Arthroplasty Today最新文献

{"title":"Donning Gloves Using the Sliding-Closed Technique Has a Larger Distance to Contamination at the Gown-Glove Interface","authors":"Hailee E. Reist MD,&nbsp;Michael B. DiCosmo MD,&nbsp;Luke C. Seeker MD,&nbsp;Andrew H. Root BS,&nbsp;James D. Michelson MD,&nbsp;Nathaniel J. Nelms MD","doi":"10.1016/j.artd.2025.101862","DOIUrl":"10.1016/j.artd.2025.101862","url":null,"abstract":"<div><h3>Background</h3><div>The surgical gown-glove interface is a known cause of bacterial contamination. Minimizing contamination from this interface can be achieved by optimizing the technique for donning gloves with the help of a sterile assistant. The purpose of this study was to evaluate the level of contamination of the inside of the glove cuff when employing a novel sliding-closed (SC) gloving technique vs a traditional open gloving technique.</div></div><div><h3>Methods</h3><div>We conducted a comparative study between a traditional open gloving technique and a novel SC gloving technique. Surgeons applied ultraviolet indicator lotion before donning a surgical gown and sterile gloves using either technique. Three surgeons were experienced with the SC technique and 3 surgeons had no experience with this technique. Contamination of each glove was analyzed by 2 blinded inspectors in a darkened room by measuring the distance from the cuff to the closest contamination.</div></div><div><h3>Results</h3><div>Regardless of previous experience, the SC technique had a significantly greater distance to contamination compared to the open technique (open = 65 mm [interquartile range 46.3-98.8], SC = 150 mm [interquartile range 110-170], <em>P</em> ≤ 0.001). Surgeons with experience using the SC technique had a greater median distance to contamination (125 mm) than those who without experience with this technique (90 mm, <em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>Performing the SC-assisted gloving technique results in a significantly greater cuff to contamination distance, compared to the traditional open gloving technique. Surgeons should consider adopting this technique to help minimize infection risk alongside standard infection control measures.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101862"},"PeriodicalIF":2.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Hip Offset is an Important Factor in the Success of Abductor Mechanism Insufficiency Repair After Total Hip Arthroplasty: A Case Series","authors":"Samo Roškar MD ,&nbsp;Neža Trebše MD ,&nbsp;René Mihalič MD, PhD ,&nbsp;Nejc Kurinčič MD ,&nbsp;Mateja Blas MSc ,&nbsp;Rihard Trebše MD, PhD","doi":"10.1016/j.artd.2025.101861","DOIUrl":"10.1016/j.artd.2025.101861","url":null,"abstract":"<div><h3>Background</h3><div>Hip abductor mechanism deficiency due to abductor tendon degeneration, tear, or intraoperative damage during total hip arthroplasty (THA) may cause severe walking disability. For severe abductor weakness in native hip joints, Whiteside muscle transfer is a good solution. However, the literature on the results of abductor mechanism reconstruction (AMR) after THA remains limited. Our study aimed to assess the outcome of AMR in patients with THA suffering from Milwaukee III and IV hip abductor deficiency.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective cohort study of THA with hip abductor mechanism deficiency treated surgically with AMR. Data were collected between January 2011 and December 2019 and included the following parameters: patient’s data, subjective level of pain, Harris Hip Score (HHS), gait pattern, extent of hip abductor tear, and offset measurements.</div></div><div><h3>Results</h3><div>The cohort included 16 THAs with AMR in 16 patients. The whole group median HHS improved from 37.1 interquartile range (IQR) (31.0-38.7) to 73.9 IQR (63.5-83.7) (<em>P</em> &lt; .001). In a subgroup of 9 hips, the global offset was preserved after THA while it was reduced in remaining 7 hips. All patients with preserved global offset had significantly better clinical outcome compared to the group with reduced global offset (median HHS improvement was 48 IQR [46-53] compared to 22 IQR [18-25], <em>P</em> = .001).</div></div><div><h3>Conclusions</h3><div>Our study showed favorable outcome of the AMR for chronic, Milwaukee III and IV hip abductor deficiency after THA. It is the first study to show that restoration of global offset after THA is of utmost importance to avoid chronic abductor mechanism deficiency.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"36 ","pages":"Article 101861"},"PeriodicalIF":2.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Patient Education as a Tool for Reducing Postoperative Opioid Use Following Primary Total Hip Arthroplasty: One Institution’s Experience","authors":"Catherine M. Call MD ,&nbsp;Zoë A. Walsh MPH ,&nbsp;Diane Jeselskis BSN ,&nbsp;Ryan J. Mountjoy MD ,&nbsp;Brian J. McGrory MD, MS ,&nbsp;Adam J. Rana MD","doi":"10.1016/j.artd.2025.101870","DOIUrl":"10.1016/j.artd.2025.101870","url":null,"abstract":"<div><h3>Background</h3><div>Minimizing postoperative opioids remaining after total hip arthroplasty (THA) is important for patient outcomes and community safety. The purpose of this study was to investigate whether completion of one preoperative patient education class prior to THA was associated with reduced opioid consumption at 2 weeks postoperatively. Secondary goals included evaluating whether satisfaction scores and postoperative healthcare utilization were impacted by class attendance, and whether demographic characteristics varied between groups that may highlight care disparities for our practice to address.</div></div><div><h3>Methods</h3><div>Patients undergoing primary THA between January 2022 and December 2024 at a single large academic institution were retrospectively evaluated for inclusion, identifying 372 patients who completed the education class and 30 patients who did not. All patients received a multimodal perioperative pain management protocol standardized at our institution.</div></div><div><h3>Results</h3><div>The number of morphine milligram equivalents (MMEs) consumed in the 2 weeks following THA was significantly lower among the class completion group (84.60 vs 127.30 MMEs; <em>P</em> = .04). On multivariable analysis, patients who attended the preoperative education class consumed 41.57 fewer MMEs compared to those who do not attend (95% confidence interval: −75.87 to −7.27; <em>P</em> = .018). No differences in complications, 2-week refill requests, emergency department visits, or readmission were noted. Functional outcome and satisfaction scores were high among both groups.</div></div><div><h3>Conclusions</h3><div>THA patients who completed an education class preoperatively consumed significantly fewer prescribed opioids as measured at the 2-week mark following surgery compared to those who did receive education. Our results support the role of patient education in reducing opioid use following arthroplasty.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101870"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malnutrition is Common in Patients Utilizing Glucagon-Like Peptide-1 Agonists Prior to Total Joint Arthroplasty","authors":"Zachary Jodoin MD,&nbsp;William H. Young MD,&nbsp;Daanish Sheikh BS,&nbsp;Belinda Pena FNP,&nbsp;Chance C. Moore MD,&nbsp;Frank Buttacavoli MD","doi":"10.1016/j.artd.2025.101865","DOIUrl":"10.1016/j.artd.2025.101865","url":null,"abstract":"<div><h3>Background</h3><div>The rising prevalence of obesity and the increased use of glucagon-like-peptide-1 (GLP-1) receptor agonists for weight loss and diabetes has led to more patients qualifying for elective total joint arthroplasty (TJA). While these medications promote weight reduction, they may predispose patients to nutritional deficiencies. This study aims to evaluate the preoperative nutritional status of GLP-1 users undergoing TJA compared to nonusers.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted at a high-volume center on patients who underwent elective primary TJA between January 1 and May 1, 2025. Patients were included if they had complete preoperative nutritional labs. Nutritional markers included hemoglobin, albumin, total protein, prealbumin, calcium, alkaline phosphatase, and 25-hydroxy vitamin D. Malnutrition was defined as ≥1 laboratory deficiency; severe malnutrition as ≥2 deficiencies. GLP-1 use, indication, and duration were recorded. Statistical analyses included t-tests, chi-square tests, and odds ratio calculations.</div></div><div><h3>Results</h3><div>A total of 165 patients met inclusion criteria, with 29 (17.6%) actively using GLP-1 receptor agonists. The cohorts were matched for comorbidities. GLP-1 users had higher rates of malnutrition (38% vs 8.8%, <em>P</em> &lt; .001; odds ratio = 6.2), severe malnutrition (17.2% vs 2.9%, <em>P</em> = .009; odds ratio = 6.88), and lower albumin (<em>P</em> &lt; .001), prealbumin (<em>P</em> = .003), and total protein (<em>P</em> = .024) levels compared to controls.</div></div><div><h3>Conclusions</h3><div>GLP-1 agonist use is associated with significantly higher rates of preoperative nutritional deficiencies in patients undergoing elective TJA. Given the high risk of malnutrition in this growing patient population, targeted nutritional screening and optimization should be considered standard practice in the preoperative evaluation of GLP-1 users.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101865"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rheumatoid Arthritis Flare Presenting as Prosthetic Joint Infection With Synovial Next Generation Sequencing Guiding Treatment: A Case Report","authors":"Jonathan Lash MD,&nbsp;Andrew Murphy MD,&nbsp;Marcus Voigt MD,&nbsp;Alexander Burbelo BS,&nbsp;Matthew Bullock DO, MPT","doi":"10.1016/j.artd.2025.101875","DOIUrl":"10.1016/j.artd.2025.101875","url":null,"abstract":"<div><div>A patient with rheumatoid arthritis (RA) experienced a flare that mimicked a prosthetic joint infection several years after undergoing total knee arthroplasty. She presented with gradual worsening knee pain following discontinuation of her RA medication. Elevated inflammatory markers and an increased synovial cell count were noted, but synovial fluid polymerase chain reaction testing was negative. A nonoperative treatment approach was chosen, and she resumed her RA medication which led to symptom resolution. Next-generation sequencing played a pivotal role in ruling out infection and identifying the rheumatic cause of the knee pain, thereby avoiding unnecessary revision surgery. Next-generation sequencing may be a valuable diagnostic tool in clinically ambiguous cases.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101875"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronal Alignment in Revision Total Knee Arthroplasty: A Comparison of Cemented Vs Press-Fit Stems for Restoring Mechanical Axis","authors":"Niccolò Giabbani MD ,&nbsp;Matteo Innocenti MD ,&nbsp;Rudy Sangaletti MD ,&nbsp;Fabrizio Matassi MD ,&nbsp;Francesco Benazzo MD ,&nbsp;Roberto Civinini MD ,&nbsp;Marco Mugnaini MD ,&nbsp;Luigi Zanna MD","doi":"10.1016/j.artd.2025.101863","DOIUrl":"10.1016/j.artd.2025.101863","url":null,"abstract":"<div><h3>Background</h3><div>Restoring a neutral coronal alignment in revision total knee arthroplasty (rTKA) is paramount. Stem length and fixation type influence final limb alignment. This study compared overall limb alignment, measured by hip-knee-ankle (HKA) angle, in revisions using short-cemented (&lt;75 mm), long-cemented (&gt;75 mm), and press-fit stems. Secondary aims included evaluating coronal and sagittal alignment of tibial and femoral components and assessing canal fill ratio (CFR) in the press-fit group.</div></div><div><h3>Methods</h3><div>A retrospective multicenter review of 124 rTKAs from January 2019 to January 2022 was conducted. Included cases had revision of both femoral and tibial components using stems, with postoperative weight-bearing radiographs. Patients were divided into 3 groups based on stem type. Radiographic assessments included HKA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and CFR. analysis of variance and chi-square tests were used for statistical analysis.</div></div><div><h3>Results</h3><div>Data from 81 rTKAs were analyzed. Mean HKA was similar across all groups (group A: 178.9°, group B: 178.7°, group C: 178.7°; <em>P</em> = .985). No significant differences were found in mLDFA or mMPTA between groups. However, mLDFA showed more variability than mMPTA (<em>P</em> = .021), indicating greater femoral alignment deviation. CFR in press-fit stems averaged 77.3%, with no significant side-to-side differences.</div></div><div><h3>Conclusions</h3><div>Short-cemented stems achieved alignment comparable to long-cemented and press-fit stems. Femoral alignment was more variable than tibial. Short-cemented stems provide a flexible option with reliable alignment outcomes.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101863"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of Articular Cartilage Depth in Total Knee Arthroplasty","authors":"Evan P. Johnson MD ,&nbsp;Nicholas M. Brown MD ,&nbsp;Michael D. Hellman MD ,&nbsp;Tyler E. Calkins MD ,&nbsp;Nuanqiu Hou MS ,&nbsp;John R. Crockarell MD ,&nbsp;James L. Guyton MD ,&nbsp;Christopher T. Holland MD, MS ,&nbsp;William M. Mihalko MD, PhD ,&nbsp;Marcus C. Ford MD","doi":"10.1016/j.artd.2025.101869","DOIUrl":"10.1016/j.artd.2025.101869","url":null,"abstract":"<div><h3>Background</h3><div>Understanding cartilage thickness is critical for execution of an unrestricted, calipered kinematic total knee arthroplasty (TKA). Historically, condylar cartilage was assumed to be 2 mm thick. However, thickness may vary based on age, sex, body mass index, anterior cruciate ligament (ACL) status, and alignment. This study aimed to determine in vivo cartilage thickness in patients undergoing TKA and evaluate which factors affect variation. Our hypothesis was in vivo cartilage thickness would be 2 mm on average, but some patients would have greater than 2 mm based on demographic factors.</div></div><div><h3>Methods</h3><div>This multicenter, prospective cross-sectional cohort study evaluated condyle cartilage thickness from resected fragments. Univariate statistics and general linear models were used.</div></div><div><h3>Results</h3><div>Among 806 TKA cases, the mean unworn femoral cartilage thickness was as follows: distal medial 2.0 mm; distal lateral 2.2 mm; posterior medial 2.0 mm; and posterior lateral 2.2 mm. The mean unworn tibia cartilage thickness was as follows: medial spine 2.4 mm; medial center 1.4 mm; lateral spine 2.1 mm; and lateral center 2.5 mm. In patients with unworn femoral cartilage, approximately 18.5% had cartilage greater than 3 mm. In patients with unworn tibial cartilage, approximately 34.7% had cartilage greater than 3 mm. An incompetent ACL was correlated with thinner posteromedial femoral cartilage. Increased thickness was correlated with younger age, men.</div></div><div><h3>Conclusions</h3><div>A subset had unworn cartilage thickness greater than 3.0 mm, supporting our hypothesis. In an ACL deficient knee, the posteromedial cartilage was partially worn and should be considered for MCL isometry. Significant correlations were found based on age, gender, ACL status, alignment, body mass index, and race.</div></div><div><h3>Level of Evidence</h3><div>Level 2, Prospective cohort study.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101869"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unstable Lumbar Vertebral Body Fracture During Total Hip Arthroplasty Using the Anterolateral Spine Approach in Diffuse Idiopathic Skeletal Hyperostosis: A Case Report and Literature Review","authors":"Shinichi Ueki MD ,&nbsp;Takeshi Shoji MD, PhD ,&nbsp;Naosuke Kamei MD, PhD ,&nbsp;Hiroki Kaneta MD ,&nbsp;Hiroyuki Morita MD ,&nbsp;Yosuke Kozuma MD ,&nbsp;Naoto Nakayama MD ,&nbsp;Nobuo Adachi MD, PhD","doi":"10.1016/j.artd.2025.101874","DOIUrl":"10.1016/j.artd.2025.101874","url":null,"abstract":"<div><div>This case report describes a 72-year-old man with diffuse idiopathic skeletal hyperostosis who sustained a rare unstable lumbar vertebral body fracture during total hip arthroplasty (THA) using the anterolateral supine approach. Despite a successful THA, the patient developed severe postoperative back pain, leading to the diagnosis of a lumbar vertebral fracture. Prompt posterior spinal fusion effectively relieved the pain. This report emphasizes recognizing high-risk patients, such as those with diffuse idiopathic skeletal hyperostosis complicated by obesity or kyphosis, before THA, and underscores the need for careful perioperative management and intraoperative positioning to reduce stress on the lumbar spine.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101874"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dislocated Dual-Mobility Hip Implants Are Unlikely to Be Successfully Closed Reduced and Are More Likely to Require Revision Than Standard Articulation Implants","authors":"Janyne Mallender DO,&nbsp;Kendall Schwartz BS,&nbsp;Christian Leber BS,&nbsp;Tony Huyhn MD,&nbsp;Paulo Castaneda MD,&nbsp;J. Brock Walker MD","doi":"10.1016/j.artd.2025.101860","DOIUrl":"10.1016/j.artd.2025.101860","url":null,"abstract":"<div><h3>Background</h3><div>The natural history of dislocated dual-mobility (DM) total hip arthroplasties remains unclear, particularly regarding closed reduction success and revision rates compared to standard articulations (SAs). This study compared closed reduction success and subsequent reoperation rates between dislocated DM and SA hips.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted across a large health system, identifying patients with dislocated total hip arthroplasties using International Classification of Disease, Tenth Revision codes. Inclusion required an attempted closed reduction. Patients were stratified by implant type (DM vs SA). Data collected included demographics, prior surgeries, reduction attempts, intraprosthetic dissociation (IPD), subsequent instability, and revision surgery. Outcomes were compared between groups.</div></div><div><h3>Results</h3><div>Seventy-four patients met the inclusion criteria (26 DM, 48 SA). Successful closed reduction was significantly lower in the DM vs SA group (34.6% vs 90%; <em>P</em> &lt; .001). Among the 26 dislocated DM hips, 15 experienced IPD, including five initially missed. Revision surgery was more frequent in the DM group compared to SA (79.2% vs 53.4%; <em>P</em> &lt; .004). Among those with initially successful closed reductions, rates of recurrent instability requiring revision surgery did not differ significantly (DM 44.4% vs SA 41.9%; <em>P</em> = .84).</div></div><div><h3>Conclusions</h3><div>Dislocated DM implants are significantly less likely to be successfully closed reduced and more likely to require revision surgery than SA implants, largely due to the high rate of IPD. Missed IPD contributes substantially to the increased reoperation risk and highlights the importance of accurate diagnosis following dislocation.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101860"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Lithium Use and Periprosthetic Fracture After Total Hip Arthroplasty","authors":"Rafa Rahman MD, MPH,&nbsp;Billy Kim MD,&nbsp;Benjamin Basseri MD,&nbsp;Michael Mazzucco BS,&nbsp;Alexander McLawhorn MD, MBA","doi":"10.1016/j.artd.2025.101851","DOIUrl":"10.1016/j.artd.2025.101851","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic fracture (PPFx) is a devastating complication following total hip arthroplasty (THA), with concern for higher risk in osteoporotic patients. Lithium is associated with higher bone mineral density, and has emerged as a potential low-cost, widely available method for preventing fractures, promoting fracture healing, and improving implant osseointegration. This study investigated the association between lithium use and risk of PPFx following THA.</div></div><div><h3>Methods</h3><div>Retrospective review of the PearlDiver Mariner Patient Claims Database was performed, querying all patients who underwent THA for osteoarthritis from 2010 to 2022. Lithium-use patients were those who filled lithium prescriptions for at least 90 days before and 90 days after THA. These patients were propensity-score matched to controls not on lithium in a 1:4 ratio, matching for age, diagnosis of bipolar disorder, gender, body mass index, Charlson Comorbidity Index, and insurance. PPFx rate was compared between groups at 90 days and 2 years postoperatively. Secondarily, rate of aseptic loosening, revision, and prosthetic joint infection were compared between groups.</div></div><div><h3>Results</h3><div>Four thousand six hundred seventy patients were included, with 934 patients on lithium and 3736 controls. There was no difference in PPFx rate (90 day: lithium 1.3% vs no lithium 1.2%, <em>P</em> = .97; 2 year: lithium 1.7% vs no lithium 1.9%, <em>P</em> = .93), aseptic loosening, revision, or prosthetic joint infection.</div></div><div><h3>Conclusions</h3><div>Despite the theoretical benefit of lithium on bone density, it was not associated with a difference in the rate of PPFx or other surgical complication following THA. Further work is needed to address treatment of osteoporosis and prevention of periprosthetic fracture in the arthroplasty population.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"35 ","pages":"Article 101851"},"PeriodicalIF":2.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}