95%CI: 0.95-0.99, P < 0.01). Subgroup analysis of CPAK I patients demonstrated that restricted KA-TKA had better KSS objective (P = 0.04), a higher proportion of satisfied patients (P = 0.02) at 6 months, and better OKS (P = 0.03) than unrestricted KA-TKA.

Conclusion: CPAK I was the most prevalent phenotype in an Asian population. CPAK I patients undergoing restricted KA-TKA had better functional outcomes and satisfaction rates than those who underwent unrestricted KA-TKA. Future studies should focus on evaluating outcomes of different alignment strategies to personalize treatment for Asian CPAK phenotypes.

Introduction: The choice of femoral stem design during total hip arthroplasty (THA) through the Direct Anterior Approach (DAA) is critical. Shortened stems offer potential benefits such as bone preservation and reduced stress shielding. This study aimed to compare early complications at one year of follow-up between shortened and standard stems in DAA THA.

Methods: A retrospective monocentric case-control study included patients undergoing DAA THA from 2013 to 2023. Two cohorts were analyzed: 537 THA with standard stems and 346 THA with shortened stems. Three hundred forty-three patients in each group were matched (1:1) based on age, sex, and Body Mass Index (BMI). Two independent observers assessed femoral complications at one year. Femoral stem positioning was measured.

Results: The mean follow-up was 12 ± 0.5 months. The mean age was 64.1 ± 11.7 years. The mean BMI was 26.4 ± 4.4 kg/m². Shortened stems showed a significantly lower rate of femoral complications (1.4% vs. 5.5%, P = 0.005), particularly for the GT fractures (P = 0.006). In the shortened group, stem alignment was neutral in 69% of cases, varus in 27%, and valgus in 4%.

Conclusion: Shortened stems in DAA THA were associated with a lower rate of femoral complications, particularly fewer GT fractures. Although shortened stems were more often positioned in varus, this did not impact short-term complication rates.

Trial registration: The Advisory Committee on Research Information Processing in the Field of Health (CCTIRS) approved this study on June 4, 2015 (Study ID 15-430). Video Abstract.

Background: Intraoperative measurement of component orientation represents a basis for optimizing outcomes after total hip arthroplasty (THA). Although the use of computer navigation systems in THA has improved the accuracy of component positioning, they have not gained widespread popularity due to their complexity, time demands, and time-consuming protocols.

Methods: We developed an Inertial Measurement Unit-based Hip Smart Trial system (IMUHST) to assist with intra-operative monitoring of hip posture. An in vitro validation experiment was conducted using a sawbones with a three-dimensional (3D) measurement model as the reference standard.

Results: The absolute mean error, Bland-Altman analysis, and Intra-class Correlation Coefficient revealed that the accuracy and precision of this system meet the threshold for clinical application.

Conclusions: In conclusion, this in vitro validation demonstrates that the IMUHST system provides accurate component orientation measurements while eliminating the cost and complexity of optical navigation, offering a practical solution for widespread adoption. Video Abstract.

Background: While same-day discharge models for knee arthroplasty have gained significant traction in China's evolving healthcare landscape, patient perspectives on ambulatory surgical pathways remain underexplored. This qualitative study addresses a critical gap in the literature by systematically assessing patient experiences and perceptions regarding knee arthroplasty within China's emerging ambulatory care framework.

Methods: A prospective cohort of 195 consecutive patients scheduled for primary knee arthroplasty at a tertiary orthopedic referral center underwent structured data collection through the WenJuanXing platform between January 1 and June 1, 2024. This cross-sectional survey employed an anonymous voluntary survey instrument administered at two critical timepoints: 1) prior to any clinical discussions regarding postoperative care pathways, and 2) before initiation of standardized preoperative education protocols.

Results: In total, 188 participants (96%, 188/195) completed the survey. Of them, 70% were female and 84% were 60 years or older. While 68% were familiar with ambulatory surgery, awareness did not significantly differ by age (P = 0.64), sex (P = 0.19), occupation (P = 0.42), location (P = 0.55), or education level (P = 0.81). Interestingly, only 8 patients anticipated discharge within 24 h post-surgery, with most (71.8%) expecting a 3-day or more stay. However, if postoperative care was assured, 66% expressed comfort with same-day or 24-h discharge. 93% considered ambulatory knee arthroplasty suitable, and 71.8% believed it would yield superior outcomes through quicker recovery and reduced complications, infections, and pain. Despite this optimism, only 45% were willing to endure longer waits, and a third were open to paying more or traveling farther for ambulatory knee arthroplasty.

Conclusion: The study reveals that most Chinese patients initially want ≥ 3-day stays but may accept 24-h discharge for knee arthroplasty. One-third are unaware of ambulatory knee arthroplasty, so more education is needed as procedures rise.

Background: Neuropathic pain, weakness, and/or numbness can complicate partial or total knee arthroplasty (KA). This study evaluates peripheral nerve surgery following KA and proposes a treatment algorithm.

Methods: Patients who underwent peripheral nerve surgery for neuropathic symptoms (neuropathic pain and/or motor dysfunction) following KA between 2012-2024 (≥ 3-month follow-up) were included. Demographics, comorbidities, and type of treatment were collected, and a cross-sectional survey assessed satisfaction (Patient Global Impression of Change, PGIC) and quality of life (EuroQol-5-Dimension-5-Level, EQ-5D-5L).

Results: Twenty-seven lower extremities treated in 26 patients with a median age of 67.0 years (IQR: 58.0-71.8) were included. Surgical indications included neuropathic pain (n = 24/27, 88.9%), foot drop (n = 1/27, 3.7%), or both (n = 2/27, 7.4%). Median time between KA and nerve surgery was 29.5 months (IQR: 12.5-71.0). Procedures included saphenous or infrapatellar branch neurectomy with active management of the nerve ending (targeted muscle reinnervation (TMR) or regenerative peripheral nerve interface (RPNI)) (48.1%, n = 13), nerve decompression (40.7%, n = 11), or a combination of the two (11.1%, n = 3). Twenty-one patients (80.8%, 22 extremities) completed the survey with a median follow-up of 1.9 years (IQR: 1.1-4.2). Improvement (PGIC) was reported in 21 extremities (95.5%), the mean EQ-5D-5L index was 0.854 (± 0.102) (US general population: 0.851 (± 0.205)).

Conclusion: Peripheral nerve surgery is beneficial for patients with neuropathic pain, numbness, and/or weakness following KA. We recommend common peroneal nerve decompression for lateral knee pain and/or foot drop, active saphenous nerve management with TMR or RPNI for medial knee pain, or a combination of the two based on the clinical scenario. These findings may aid in the decision-making process for patients with neuropathic pain following KA and warrant further validation in larger, prospective studies.

Background and purpose: Periprosthetic joint infection (PJI) is a devastating but rare complication. Its incidence ranges between 1%-2% in primary arthroplasties. However, infection rates are much higher in megaprostheses (15%-43%). Revision of megaprostheses (MP) is a highly complex procedure associated with massive bone loss, so that implant retention occurs as a viable initial therapy option even in chronic infections. Unfortunately, literature regarding therapy strategies and outcome reports for PJI in MP is scarce. Reinfection rates are reported to be between 22 and 58%. We therefore proposed the following questions: What is the overall outcome of PJI in MP in our cohort, and are there significant differences in infection-free survival between various surgical strategies?

Methods: In this retrospective cohort study, 50 cases of PJI in MP treated from 2010 to 2022 were identified. The median (IQR) age was 70.5 (16.3) years. Mean follow-up was 19.0 months. Treatment outcome was categorized following international consensus criteria.

Results: Overall infection-free implant survival was 42.0%. 7 patients died in direct association with the ongoing PJI, and 7 had to undergo amputation. Two-stage revision had the highest success rate of 71.4% (5/7), followed by multi-stage surgery (57.1%; 4/7), DAIR (38.7%; 12/31), and single-stage revision (0%; 0/5) (P = 0.009). Overall, treatment success rates following DAIR were 55.6% (10/18) for acute and 15.4% (2/13) for chronic infections (P = 0.027). The most common pathogens were coagulase-negative Staphylococci (42.0%; 21/50) and Staphylococcus aureus (34.0%; 17/50). Gram-negative pathogens accounted for 16.0% (8/50).

Conclusions: PJI in MP remains a devastating complication with low success rates. Two-stage revision is the most promising treatment option, but it requires patients to be able to cope with the burden of multiple surgeries. DAIR cannot be recommended as a definitive treatment for chronic cases (15% success rate) and should be questioned in acute cases (56% success rate), as infection eradication is rare. DAIR can be considered a low-impact surgery for infection control if more extensive surgery is not viable. Video Abstract.

Background: Demographic factors are driving the further increase of total hip (THA) and total knee arthroplasty (TKA) volumes in the next decades. This will face the healthcare systems with new challenges. To find ways that optimize the utilization of the limited resources, it is important to understand which factors influence the outcomes at different points along the treatment pathway.

Questions/purposes: We aimed to identify variables associated with physical function from hospital admission to discharge and at 12 months postsurgery (12 M). This study investigated for patients undergoing THA or TKA: What is the association between patients' characteristics, surgery variables, and treatment decisions with patient-reported outcomes (PROs) at discharge as well as at 12 M?

Patients/methods: We conducted a secondary, retrospective cohort analysis using longitudinal data from 6,144 THA and TKA patients who participated in the "PROMoting Quality Trial". Physical function was assessed via the Hip Disability and Osteoarthritis Outcome (HOOS-PS) and Knee Injury and Osteoarthritis Outcome (KOOS-PS) scores. Stepwise selection and multivariate linear regression models were applied to identify variables associated with physical function at discharge and 12 M. The factors analyzed included surgery variables (surgeon presence, surgeon experience, surgery duration, complication) and treatment decisions (early mobilization, remote monitoring), along with patient characteristics.

Results: We included 3,375 THA patients and 2,769 TKA patients. Admission HOOS-PS score, sex (being male), and early mobilization were the strongest predictors of better physical function at discharge for patients in the THA group, whereas admission HOOS-PS score, senior staff presence, and remote monitoring (intervention group) were significant predictors of better physical function for the THA patients at 12 M. For the patients in the TKA group, admission KOOS-PS score, early mobilization, and high surgeon experience were the strongest predictors of improved physical function at discharge. The admission KOOS-PS score, surgery duration, and being in the remote monitoring group were the strongest predictors of better physical function at 12 M.

Conclusion: Early mobilization was significantly associated with better physical function at discharge from the clinic in both procedures, TKA and THA. The preoperative physical function scores and being allocated to the remote monitoring group were the strongest predictors of better physical function at 12 M.