Arthroplasty Today最新文献

{"title":"Early Clinico-Radiographic Outcomes of Cementless Collared Triple Taper Stems in Osteoporotic Patients Undergoing Elective Total Hip Arthroplasty: A Descriptive Analysis","authors":"Ahmad M. Zedan BS,&nbsp;Jessica L. Abrolat MS,&nbsp;Maithily Diaz MS,&nbsp;Alan Zhong,&nbsp;Jeffrey J. Barry MD,&nbsp;Erik N. Hansen MD,&nbsp;Stefano A. Bini MD,&nbsp;Claudio Diaz-Ledezma MD","doi":"10.1016/j.artd.2026.102109","DOIUrl":"10.1016/j.artd.2026.102109","url":null,"abstract":"<div><h3>Background</h3><div>Osteoporosis is a well-established risk factor for early femoral failure following cementless total hip arthroplasty (THA). The performance of cementless collared triple-taper stems (CTTSs) in patients with a confirmed diagnosis of osteoporosis remains poorly defined. This study aimed to evaluate early clinico-radiographic outcomes of CTTS in osteoporotic patients undergoing elective THA.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 96 patients (87.5% women; mean age 69.5 ± 7.4 years) who underwent elective THA with a CTTS between 2018 and 2025. Osteoporosis was confirmed by either dual-energy x-ray absorptiometry T-score ≤ −2.5 or history of fragility fracture. Preoperative morphology and postoperative canal fill ratios, alignment, and subsidence (&gt;3 mm) were assessed. Femoral failure was defined as periprosthetic fracture or aseptic loosening.</div></div><div><h3>Results</h3><div>Preoperative morphology demonstrated a predominance of wide canals (Dorr B: 67.5%, Dorr C: 26%) and a mean morphological cortical index of 2.55. Postoperatively, high mean canal fill ratios were achieved (Z1: 0.66; Z2: 0.79; Z3: 0.76; Z4: 0.74), indicating reliable metaphyseal and diaphyseal fit. Despite osteoporotic bone quality, no cases of measurable subsidence were observed. Prominent collars occurred in 34.4% and neocortex formation in 5.2%, with no associated complications. At a mean follow-up of 2 years (range 1–7), the primary outcome of femoral failure was 0% at 90 days, 1 year, and final follow-up.</div></div><div><h3>Conclusions</h3><div>Cementless CTTS demonstrated reliable early fixation with no femoral failures in a rigorously defined osteoporotic cohort. These findings suggest that cementless CTTS may be a viable option for femoral fixation in osteoporotic patients undergoing elective THA.</div></div><div><h3>Level of Evidence</h3><div>Level III, Therapeutic study.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102109"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is It the Trunnion or Is It the Liner? Investigating Bilateral Dual-Mobility Constructs With Different Inner Femoral Head Compositions","authors":"Gabrielle Dykhouse BS,&nbsp;Henry Somerby BA,&nbsp;Jonggu Shin MD,&nbsp;Ittai Shichman MD,&nbsp;Daniel Ramirez MD,&nbsp;Aarti Shenoy PhD,&nbsp;Peter Sculco MD","doi":"10.1016/j.artd.2026.102084","DOIUrl":"10.1016/j.artd.2026.102084","url":null,"abstract":"<div><div>Dual-mobility designs aim to reduce dislocation with a dual head, creating a larger effective head size. However, concerns exist regarding corrosion from dissimilar metal interfaces. An 80-year-old female patient exhibited elevated cobalt (2.6 μg/L) and titanium (7.8 μg/L) but normal chromium (1.2 μg/L) levels after 5 years. She had staged bilateral total hip arthroplasty with identical modular liners, a 22 mm cobalt-chrome and a 28 mm ceramic head in the left and right hips, respectively. Magnetic resonance imaging showed left-sided ALTR. At revision, the trunnion and head showed gross corrosion. Biomechanical analysis confirmed trunnionosis of the 22-mm cobalt-chrome head without liner corrosion, suggesting dual mobility may increase the risk for trunnionosis at this size. This case highlights cobalt-chrome head risks and identifies trunnion corrosion as a cause of metallosis.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102084"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterotopic Ossification Following Total Hip Arthroplasty: A Contemporary Approach-Based Review for Surgeons Utilizing the Direct Anterior Approach","authors":"Connor Buchanan BS,&nbsp;McKenzie W. Culler BA,&nbsp;Mohammad Poursalehian MD,&nbsp;Lucas Anderson MD,&nbsp;Andrew G. Yun MD,&nbsp;Nathanael D. Heckmann MD","doi":"10.1016/j.artd.2026.102110","DOIUrl":"10.1016/j.artd.2026.102110","url":null,"abstract":"<div><h3>Background</h3><div>The direct anterior approach (DAA) has become the most frequently utilized surgical approach for total hip arthroplasty (THA) in the United States. There is a growing need to clarify the differential risk of complications associated with the DAA compared to other surgical approaches. Heterotopic ossification (HO) is a well-recognized complication following THA that may result in pain and stiffness. Despite its clinical relevance, the risk of HO in DAA patients remains poorly described. In this review, we provide a comprehensive overview of HO following THA, with a particular focus on the DAA.</div></div><div><h3>Methods</h3><div>A comprehensive literature search of the PubMed/Medline database was performed using search terms “total hip arthroplasty,” “heterotopic ossification,” and “approach.” Article titles and abstracts were reviewed to determine relevance. Randomized controlled trials, systematic reviews, meta-analyses, comparative studies, and case series were included. Articles not published in the English language were excluded.</div></div><div><h3>Results</h3><div>HO results from trauma-induced differentiation of osteoprogenitor cells in soft tissue surrounding the hip joint. Surgical approach is a determinant of HO risk after THA, with the DAA producing the lowest incidence of HO. Other risk factors for the development of HO have been identified, including male gender and advanced age. Prophylaxis against HO includes perioperative nonsteroidal anti-inflammatory drugs, tranexamic acid, and local radiation therapy, while management involves surgical resection of ectopic bone in symptomatic patients.</div></div><div><h3>Conclusions</h3><div>This review synthesizes data from recent systematic reviews and case series to provide arthroplasty surgeons with an understanding of postoperative HO risk, stratified by surgical approach.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102110"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended Oral Antibiotics After Primary Total Hip and Knee Arthroplasty in an Ambulatory Surgery Center: A Bayesian Threshold and Cost-Effectiveness Analysis","authors":"Breydan H. Wright MD,&nbsp;Charlotte C. Baker BS,&nbsp;Zachary M. Ricciardelli BS,&nbsp;Joseph M. Schwab MD,&nbsp;Thomas L. Bradbury MD,&nbsp;Courtney Levit BS,&nbsp;George N. Guild III MD","doi":"10.1016/j.artd.2026.102108","DOIUrl":"10.1016/j.artd.2026.102108","url":null,"abstract":"<div><h3>Background</h3><div>Given evidence for extended oral antibiotic prophylaxis (EOA), we compared EOA with no EOA after primary total hip and knee arthroplasty in an ambulatory surgery center (ASC) using Bayesian and probabilistic cost modeling.</div></div><div><h3>Methods</h3><div>This retrospective study included same-day discharge THA/TKA cases at a single ASC. The primary outcome was 90-day periprosthetic joint infection (PJI). Bayesian logistic regression estimated posterior odds ratios (ORs) and probabilities of benefit. Probabilistic cost-effectiveness analysis incorporated antibiotic and debridement, antibiotics, and implant retention costs.</div></div><div><h3>Results</h3><div>Among 7723 TKAs (EOA n = 2337; no-EOA n = 5386) and 5872 THAs (EOA n = 1670; no-EOA n = 4202), 90-day PJI rates were 0.13% versus 0.26% in TKA and 0.48% versus 0.40% in THA. Median posterior ORs were 0.58 for TKA (84.3% probability of benefit) and 1.24 for THA (30.7%). In TKA, the absolute risk reduction was 1.13 per 1000 cases, yielding a number needed to treat of 885;clinically favorable values would require baseline PJI rates of 0.8%-1.2%. With costs of $15 for EOA and $30,000 for PJI, EOA was cost-effective at $50,000 per PJI averted and cost-saving when PJI costs exceeded $13,000 in TKA, but not THA. Patient-reported outcome improvements were similar.</div></div><div><h3>Conclusions</h3><div>In this low-risk, same-day discharge ASC cohort, EOA showed a modest probablitly of benefit and favorable economic performance in TKA. These findings support selective, risk-based use consistent with antibiotic stewardship.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102108"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Carbon Monoxide Breathalyzer is Effective at Identifying Smokers Before Total Joint Arthroplasty","authors":"Jacquelina Achkar BSc, MD,&nbsp;Michael Tanzer MD, FRCSC, FAAOS,&nbsp;Nawaf Alamiri MD, FRCSC,&nbsp;Sean Gilman MD, FRCP,&nbsp;Claudine Després MD, CCFP,&nbsp;Adam Hart BEng, MASc, MD, FRCSC","doi":"10.1016/j.artd.2026.102089","DOIUrl":"10.1016/j.artd.2026.102089","url":null,"abstract":"<div><h3>Background</h3><div>Smoking is a major risk factor for delayed wound healing and prosthetic joint infections, yet it is poorly identified and modified before surgery. Patients often omit or downplay their consumption, and objective methods of screening for smoking are lacking. Carbon monoxide (CO) breath testing is a validated, noninvasive tool to detect recent smoking but has yet to be used to screen patients planned for total joint arthroplasty (TJA). This study compares self-reported smoking status to a CO breathalyzer test in patients listed for TJA.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study of patients with end-stage arthritis listed for TJA surgery at a single academic center. All participants completed a standardized smoking questionnaire and then underwent CO breath testing using a validated handheld breathalyzer. CO levels were categorized as low (0-6 ppm), borderline (7-9 ppm), or high (≥10 ppm). The primary outcome was the concordance between self-reported smoking status and CO levels.</div></div><div><h3>Results</h3><div>A total of 153 patients were enrolled, of whom 29 self-identified as <em>active smokers</em>, 14 as <em>exposed nonsmokers</em> (<em>ENS</em>), and 110 as <em>nonsmokers</em>. Smokers exhibited the highest mean CO levels (13.6 ± 7.5 ppm), followed by ENS patients (9.0 ± 7.4 ppm), while <em>nonsmokers</em> had significantly lower levels (1.6 ± 1.6 ppm; <em>P</em> &lt; .001). In the ENS group, 42.9% had high CO levels, indicating possible discordance between self-report and biochemical testing.</div></div><div><h3>Conclusions</h3><div>CO breath testing is a low-cost, noninvasive tool that successfully differentiated between self-reported active smokers and <em>nonsmokers</em> among patients who are planned to undergo a TJA. Some patients who identified as <em>nonsmokers</em> with an unclear exposure history were found to have high CO levels upon testing. Integrating CO screening into preoperative assessment may enhance identification of recent smoke exposure and support targeted counseling prior to TJA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102089"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148635968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Coronal Plane Alignment of the Knee Classification May be Unreliable With Advanced Knee Arthritis","authors":"Brandon H. Naylor DO,&nbsp;Charlotte C. Baker BS,&nbsp;Anita Alex Bradham BA,&nbsp;Natalie L. Gresham BS,&nbsp;Zachary M. Ricciardelli BS,&nbsp;Joseph M. Schwab MD","doi":"10.1016/j.artd.2026.102102","DOIUrl":"10.1016/j.artd.2026.102102","url":null,"abstract":"<div><h3>Background</h3><div>Kinematic alignment (KA) seeks to restore native, prearthritic alignment, including the arithmetic hip–knee–ankle angle (aHKA) and joint line obliquity (JLO). Advanced osteoarthritis may alter these parameters through erosion, subchondral collapse, or insufficiency fracture, potentially misrepresenting the native coronal plane alignment of the knee (CPAK) phenotype. Therefore, we sought to evaluate concordance in CPAK phenotype parameters between the severely arthritic knee and the contralateral healthy knee within the same patient.</div></div><div><h3>Methods</h3><div>We performed a radiographic review of 578 patients with bilateral, weight-bearing, long-leg radiographs obtained prior to total knee arthroplasty. The inclusion criteria required a Kellgren–Lawrence grade 4 knee (arthritic) and a contralateral Kellgren–Lawrence grade 0 or 1 knee (healthy). Absolute side-to-side differences were calculated for aHKA, JLO, medial proximal tibial angle, and lateral distal femoral angle, with additional stratification based on the predominant compartment of arthritic degeneration (medial or lateral).</div></div><div><h3>Results</h3><div>Ninety patients met the inclusion criteria. The mean absolute differences between healthy and arthritic knees were 3.5° for aHKA, 2.3° for JLO, 2.4° for medial proximal tibial angle, and 1.7° for lateral distal femoral angle. CPAK concordance between healthy and arthritic knees was limited, with matching phenotypes in only 41% of patients with medial arthritis and 50% with lateral arthritis.</div></div><div><h3>Conclusions</h3><div>Advanced knee osteoarthritis may lead to permanent bony changes that alter the measured CPAK phenotype. Replicating this pathologic alignment during kinematic alignment total knee arthroplasty could result in unintended component malposition. Careful preoperative radiographic assessment is essential to identify and account for these deformities.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102102"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148635970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Hip and Knee Arthroplasty Clinic Flow: A Prospective Evaluation of Artificial Intelligence Scribe Technology","authors":"Zachary Grand BS,&nbsp;Jonathan Brutti BS,&nbsp;Klaudia Greer BS,&nbsp;Jason Mirharooni BS,&nbsp;Andrew McDaid PhD,&nbsp;Charles M. Lawrie MD, MSc","doi":"10.1016/j.artd.2026.102095","DOIUrl":"10.1016/j.artd.2026.102095","url":null,"abstract":"<div><h3>Background</h3><div>The increasing burden of clinical documentation contributes to physician inefficiency and burnout, with electronic health record implementation significantly increasing documentation time from 16% to 28% of clinical time. While human medical scribes have shown benefits, artificial intelligence (AI) scribes represent a promising solution. This study evaluated the impact of AI scribe technology on clinical encounter duration and physician workload in a high-volume hip and knee arthroplasty clinic.</div></div><div><h3>Methods</h3><div>This prospective quality-improvement cohort study was conducted by a single surgeon at one institution from November 2024 to February 2025. Hip and knee arthroplasty patients were divided into 2 cohorts: a control group using traditional physician and medical assistant documentation within the electronic medical record and an intervention group using AI-powered clinical documentation. Clinical encounter duration was assessed by 3 independent reviewers using direct observation and stopwatch timing. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) was completed after each clinic day to quantify subjective physician workload across 6 domains on a 20-point scale.</div></div><div><h3>Results</h3><div>A total of 112 patient encounters were analyzed: 55 with AI scribes and 57 with traditional documentation. Encounter time was significantly shorter in the AI group, with a mean of 12.03 minutes (range, 4.01-22.13) compared to 15.06 minutes (range, 6.20-32.27) for traditional documentation (<em>P</em> &lt; .001). Overall, physician workload measured by NASA-TLX was lower with AI assistance, with a mean total score of 30.0 (range, 26-40) vs 40.2 (range, 11-73) for traditional documentation (<em>P</em> = .485). The AI group showed consistently lower mean scores across all NASA-TLX subdomains, including temporal demand (5.8 vs 10.4), effort (6.8 vs 10.0), and frustration (3.4 vs 5.4).</div></div><div><h3>Conclusions</h3><div>AI scribe implementation significantly reduced clinical encounter duration by approximately 20% and demonstrated promising improvements in physician workload metrics.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102095"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148635972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Octenidine-Based Versus Chlorhexidine-Based Preoperative Skin Antisepsis in Primary Hip and Knee Arthroplasty","authors":"Abialevich Artsiom MD,&nbsp;Benkovich Vadim MD","doi":"10.1016/j.artd.2026.102113","DOIUrl":"10.1016/j.artd.2026.102113","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infection (SSI) and periprosthetic joint infection (PJI) remain major complications after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Preoperative antisepsis bundles are essential components of infection-prevention pathways; however, comparative data on octenidine-based vs chlorhexidine-based protocols remain limited. This study compared infectious and wound-related outcomes between these bundles in primary THA and TKA.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 1767 consecutive patients who underwent primary THA or TKA between March 2015 and September 2024. Patients were stratified by antisepsis bundle: chlorhexidine-based group, 867 patients; and octenidine-based group, 900 patients. Baseline characteristics, American Society of Anesthesiologists class, comorbidities, procedure type, wound complications, SSI, PJI, readmission, and revision surgery were analyzed. Primary outcomes were 30-day superficial SSI, 90-day deep SSI/PJI, and 1-year PJI. Secondary outcomes included composite infectious and wound-related events. Between-group comparisons and adjusted analyses were performed where permitted.</div></div><div><h3>Results</h3><div>Baseline characteristics were comparable. Thirty-day superficial SSI occurred in 0.8% of chlorhexidine patients and 1.1% of octenidine patients (Relative risk [RR], 1.38; 95% confidence interval (CI), 0.53-3.61; <em>P</em> = .682). Ninety-day deep SSI/PJI occurred in 0.1% vs 0.0% (RR, 0.32; 95% CI, 0.01-7.80; <em>P</em> = .491), and 1-year PJI in 0.1% vs 0.0% (RR, 0.32; 95% CI, 0.01-7.80; <em>P</em> = .491). Composite infectious events were similar (0.9% vs 1.1%; RR, 1.20; 95% CI, 0.47-3.04; <em>P</em> = .875). Composite wound-related events occurred in 45.1% vs 41.7% (RR, 0.92; 95% CI, 0.83-1.03; <em>P</em> = .159).</div></div><div><h3>Conclusions</h3><div>Octenidine-based preoperative antisepsis showed outcomes comparable to chlorhexidine-based antisepsis in primary THA and TKA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102113"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“E-Spot” (Obturator ‘E’xternus Tendon Femoral Origin) as an Intraoperative Landmark for Femoral Preparation During “Off-Table” Anterior Approach","authors":"Elad Apt MD,&nbsp;Graeme Hoit MD,&nbsp;Bheeshma Ravi MD, PhD, FRCSC,&nbsp;Daniel Pincus MD, PhD, FRCSC","doi":"10.1016/j.artd.2026.102040","DOIUrl":"10.1016/j.artd.2026.102040","url":null,"abstract":"<div><h3>Background</h3><div>This study introduces the obturator externus tendon femoral origin, termed “E-spot,” as a landmark during “off-table” anterior approach total hip arthroplasty (THA). Aims were to determine whether the E-spot could (1) be identified reliably in all cases and (2) help as a reference during femoral preparation to determine the extent of capsular release and femoral implant position.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 306 consecutive patients who underwent primary THA by the senior author via an anterior approach between October 2022 and October 2024 was conducted. We attempted to visualize and preserve the obturator externus tendon in all cases and then use it as a reference to determine the extent/completion of capsular release and femoral implant position. Clinical outcomes and complications were assessed at a minimum of 6 months postoperatively to up to 2 years.</div></div><div><h3>Results</h3><div>E-spot could (1) be reliably identified as well as (2) the stem to E-spot distance measured in every case (306 out of 306 or 100% reproducibility). There was 1 periprosthetic fracture (Vancouver B2) requiring revision surgery at 2 months postoperatively and 1 dislocation at 3 months postoperatively (0.65% overall early complication rate). No other surgical complications were observed.</div></div><div><h3>Conclusions</h3><div>Identifying E-spot in a systematic way is a safe and reliable method of enabling femoral exposure and referencing femoral component position. Based on these results, we now routinely use E-spot to determine the completion of femoral capsular release, assess femoral component position, assure hip stability, and protect the trochanter from injury during off-table anterior THA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102040"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Survivorship Analysis of a Modern Anatomic Cementless Tibial Baseplate: A Multicenter Retrospective Study","authors":"Alexander Burbelo BS,&nbsp;Rex Lutz DO,&nbsp;Steven Fischer DO,&nbsp;Harrison Patrizio DO,&nbsp;Marcus Voigt MD,&nbsp;Liam Cleary MD,&nbsp;Trace Clark BS,&nbsp;Arjun Saxena MD,&nbsp;Alvin Ong MD,&nbsp;Matthew Bullock DO, MPT","doi":"10.1016/j.artd.2026.102117","DOIUrl":"10.1016/j.artd.2026.102117","url":null,"abstract":"<div><h3>Background</h3><div>Cementless total knee arthroplasty has seen increased adoption given the potential for durable biologic fixation. However, limited data exist on modern anatomic cementless tibial baseplate designs. This study evaluates early survivorship and functional outcomes of a novel cementless tibial baseplate compared to a cemented counterpart from the same manufacturer.</div></div><div><h3>Methods</h3><div>A multicenter retrospective review was conducted of 394 patients undergoing primary total knee arthroplasty at 2 academic-affiliated institutions from 2018 to 2023. Of these, 183 received a porous anatomic cementless tibial baseplate (Smith &amp; Nephew, Memphis, TN) and 211 received a Genesis II cemented tibial baseplate. Mean follow-up was 1.4 years and 2.7 years, respectively. The primary outcome was all-cause revision-free survivorship; secondary outcomes included aseptic tibial loosening and Knee Injury and Osteoarthritis Outcome for Joint Replacement scores.</div></div><div><h3>Results</h3><div>One patient in each group required revision for aseptic tibial baseplate loosening. Two-year all-cause revision-free survivorship was 96.2% (95% confidence interval [CI]: 91.2-100) in the cementless group and 96.0% (95% CI: 92.6-99.6) in the cemented group (<em>P</em> = .92). Unadjusted Cox regression demonstrated no statistically significant difference in revision risk (hazard ratio 3.27, 95% CI 0.52–20.53; <em>P</em> = .207); however, estimates were imprecise and the hazard ratio consistently favored the cemented cohort. No significant between-group difference in Knee Injury and Osteoarthritis Outcome for Joint Replacement improvement was identified after multivariable adjustment (β = 3.46; 95% CI, −1.31 to 8.24; <em>P</em> = .154).</div></div><div><h3>Conclusions</h3><div>This cementless tibial baseplate demonstrated low early revision and aseptic loosening rates; however, imprecise Cox regression estimates preclude conclusions regarding equivalent survivorship. Longer-term prospective studies with contemporary controls are warranted.</div></div><div><h3>Level of Evidence</h3><div>III, Retrospective comparative cohort study.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102117"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148738119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}