Arthroplasty最新文献

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.

Septic hip arthritis (SHA) is a relatively rare but hazardous disease. Much controversy exists regarding the definition, diagnosis and treatment of chronic destructive SHAs. This review aims to provide an overview of the diagnostic and therapeutic approaches for chronic, destructive SHA and suggest possible research directions for this disease's future diagnosis and treatment. There is no unified naming or classification standard for SHAs. Chronic destructive SHA still requires a comprehensive diagnosis combining history, signs, bacterial culture, histopathological examination, inflammation and other indicators, of which metagenomic next-generation sequencing is a promising diagnostic tool. Previous treatment options for this disease include debridement, debridement + Girdlestone femoral head and neck resection, and debridement + Girdlestone femoral head and neck resection + two-stage arthroplasty. Among them, one-stage spacer implantation + two-stage arthroplasty is the current standard surgical option with a high success rate and low reinfection rate, while one-stage arthroplasty is a new treatment option proposed in recent years with unique advantages but limitations in terms of surgical indications. In the future, more high-quality studies are needed to provide the latest evidence to support clinical decision-making.

Background: Total knee arthroplasty (TKA) is the gold standard surgical management for end-stage knee osteoarthritis (OA). Robotic TKA (rTKA) was developed to improve bone preparation accuracy and increase reproducibility. In many settings internationally, rTKA systems have significantly higher costs for patients, and survivorship outcomes are unclear. There are several prior meta-analyses, but these focused on clinical and radiologic outcomes, and to our knowledge, none have evaluated survival. Differences in survival between semi-active or active robotic systems are also not well investigated.

Study design: Meta-analysis.

Methods: A random-effects meta-analysis was conducted on comparative studies between robotic-assisted TKAs and conventional TKAs (cTKAs) in patients undergoing TKA for primary knee OA. We searched MEDLINE, Embase, Cochrane Library, and SCOPUS from inception to 19 December 2024. Outcomes assessed were the implant survival in robotic-assisted TKA compared to conventional methods in standard primary knee OA cases, with subgrouping between active and semi-active systems performed. Secondary outcomes included associated complications, post-operative pain scores, and functional outcomes.

Results: A total of 20 comparative studies were included in the meta-analysis. Among them, 2,804 patients underwent cTKA, while 2,599 underwent rTKA. At two years, the pooled survivorship rate was 97.9% (95% CI: 96-99) in the conventional group and 98.3% (95% CI: 96.2-99.2) in the robotic group. There were no significant differences between the groups (P = 0.7). There were no significant differences between the robotic (semi-active) group and the conventional group (P = 0.5) on further unpaired T-Testing. Between 2 and 5 years, pooled survivorship rates in the conventional group were 96.8% (95% CI: 90.3-99) and 97.1% (95% CI: 91.3-99) in the robotic group. There were no significant differences between groups (P = 0.9). At ten years postoperatively, pooled survivorship rates in the conventional group were 96.9% (95% CI: 95-98) and 97.8% (95% CI: 96.7-98.5) in the robotic group. There were no significant differences between the groups (P = 0.3).

Conclusion: Conventional TKA is non-inferior to rTKA at short and long-term follow-up with regard to implant survival, complications, and postoperative pain scores, while rTKA shows subtle improvements in functional outcome measures.

Trial registration: CRD42024540997.

Background: This study compared imageless robotic-assisted total knee arthroplasty (RATKA) with accelerometer-based navigation (ABN) systems in terms of surgical accuracy and early clinical outcomes.

Methods: A retrospective analysis was conducted on 153 patients (178 knees) who had undergone primary TKA from 2017 to 2023. Surgical accuracy and functional outcomes were assessed up to 12 months post-operation using the Chi-square test, Student's t-test, and ANCOVA. Subgroup analyses based on patient demographics were also conducted.

Results: Among 153 patients, 101 underwent RATKA, and 52 received ABN. RATKA demonstrated superior alignment accuracy with a significantly lower deviation from the planned alignment (P < 0.05). Additionally, RATKA led to significantly better postoperative functional scores at 6 weeks (P = 0.001) and 3 months (P = 0.001), even after adjusting for preoperative functional differences.

Conclusions: RATKA offers enhanced precision and improves early recovery compared to ABN, supporting its potential as a preferred technology for TKA. Its ability to optimize kinematic alignment may contribute to superior patient outcomes. Compared to ABN, RATKA provides a unique advantage by achieving greater accuracy in planned alignment, which may translate into improved functional recovery. Further research with larger cohorts is recommended to confirm these findings.

The recently-completed special edition of Arthroplasty entitled 'Advances in Artificial Intelligence and Robotics in Joint Arthroplasty', brings together novel and innovative research from around the world in this cutting edge topic area. With robotics, artificial intelligence and technology-assistance (inside and out of the operating theatre) all becoming increasingly relevant to contemporary practice, we hope the readership will find this special edition an informative and thought-provoking read. Ultimately twelve individual papers were accepted for the edition, covering a range of exciting and novel applications. There clearly exists an ongoing need to provide further validation of new applications and, in many instances, replication of results away from designer sites is needed to provide robust generalizability of use. While several of the included papers show wide international collaboration, the prospect of future interactive work engaging leaders and think-tanks regionally and globally provides a tantalizing opportunity. With global health settings under increasing pressure and scrutiny to provide greater provision of joint replacement services - with the expectation of even more predictable (better) outcomes in a cost and resource efficacious manner - necessity will continue to drive further work exploring how technology-incorporation into arthroplasty care pathways might help address many of these considerations. There are undoubtedly exciting times ahead.