Arthroplasty Today最新文献

{"title":"The Prediction of Venous Thromboembolism Using Artificial Intelligence and Machine Learning in Lower Extremity Arthroplasty: A Systematic Review","authors":"Davood Dalil MD ,&nbsp;Sina Esmaeili ,&nbsp;Ehsan Safaee ,&nbsp;Sajad Asgari ,&nbsp;Nooshin Kejani MD","doi":"10.1016/j.artd.2025.101672","DOIUrl":"10.1016/j.artd.2025.101672","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a common and serious complication following lower extremity arthroplasty, such as total hip and knee arthroplasty. Due to the increasing number of these surgeries, accurately predicting VTE risk is crucial. Traditional clinical prediction models often fall short due to their complexity and limited accuracy.</div></div><div><h3>Methods</h3><div>This Preferred Reporting Items for Systematic Review and Meta-Analyses–guided systematic review summarized the application of artificial intelligence (AI) and machine learning models in predicting VTE after total joint arthroplasty. Databases including PubMed, Scopus, Web of Science, and Embase were searched for relevant studies published up to January 2024. Eligible studies focused on the predictive accuracy of AI algorithms for VTE post arthroplasty and were assessed for quality using the Newcastle-Ottawa Scale.</div></div><div><h3>Results</h3><div>A total of 7 retrospective cohort studies, encompassing 579,454 patients, met the inclusion criteria. These studies primarily employed the extreme gradient boosting model, which generally demonstrated strong predictive performance with area under the curve values ranging from 0.71 to 0.982. Models like random forest and support vector machines also performed well. However, only 1 study included external validation, critical for assessing generalizability.</div></div><div><h3>Conclusions</h3><div>AI and machine learning models, particularly extreme gradient boosting, exhibit significant potential in predicting VTE after lower extremity arthroplasty, outperforming traditional clinical prediction tools. Yet, the need for external validation and high-quality, generalizable datasets remains critical before these models can be widely implemented in clinical practice. The study underscores the role of AI in preoperative planning to enhance patient outcomes in orthopaedic surgery.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101672"},"PeriodicalIF":1.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725065","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":"Vaccination Status is Not Associated With Adverse Postoperative Outcomes Following Total Joint Arthroplasty in Patients With a Preoperative COVID-19 Diagnosis","authors":"Pramod Kamalapathy MD,&nbsp;Corinne Vennitti MD,&nbsp;Pradip Ramamurti MD,&nbsp;James Browne MD","doi":"10.1016/j.artd.2025.101673","DOIUrl":"10.1016/j.artd.2025.101673","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have shown that COVID-19 diagnosis increases rates of perioperative infection, readmission, and other complications following surgery. However, the effect of the COVID vaccine in such patients is unknown. We hypothesized that of the patients with COVID diagnosis, vaccinated patients with COVID-19 diagnosis would have lower rates of adverse complications compared to unvaccinated patients undergoing total joint arthroplasty (TJA).</div></div><div><h3>Methods</h3><div>Using a national database registry, patients aged less than 85 years undergoing elective primary total knee or total hip arthroplasty with at least 90 days of follow-up were included during the first year of COVID-19 pandemic from April 2020-April 2021. Patients were included in the COVID-19 cohort if they had a diagnosis on the day of surgery or within 30 days prior to surgery. Patients with a history of malignancy, joint injection, femoral neck fractures, tibial fractures, and those undergoing revision arthroplasty were excluded from the study. All comparisons were performed using multivariate logistic regression with significance set at <em>P</em> &lt; .05. Odds ratio and 95% confidence interval were reported for all comparisons.</div></div><div><h3>Results</h3><div>There were a total of 1280 patients with COVID-19 diagnosis matched with 3831 patients without COVID-19 diagnosis. Patients with a COVID-19 diagnosis were at an increased risk of pneumonia, acute kidney injury, urinary tract infection, and readmission following TJA compared to patients without COVID-19 diagnosis. However, there were no differences in any complications assessed between vaccinated patients and unvaccinated patients with COVID-19 diagnosis following TJA.</div></div><div><h3>Conclusions</h3><div>This study confirms that patients with a COVID-19 diagnosis in the 30 days prior to TJA, whether vaccinated or not, have increased risks of medical complications and hospital utilization. However, this study demonstrates that vaccination status does not appear to be associated with the incidence of adverse postoperative events in patients with a COVID-19 diagnosis prior to TJA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101673"},"PeriodicalIF":1.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735123","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":"Outcomes After Patellofemoral Arthroplasty With the Arthrex iBalance—A Third Generation Implant","authors":"Elizabeth C. Bond MB, ChB, FRACS ,&nbsp;Emily K. Reinke PhD ,&nbsp;Christian Zirbes BS ,&nbsp;Emily Poehlein MB ,&nbsp;Cynthia L. Green PhD ,&nbsp;Richard M. Danilkowicz MD ,&nbsp;Annunziato Amendola MD","doi":"10.1016/j.artd.2025.101666","DOIUrl":"10.1016/j.artd.2025.101666","url":null,"abstract":"<div><h3>Background</h3><div>Patellofemoral arthroplasty (PFA) is an attractive option for patients who have isolated patellofemoral disease. This study aimed to assess the functional outcomes and revision rates of primary PFA with a third-generation implant with short- to medium-term follow-up.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed the records of 49 patients (70 knees) undergoing PFA with the iBalance system by a single surgeon at a quaternary center between January 2015 and September 2022 for demographic and surgical data, as well as complications and revision rates. Patient-reported outcome scores were then collected.</div></div><div><h3>Results</h3><div>The population was majority female (81.6%) with a median age of 50 years. Four knees were revised to a total knee arthroplasty (5.7%) at an average time point of 2.3 years postoperatively (range: 1.3-3.5 years). The median Single Assessment Numeric Evaluation score at the time of follow-up was 82.5, while the median Kujala score was 72. Lower preoperative Kellgren-Lawrence grade was significantly associated with lower Knee Injury and Osteoarthritis Outcome Scores in all 5 domains (<em>P</em> &lt; .05 for all). Additional procedures were required in 17 knees (24.3%), in most cases to improve patella tracking.</div></div><div><h3>Conclusions</h3><div>This study is, to our knowledge, the first to examine outcomes of the iBalance PFA system. The results show favorable patient-reported outcomes in this cohort consistent with other 2nd and 3rd generation PFA implants, along with a revision rate similar to its prosthetic peers.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101666"},"PeriodicalIF":1.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725054","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":"Total Hip Arthroplasty After Gunshot-Related Hip Injuries: Case Series and Review of Literature","authors":"Artsiom Abialevich MD ,&nbsp;Ilan Tzaytlin MD ,&nbsp;Asaf Acker MD ,&nbsp;Vadim Benkovich MD","doi":"10.1016/j.artd.2025.101671","DOIUrl":"10.1016/j.artd.2025.101671","url":null,"abstract":"<div><div>High-velocity penetrating trauma to the hip can result in complex acetabular and femoral head fractures, often accompanied by vascular injuries and extensive soft tissue damage. Managing these injuries presents significant challenges due to contamination, bone loss, and the need for staged reconstruction. In 2 cases of severe ballistic and blast injuries, initial damage control measures included debridement, stabilization, and temporary antibiotic spacers to control infection risk. Delayed definitive total hip arthroplasty was performed after optimizing soft tissue and bony healing, leading to full functional recovery. This approach highlights the importance of staged reconstruction and multidisciplinary management in achieving successful outcomes in high-energy hip injuries.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101671"},"PeriodicalIF":1.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697465","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":"State Healthcare Regulations and Total Knee Arthroplasty Prices Across the United States","authors":"Kevin A. Wu BS ,&nbsp;Katherine M. Kutzer BS ,&nbsp;Christian A. Pean MD, MS ,&nbsp;Thorsten M. Seyler MD, PhD","doi":"10.1016/j.artd.2025.101670","DOIUrl":"10.1016/j.artd.2025.101670","url":null,"abstract":"<div><h3>Background</h3><div>The cost of healthcare services in the United States is subject to various regulatory influences, yet the impact of state-level healthcare policies and political affiliations on total knee arthroplasty (TKA) prices remains underexplored.</div></div><div><h3>Methods</h3><div>Using data from the Turquoise Health Database and publicly available sources, TKA prices were analyzed across states to examine the influence of Medicaid expansion, Certificate of Need (CON) laws, and state partisan lean. Multivariable regression models controlled for Gross Domestic Product per capita, Area Deprivation Index, and urbanization.</div></div><div><h3>Results</h3><div>Among 64,402 TKAs from 2455 hospitals ($18,164 median, interquartile range: $10,806), states with Medicaid expansion and CON laws demonstrated lower TKA prices. Republican-leaning states had significantly reduced TKA prices compared to Democrat-leaning states, even after adjusting for economic factors (<em>P</em> &lt; .0001).</div></div><div><h3>Conclusions</h3><div>Medicaid expansion and CON laws were associated with lower TKA prices across the United States. Additionally, states with Republican political leanings tended to have lower listed prices for TKA compared to Democrat-leaning states. These findings underscore the substantial influence of state healthcare policies and political factors on healthcare costs, highlighting the complexities of pricing dynamics in the US healthcare system.</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101670"},"PeriodicalIF":1.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697467","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":"Letter to the Editor: “Adverse Local Tissue Reaction and Osteolysis After Ceramic-on-Ceramic Total Hip Arthroplasty’’","authors":"Michael M. Morlock PhD","doi":"10.1016/j.artd.2025.101676","DOIUrl":"10.1016/j.artd.2025.101676","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101676"},"PeriodicalIF":1.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697468","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":"Abdominal Pannus Should Not Dictate Surgical Approach in Primary Total Hip Arthroplasty","authors":"Samantha Bialek MD,&nbsp;William Oetojo BA,&nbsp;Robert Burnham Jr. MD,&nbsp;Nicholas Brown MD","doi":"10.1016/j.artd.2025.101675","DOIUrl":"10.1016/j.artd.2025.101675","url":null,"abstract":"<div><h3>Background</h3><div>Increased pannus size is a risk factor for complications with anterior approach total hip arthroplasty (THA). However, it is unclear if changing to a posterior approach mitigates this risk. The purpose of this study was to evaluate whether abdominal pannus size had a differential effect on complication rate comparing anterior vs posterior THA.</div></div><div><h3>Methods</h3><div>One thousand consecutive primary THA patients—478 anterior and 522 posterior—were retrospectively reviewed for complications and their abdominal pannus was radiographically measured on an anteroposterior pelvis image and placed into 1 of 4 categories based on its vertical size (no pannus [G0], above symphysis [G1], below symphysis [G2], or below ischial tuberosities [G3]). Chi-squared tests for univariate and logistic regression models controlled for age, race, gender, body mass index, Charlson comorbidity index, and smoking.</div></div><div><h3>Results</h3><div>Comparing wound complications at increasing pannus size, anterior vs posterior (G0 1.9% vs 3.9%, <em>P</em> = .21; G1 7.2% vs 6.7%, <em>P</em> = .08; G2 17.9% vs 11.6%, <em>P</em> = .27; G3 16.7% vs 15.5%, <em>P</em> = .84), similar results were found with reoperations (G0 0.9% vs 1.1%, <em>P</em> = .080; G1 1.4% vs 2%, <em>P</em> = .72; G2 3.0% vs 5.8%, <em>P</em> = .41; G3 1.7% vs 4.5%, <em>P</em> = .33). Additionally, logistic regression models demonstrated no statistically significant difference in the odds of wound complications or reoperations between the approaches at each pannus size.</div></div><div><h3>Conclusions</h3><div>In patients with an abdominal pannus, there is no difference in the risk of delayed wound healing or reoperation within 90 postoperative days comparing anterior to posterior approach.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101675"},"PeriodicalIF":1.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697466","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":"Silk Fibroin Closure Eliminates the Incidence of Allergic Contact Dermatitis Compared to Cyanoacrylate Mesh in Total Joint Arthroplasty","authors":"Justin P. Moo Young MD,&nbsp;Viraj A. Deshpande BS,&nbsp;Susanne Porter FNP-BC,&nbsp;Edward J. Quilligan BS,&nbsp;Travis Scudday MD,&nbsp;Steven Barnett MD,&nbsp;Robert Gorab MD","doi":"10.1016/j.artd.2025.101668","DOIUrl":"10.1016/j.artd.2025.101668","url":null,"abstract":"<div><h3>Background</h3><div>Allergic contact dermatitis (ACD) from adhesive wound closure systems has garnered particular attention for its potential role in increasing wound complications in total joint arthroplasty (TJA). This study, performed at a high-volume orthopaedic specialty hospital, investigates the incidence of wound complications among 2 adhesive systems: a cyanoacrylate mesh (CM) adhesive and a silk fibroin (SF) adhesive.</div></div><div><h3>Methods</h3><div>All TJAs from January 2019 to April 2024 with at least 6 wks postoperative follow-up were retrospectively reviewed. Demographics and surgical outcomes were collected and analyzed. Statistical analyses were performed using Fisher’s exact tests and <em>t</em>-tests.</div></div><div><h3>Results</h3><div>A sample size of 170 CM and 85 SF subjects was calculated to achieve a power of 80%. Of the 257 patients identified (172 CM and 85 SF), 46.7% were females and 53.3% were males, with a mean age of 65.3 ± 9.0 years and a mean body mass index of 28.0 ± 4.6. Bivariate analyses revealed no significant differences in demographics or comorbidities between the CM and SF cohorts, except for frequency of American Society of Anesthesiologists 1 classification (3.9% vs 1.7%; <em>P</em> = .011). The CM cohort exhibited a significantly higher incidence of ACD (6.4% vs 0%; <em>P</em> = .018), while differences in all other clinical outcomes were nonsignificant.</div></div><div><h3>Conclusions</h3><div>There is a very low incidence of wound complications in TJA when using the SF adhesive for wound closure. There was a statistically significant increase in ACD when using the CM adhesive. SF adhesives appear to be a superior wound closure option to consider in patients undergoing TJA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101668"},"PeriodicalIF":1.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680501","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":"Factors Affecting the Elevation of Inflammatory Markers Before Primary Total Hip Arthroplasty","authors":"Byung-Chan Choi MD, PhD,&nbsp;Byung-Woo Min MD, PhD,&nbsp;Kyung-Jae Lee MD, PhD","doi":"10.1016/j.artd.2025.101669","DOIUrl":"10.1016/j.artd.2025.101669","url":null,"abstract":"<div><h3>Background</h3><div>Abnormal inflammatory marker levels are often detected in patients who have multiple comorbidities before primary total hip arthroplasty (THA) without a specific infection. This study aimed to examine the prevalence of the elevation of inflammatory markers, distribution of inflammatory markers, and factors affecting the elevation of inflammatory marker levels before primary THA.</div></div><div><h3>Methods</h3><div>A retrospective review of 511 THA cases from the outpatient clinic of a single institution was conducted. Patients were divided into 2 groups with normal (group A: n = 432) vs abnormal (group B: n = 79) C-reactive protein (CRP) values using threshold for the upper limit of normal of 0.5 mg/dL. Preoperative diagnoses and underlying diseases of the patients were reviewed. Underlying diseases and medical history included autoimmune inflammatory disease; diabetes mellitus; chronic kidney disease; histories of cancer, organ transplantation, and contralateral hip arthroplasty; and preoperative urinalysis. The distribution of inflammatory markers, prevalence of preoperative diagnosis, and underlying diseases were compared.</div></div><div><h3>Results</h3><div>The prevalence of elevated CRP levels was 15.5%. Mean values of all inflammatory markers were significantly lower in group A. The risk of elevated CRP was higher with osteonecrosis of the femoral head (ONFH) and subchondral insufficiency fracture of the femoral head (SIFFH) compared to hip arthritis (ONFH: odds ratio = 3.03; SIFFH: odds ratio = 4.85). The prevalence of autoimmune inflammatory disease was higher in group A than in group B. No difference in the prevalence of other underlying diseases was observed between the groups.</div></div><div><h3>Conclusions</h3><div>Elevated inflammatory markers are commonly observed before primary THA. Although the distribution of inflammatory markers was different, only CRP level was different based on normal range. Regarding preoperative diagnosis, ONFH and SIFFH significantly influenced the elevation of inflammatory marker levels compared to hip arthritis. Regarding underlying diseases, autoimmune inflammatory disease was the only significant factor affecting the elevation of inflammatory markers.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101669"},"PeriodicalIF":1.5,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680500","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":"Why Should I Review for Arthroplasty Today? The Benefits of Becoming a Peer Reviewer","authors":"Joshua P. Rainey MD","doi":"10.1016/j.artd.2025.101677","DOIUrl":"10.1016/j.artd.2025.101677","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101677"},"PeriodicalIF":1.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680481","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}