Arthroplasty最新文献

Background: Few studies have investigated the kinematics after reverse total shoulder arthroplasty (RTSA). This study aimed to compare the shoulder kinematics in RTSA patients during shoulder abduction on the scapular plane with and without a load and yield information regarding the function of stabilizing the joints against gravity for the functional assessment of the shoulder after RTSA, which could lead to changes in postoperative rehabilitation treatment.

Methods: Twenty RTSA patients (7 men, 13 women; mean age: 78.1 [64-90] years) were examined. First, active shoulder abduction in the scapular plane was captured using single-plane fluoroscopic X-ray images. Imaging was performed by stipulating that one shoulder abduction cycle should be completed in 6 s. Two trials were conducted: one under a load equivalent to 2% of body weight and one without a load. Next, a three-dimensional (3D) model of each humeral and scapular component was matched to the silhouette of the fluoroscopic image to estimate the 3D dynamics. By using the 3D dynamic model obtained, the kinematics of the glenosphere and humeral implant were calculated relative to the shoulder abduction angle on the scapular plane and were compared between groups with and without a load. A one-way analysis of variance and a post hoc paired t-test with a statistical significance level of 0.05 were performed.

Results: The humeral internal rotation decreased with a load at shoulder abduction between 40° and 90° on the scapular plane (P < 0.01, effect size: 0.15). No significant differences in scapular upward rotation (P = 0.57, effect size: 0.022), external rotation (P = 0.83, effect size: 0.0083) and posterior tilting (P = 0.74, effect size: 0.013) were observed between groups with and without a load. The main effect was not observed with and without a load (P = 0.86, effect size: 0.0072). However, the scapulohumeral rhythm was significantly greater without a load during shoulder joint abduction between 40° and 60° on the scapular plane.

Conclusion: In RTSA patients, the glenohumeral joint was less internally rotated, and the scapulohumeral rhythm decreased under loaded conditions. It was stabilized against the load through the mechanical advantage of the deltoid muscle and other muscles.

Background: Hispanic patients are the youngest and fastest-growing ethnic group in the USA. Many of these patients are increasingly met with orthopedic issues, often electing to undergo corrective procedures such as reverse shoulder arthroplasty (RSA). This patient population has unique medical needs and has been reported to have higher incidences of perioperative complications following major procedures. Unfortunately, there is a lack of information on the hospitalization data and perioperative complications in Hispanic patients following procedures such as RSA. This project aimed to query the Nationwide Inpatient Sample (NIS) database to assess patient hospitalization information, demographics, and the prevalence of perioperative complications among Hispanic patients who received RSA.

Methods: Information from 2016-2019 was queried from the NIS database. Demographic information, incidences of perioperative complications, length of stay, and costs of care among Hispanic patients undergoing RSA were compared to non-Hispanic patients undergoing RSA. A subsequent propensity matching was conducted to consider preoperative comorbidities.

Results: The query of NIS identified 59,916 patients who underwent RSA. Of this sample, 2,656 patients (4.4%) were identified to be Hispanic, while the remaining 57,260 patients (95.6%) were found to belong to other races (control). After propensity matching, Hispanic patients had a significantly longer LOS (median = 1.4 days) than the patients in the control group (median = 1.0, P < 0.001). The Hispanic patients (89,168.5 USD) had a significantly higher cost of care than those in the control group (67,396.1 USD, P < 0.001). In looking at postoperative complications, Hispanic patients had increased incidences of acute renal failure (Hispanics: 3.1%, control group: 1.1%, P = 0.03) and blood loss anemia (Hispanics: 12.7%, control group: 10.9%, P = 0.03).

Conclusions: Hispanic patients had significantly longer lengths of stay, higher costs of care, and higher rates of perioperative complications compared to the control group. For patients who are Hispanic and undergoing RSA, this information will aid doctors in making comprehensive decisions regarding patient care and resource allocation.

Background: Appropriate soft tissue management represents a critical step in treating periprosthetic joint infection (PJI). This review discusses relevant guidelines that surgeons should follow in the management of soft tissues in PJI treatment. BODY: It is imperative for arthroplasty surgeons to thoroughly debride and rebuild soft tissue with a good blood supply. Relevant guidelines that surgeons should follow rigorously include preoperative evaluation of soft tissue status and plan-making, adequate surgical area exposure, intraoperative removal of all necrotic and infected soft tissues, adequate coverage of soft tissue defects, timely postoperative assessment and management of soft tissues, wound management and proper rehabilitation.

Conclusion: Soft tissue management plays a critical role in the treatment of PJI. To improve the infection control rate and postoperative joint function, surgeons should be familiar with these general principles and rigorously practice them in PJI management.

Background: Wearable sensors have become a complementary means for evaluation of body function and gait in lower limb osteoarthritis. This study aimed to review the applications of wearable sensors for gait analysis after total knee arthroplasty (TKA).

Methods: Five databases, including Web of Science Core Collection, Embase, Cochrane, Medline, and PubMed, were searched for articles published between January 2010 and March 2023, using predetermined search terms that focused on wearable sensors, TKA, and gait analysis as broad areas of interest.

Results: A total of 25 articles were identified, involving 823 TKA patients. Methodologies varied widely across the articles, with inconsistencies found in reported patient characteristics, sensor data and experimental protocols. Patient-reported outcome measures (PROMs) and gait variables showed various recovery times from 1 week postoperatively to 5 years postoperatively. Gait analysis using wearable sensors and PROMs showed differences in controlled environments, daily life, and when comparing different surgeries.

Conclusion: Wearable sensors offered the potential to remotely monitor the gait function post-TKA in both controlled environments and patients' daily life, and covered more aspects than PROMs. More cohort longitudinal studies are warranted to further confirm the benefits of this remote technology in clinical practice.

Background: Few studies have investigated the association between obesity, preoperative weight loss and postoperative outcomes beyond 30- and 90-days post-arthroplasty. This study investigated whether body mass index (BMI) and preoperative weight loss in people with obesity predict postoperative complications and patient-reported outcomes 6 months following total knee or hip arthroplasty.

Methods: Two independent, prospectively collected datasets of people undergoing primary total knee or hip arthroplasty for osteoarthritis between January 2013 and June 2018 at two public hospitals were merged. First, the sample was grouped into BMI categories, < 35 kg/m² and ≥ 35 kg/m². Subgroup analysis was completed separately for hips and knees. Second, a sample of people with BMI ≥ 30 kg/m² was stratified into participants who did or did not lose ≥ 5% of their baseline weight preoperatively. The presence of postoperative complications, Oxford Hip Score, Oxford Knee Score, EuroQol Visual Analogue Scale and patient-rated improvement 6 months post-surgery were compared using unadjusted and adjusted techniques.

Results: From 3,552 and 9,562 patients identified from the datasets, 1,337 were included in the analysis after merging. After adjustment for covariates, there was no difference in postoperative complication rate to 6 months post-surgery according to BMI category (OR 1.0, 95%CI 0.8-1.4, P = 0.8) or preoperative weight loss (OR 1.1, 95%CI 0.7-1.8, P = 0.7). There was no between-group difference according to BMI or preoperative weight change for any patient-reported outcomes 6 months post-surgery.

Conclusion: Preoperative BMI or a 5% reduction in preoperative BMI in people with obesity was not associated with postoperative outcomes to 6 months following total knee or hip arthroplasty.