Arthroplasty最新文献

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.

Aims: This study aimed to assess whether the clinical outcomes of one-stage revision surgery for chronic knee periprosthetic joint infection (kPJI), guided by precision pathogen diagnosis strategies, are non-inferior to those of conventional two-stage revision surgery.

Methods: A retrospective analysis was conducted on chronic kPJI patients who underwent precision pathogen detection and revision arthroplasty at the First Affiliated Hospital of Fujian Medical University between January 2016 and September 2022. Clinical characteristics, pathogen detection rates, targeted antibiotic therapy, reinfection rates, and functional outcomes were compared between patients who underwent one-stage and two-stage revision surgeries.

Results: Thirty patients who underwent one-stage revision surgery with pathogen detection through precision pathogen diagnosis strategies were included in this study and were matched with 30 patients who received two-stage revision surgery via propensity score matching (PSM). The baseline clinical characteristics did not significantly differ between the two groups. Utilizing our optimized pathogen detection protocol, successful pathogen identification was achieved in all cases across both groups. The median duration of intravenous antibiotic administration in the one-stage revision cohort was 16.5 (8.5,23.0) days, followed by a 6-week course of sequential oral antibiotics. Both the one-stage and two-stage revision groups had 3 cases of reinfection each, with no statistically significant difference in success rates between the groups (P > 0.999). Furthermore, no significant differences were found in the range of motion (ROM) (P = 0.332) or Knee Society score (KSS) (P = 0.117) between the one-stage and two-stage revision groups at the 2-year postoperative follow-up. The Kaplan‒Meier survival curves for prosthesis infection-free survival nearly overlapped, with no statistically significant differences between the two groups (P = 0.675).

Conclusion: When pathogen identification is achieved through precision diagnostic strategies, the efficacy of one-stage revision surgery combined with targeted antibiotic therapy is comparable to that of two-stage revision surgery.

Background: The extent of geographic variation in knee phenotypes remains insufficiently documented. This systematic review intends to elucidate the regional disparities in the distribution of Coronal Plane Alignment of the Knee (CPAK) types across different geographic areas.

Methods: A systematic review of the literature was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting the distribution of knee phenotypes, as classified by the CPAK system, in both healthy and arthritic populations, were included in the analysis. Based on the methods in the literature, the Hoy Risk of Bias Tool was used to assess the methodological quality of the included studies. To compare geographical differences in CPAK types among patients with arthritis, as well as healthy people.

Results: A total of 29 studies (28 retrospective and 1 prospective) were included in this review, encompassing 27,660 knees in 22,342 subjects. The methodological quality of the included studies was assessed using the Hoy Risk of Bias Tool, and the quality was good. Among the healthy knees (n = 4,082), CPAK type II was predominant in Europe (41.7%) and Asia (36.7%). In contrast, among arthritic knees (n = 21,632), CPAK type I was most common in Asia (51.3%), North America (32.8%), and Europe (32.8%), while CPAK type II was prevalent in Australia (29.3%) and Africa (25.5%). Notably, the proportions of CPAK type I (P < 0.001) and II (P = 0.002) knees varied significantly across different geographic regions among arthritic knees, while no significant differences were observed among healthy knees (P = 0.48, P = 0.305).

Conclusion: Significant variations in CPAK distributions among arthritic knees were observed across countries, while no significant differences were observed among healthy knees. Surgeons in different regions need to make individual surgical plans according to the CPAK types of patients. Video Abstract.

Background: Functional alignment (FA) in total knee arthroplasty (TKA) can achieve soft tissue balance by fine-tuning adjustments of bony resections and component alignment with less soft tissue release. However, joint line orientation relative to the floor in the knee and ankle after TKA is not well studied.

Methods: A randomized-controlled trial was performed in 30 patients with robotic-assisted bilateral TKA using FA and mechanical alignment (MA) in the same patient. The outcome measures were as follows: (1) standing radiographic knee and ankle alignment; (2) clinical outcomes at 1, 3 and 6 months postoperatively (including forgotten joint score (FJS), KOOS, knee range of motion); (3) patient satisfaction score; and (4) soft tissue release.

Results: Postoperative hip-knee-ankle angles between the FA and MA groups were similar (2.4° versus 2.4°, P = 0.952). Knee joint line orientation was significantly more parallel to the floor in the FA group (3.0° versus 4.7°, P < 0.001). There was no significant difference in ankle joint line orientation relative to the floor in the FA and MA groups (91.0° versus 92.4°, P = 0.099 for tibial plafond inclination and 92.5° versus 93.2°, P = 0.564 for talar dome inclination). However, in knees with preoperative varus with apex distal joint line orientation (coronal plane alignment of the knee (CPAK) classification type I), FA significantly achieved a more parallel knee and ankle joint line orientation relative to the floor (3.1° versus 5.1°, P = 0.002 for knee and 91.0° versus 93.5°, P = 0.028 for tibial plafond inclination). FA can obtain a balanced knee with significantly lower posteromedial releases (23.3% versus 76.7%, P < 0.001), with no superficial MCL release needed (0% versus 6.67%, P < 0.01). The FA group achieved significantly higher FJS at 3 months (53.3 versus 46.0, P = 0.015) and 6 months (67.8 versus 57.8, P < 0.001) with a higher patient satisfaction score (79.2 versus 84.3, P = 0.001).

Conclusion: Functional alignment can control the overall lower limb alignment similarly to mechanical alignment, with a knee joint line more parallel to the floor. Additionally, the ankle joint line was more parallel in knees with CPAK type I. FA can also provide a more balanced knee with less soft tissue release, a higher functional score, and greater patient satisfaction compared to mechanical alignment.

Background: Outcomes from Total Joint Arthroplasty (TJA) are variable but generally favorable. However, the literature is lacking regarding direct comparisons of important outcomes across TJA sites. Such comparisons are of paramount importance to informing future bundled care reform and patient optimization. Thus, we compared the rates of adverse events, filled prescriptions, and costs at 90 days and 365 days after TJA for knee, hip, and shoulder patients.

Methods: We conducted a retrospective cohort study of multi-payor claims data with patients (n = 2416) who underwent hip (n = 909), knee (n = 1250), or shoulder (n = 257) TJA within an academic health system. Univariable and multivariable logistic regression models were used to assess the association between the TJA surgical site and adverse events (i.e., medical and surgical complications) and prescriptions filled. Univariable and multivariable gamma regression models were used to assess the association between the TJA surgical site and total cost and surgical episode cost.

Results: In all regression models, the hip location was used as the reference group. There were no differences in the adjusted odds of medical complications between the TJA surgical sites after adjusting for confounders at 90 days or 365 days. For surgical complications, the adjusted odds were 2.66 times higher in the knee (P < 0.001) and 4.48 times higher in the shoulder (P < 0.001) at 90 days. At 365 days, the odds were 2.54 times higher in the knee (P < 0.001) and 4.10 times higher in the shoulder (P < 0.001). There was an increase in the adjusted odds of antiepileptic and NSAIDS being filled in knee and shoulder patients compared to hip patients at 31-90 days (both P < 0.001). At 0-365 days, knee patients had increased adjusted odds of filled antibiotic (P = 0.032), antiepileptic (P = 0.001), and opioid (P = 0.005) prescriptions compared to hip patients, while shoulder patients only increased odds of antiepileptic (P = 0.028). Lastly, in adjusted models, both the knee and shoulder had a significant increase in total health system costs, with a 9% and 14% increase in cost, respectively (P < 0.01).

Conclusion: Patients undergoing TKA and TSA may have an increased risk for surgical complications and longer-term opioid prescriptions (TKA only) compared to those undergoing THA. Collectively, these results can inform future population-based approaches to managing osteoarthritis care pathways or reimbursement policies for TJA across multiple joint sites.

Background: The hip dysfunction and osteoarthritis outcome score for joint replacement (HOOS JR) has been widely used to assess patient hip function. The subjective hip value (SHV) has become increasingly recognized as an efficient single-question survey for assessing hip joint function. This study aimed to determine the psychometric properties of the SHV in evaluating hip function in patients undergoing total hip arthroplasty (THA) in correlation with the traditional HOOS JR.

Methods: This was a retrospective review of 1,157 distinct patients who underwent primary THA between January 2021 and December 2023. Scores for SHV and HOOS JR were collected preoperatively, as well as 3 months and 1 year postoperatively. Validity was determined using Pearson's correlation tests between the SHV and HOOS JR.

Results: Overall, the SHV was highly correlated with the HOOS JR at 3 months (R = 0.71, P < 0.001) and 1 year postoperatively (R = 0.79, P < 0.001). Additionally, changes in the SHV showed significant correlations with changes in the HOOS JR between the preoperative and postoperative periods. The SHV also had substantially fewer ceiling effects compared to the HOOS JR.

Conclusions: The SHV is a valid and responsive single-item assessment for hip joint function following primary THA. Despite its limitations, its efficiency and ease of use make it a feasible option for routine clinical assessments, providing clinicians with valuable insights into patients' recovery. Subsequently, the integration of the SHV into orthopedic practice holds promise for enhancing the management of postoperative care and improving patient outcomes.

Background: Robotic-assisted (RA) and computer-navigated (CN) total hip arthroplasty (THA) are increasingly performed, but prior studies comparing the two techniques and their outcomes were limited. This study aimed to compare clinical outcomes and costs of receiving THA using RA and CN technology.

Methods: We conducted a retrospective cohort study using a nationwide administrative database from January 1, 2010, to October 31, 2022. The study included patients undergoing THA either via RA (n = 4,473) or CN (n = 4,473) technology. Subjects were matched for age and pertinent comorbidities. Clinical outcomes evaluated included emergency department visits and readmissions within 90 days of surgery, lengths of stay, and implant-related complications within 90 days and 2 years of surgery. Costs were analyzed on the day of surgery and within a 90-day global period. Statistical analysis was performed using multivariate logistic regression analysis with a P < 0.01 considered statistically significant.

Results: There were no significant differences between the RA and CN cohort in ED visits or readmission within 90 days of surgery or in lengths of stay. Similarly, no differences were found in any of the implant-related complications at 90 days or 2 years following surgery. Same-day mean reimbursement for RA-THA was higher than for CN-THA ($4,472.23 vs. $3,890.61; P < 0.01). 90-day reimbursement did not differ significantly.

Conclusion: We demonstrated that readmission, ED visits, lengths of stay, and short-term implant-related outcomes did not differ between RA and CN-THA cohorts. Further studies are needed to explore the long-term benefits and cost implications of RA-THA.