Arthroplasty Today最新文献

{"title":"Superior Sensitivity of the Forgotten Joint Score in Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials","authors":"Anand Dhaliwal MD,&nbsp;Alexander Baur DO,&nbsp;Brendan J. Liakos DO,&nbsp;Muzammil Akhtar MD,&nbsp;Shaunton Stubbs DO,&nbsp;Jaspreet Sidhu DO","doi":"10.1016/j.artd.2026.102061","DOIUrl":"10.1016/j.artd.2026.102061","url":null,"abstract":"<div><h3>Background</h3><div>The Forgotten Joint Score (FJS) is a patient-reported outcome (PRO) measure assessing joint awareness after total knee arthroplasty (TKA). Unlike traditional PROs, it is particularly sensitive to the “forgotten” quality of the joint, correlating with patient satisfaction and long-term success. This systematic review evaluates the FJS compared to conventional PROs in assessing TKA outcomes.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Embase, and the Cochrane Library identified randomized controlled trials reporting FJS alongside other PROs in primary TKA. Studies included various alignment techniques, implants, and robotic assistance. Independent reviewers performed data extraction and risk of bias assessments. Pooled FJS scores were analyzed using random-effects models, with subgroup analyses by surgical technique and prosthesis type.</div></div><div><h3>Results</h3><div>Fourteen randomized controlled trials (1244 knees) met inclusion criteria. FJS scores ranged from 19.00 to 98.00, with a mean of 73.61. Unlike Western Ontario and McMaster Universities, Oxford Knee Score, and Knee Society Score, the FJS showed no significant ceiling effect. Chi-square tests demonstrated that FJS detected significant postoperative improvements compared to Western Ontario and McMaster Universities and Knee Society Score (<em>P</em> = .011 and <em>P</em> = .037). Subgroup analyses found no significant differences in FJS or other PROs, though recent studies suggest a trend favoring kinematic alignment.</div></div><div><h3>Conclusions</h3><div>The FJS demonstrates superior sensitivity and avoids ceiling effects compared to traditional PROs, making it a valuable tool for evaluating subtle differences in TKA outcomes. Its ability to detect nuanced improvements highlights its clinical relevance in optimizing surgical techniques and enhancing patient-centered care. Future research should prioritize the FJS to refine alignment strategies and implant designs.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102061"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148635969","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 Modular Cup-in-Cup Construct in Revision Total Hip Arthroplasty","authors":"Ryan C. Palmer MD,&nbsp;McKenzie Culler MD,&nbsp;Pranit Kumaran BS,&nbsp;Donald B. Longjohn MD,&nbsp;Daniel A. Oakes MD,&nbsp;Nathanael D. Heckmann MD","doi":"10.1016/j.artd.2026.102114","DOIUrl":"10.1016/j.artd.2026.102114","url":null,"abstract":"<div><h3>Background</h3><div>The modular cup-in-cup technique, in which a modular primary acetabular component is cemented into a highly porous monobloc tantalum revision shell, provides the intraoperative flexibility to change bearings if subsequent re-revision is required. This study seeks to characterize the early outcomes of this technique.</div></div><div><h3>Methods</h3><div>A single-center retrospective review was performed of all patients who underwent revision total hip arthroplasty (rTHA) utilizing a modular acetabular component cemented into a highly porous monobloc tantalum revision shell. Preoperative and postoperative radiographs were assessed to quantify bone loss, cup position, and aseptic loosening. All-cause reoperation, revision for aseptic loosening, and revision for instability were estimated using the Kaplan–Meier method.</div></div><div><h3>Results</h3><div>In total, 27 hips were identified with a mean follow-up of 21.6 months. The most common indication for revision was aseptic loosening (48.1%). Preoperatively, 16 (59.3%) hips had Paprosky 3A defects, 7 (25.9%) had Paprosky 3B, 2 (7.4%) had Paprosky 2C defects, and 1 (3.7%) had a Paprosky 2A defect. In total, 4 (14.8%) patients underwent reoperation, 3 (11.1%) for instability and 1 (3.7%) for irrigation and debridement. All patients revised for instability were converted from a dual mobility articulation to a constrained liner. No radiographic loosening was observed at final follow-up. Estimated 3-year survivorships for all-cause reoperation and revision for instability were 84.6% (95% confidence interval: 46.6-95.6%) and 88.5% (95% confidence interval, 48.8-97.6%), respectively.</div></div><div><h3>Conclusions</h3><div>The modular cup-in-cup technique is a viable option for rTHA patients at increased risk of instability. This technique provides surgeons the flexibility to exchange the articulation if recurrent instability occurs.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102114"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737352","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":"Tranexamic Acid Use Is Associated With Lower Rates of Transfusion in Patients Undergoing Revision Total Hip Arthroplasty for Periprosthetic Joint Infection","authors":"Sahil S. Telang BS,&nbsp;Julian Wier MD,&nbsp;Pranit Kumaran BS,&nbsp;Steven H. Liu MD,&nbsp;Jacob Becerra MD,&nbsp;Jay R. Lieberman MD,&nbsp;Nathanael D. Heckmann MD","doi":"10.1016/j.artd.2026.102106","DOIUrl":"10.1016/j.artd.2026.102106","url":null,"abstract":"<div><h3>Background</h3><div>While tranexamic acid (TXA) is widely used in primary total hip arthroplasty (THA), it has not been studied extensively during revision THA for periprosthetic joint infection (PJI). Since revision procedures for infection are associated with greater intraoperative blood loss and a higher likelihood of transfusion, investigation of TXA use in first-stage revision THA for PJI is warranted to define its impact on postoperative bleeding risk, transfusion requirements, and safety profile.</div></div><div><h3>Methods</h3><div>Querying a large healthcare database, we identified adult patients between 2016 and 2023 undergoing stage-one revision THA for PJI. Patients who received TXA were subsequently identified. Propensity score matching was used to balance cohorts. Mixed-effects logistic regression models were used to assess primary outcome, transfusion. Secondary outcomes included postoperative bleeding outcomes, wound complications, deep vein thrombosis, and pulmonary embolism.</div></div><div><h3>Results</h3><div>After 1:1 propensity matching, 10,404 patients that had explanation of their THA and placement of an antibiotic spacer were included, with all hospital characteristics, patient demographics, and comorbidities demonstrating standardized mean differences &lt;0.10. TXA-treated patients had significantly lower rates of postoperative transfusion (15.94% vs 17.78%; adjusted odds ratio = 0.86, 95% confidence interval [CI] = 0.76-0.99, <em>P</em> = .030) and wound complications (16.69% vs 22.72%; odds ratio = 0.66, 95% confidence interval = 0.59-0.73). Similar rates were found for aggregate bleeding complications, deep vein thrombosis, and pulmonary embolism in both cohorts.</div></div><div><h3>Conclusions</h3><div>TXA is associated with a reduction in postoperative transfusion and wound complications in patients undergoing revision THA for PJI.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102106"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737349","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":"High-Volume Hospitals Are Associated With Lower Rates of Mortality Following Revision Arthroplasty for Periprosthetic Joint Infection","authors":"Julian Wier MD,&nbsp;McKenzie W. Culler BA,&nbsp;Avinash Iyer BS,&nbsp;Ryan Palmer MD,&nbsp;Sagar Telang MD,&nbsp;Jay R. Lieberman MD,&nbsp;Nathanael D. Heckmann MD","doi":"10.1016/j.artd.2026.102111","DOIUrl":"10.1016/j.artd.2026.102111","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between hospital case volume and postoperative morbidity following revision arthroplasty for periprosthetic joint infection (PJI) has not been defined. As such, we sought to compare 90-day postoperative mortality rates among patients undergoing antibiotic spacer placement for PJI of the hip or knee between high- vs low-volume hospitals.</div></div><div><h3>Materials and methods</h3><div>The Premier Healthcare Database was queried from 2016 to 2023 for adult patients undergoing antibiotic spacer placement for PJI. Using the Metropolis–Hastings algorithm, a single hospital volume threshold, below which mortality increased, was identified. Patients were divided by those operated on by high- vs low-volume hospitals. Multivariable logistic regression was conducted to assess odds of 90-day mortality and sepsis.</div></div><div><h3>Results</h3><div>In a cohort of 55,670 PJIs, postoperative mortality was decreased in patients who were operated on by hospitals performing ≥35 antibiotic spacers annually (high volume). The adjusted odds of mortality (adjusted odds ratio = 0.76; 95% confidence interval = 0.65-0.88, <em>P</em> &lt; .001) and sepsis (adjusted odds ratio = 0.69; 95% confidence interval = 0.66-0.73, <em>P</em> &lt; .001) were significantly lower among patients operating at high-volume hospitals.</div></div><div><h3>Conclusions</h3><div>Patients receiving PJI care at hospitals performing greater than 35 antibiotic spacers annually died less frequently and had improved outcomes than those presenting to lower volume centers. These findings reinforce emerging evidence in support of centralized PJI care centers to improve patient survival.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102111"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737350","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":"Precision and Accuracy of Polyethylene Thickness in Total Knee Arthroplasty: A Comparison of Conventional Measured Resection and Robotic-Assisted Techniques","authors":"Kory B. Dylan Pasko MD,&nbsp;McKenzie W. Culler BA,&nbsp;Torie Oishi BS,&nbsp;Avinash Iyer BS,&nbsp;Nathanael D. Heckmann MD,&nbsp;Andrew G. Yun MD","doi":"10.1016/j.artd.2026.102097","DOIUrl":"10.1016/j.artd.2026.102097","url":null,"abstract":"<div><h3>Background</h3><div>Total knee arthroplasty (TKA) aims to restore native knee kinematics through accurate bone resection and balanced flexion and extension gaps. Polyethylene thickness is a critical determinant of joint line preservation and stability. This study compared polyethylene implant accuracy and precision relative to the preoperative plan in robotic-assisted (RA) and conventional (C) TKA.</div></div><div><h3>Methods</h3><div>A retrospective review was performed of all patients who underwent TKA by a single surgeon at a single institution between March 1, 2018, and July 31, 2022. Patients were classified as having undergone either RA-TKA or C-TKA. A 9-mm polyethylene thickness was planned in all cases to achieve balanced flexion and extension gaps. Patient demographics and final polyethylene thickness were recorded. Mean differences from the planned thickness, deviation from the plan, and variance were compared.</div></div><div><h3>Results</h3><div>A total of 815 patients were included, with 404 (49.6%) undergoing C-TKA and 411 (50.4%) undergoing RA-TKA. Sex distribution did not differ between groups, though patients in the RA-TKA group were significantly older (70.46 ± 8.52 years vs 69.14 ± 8.34 years, <em>P</em> = .027). Mean polyethylene thickness was greater in C-TKA than RA-TKA (10.67 mm ± 1.18 mm vs 9.34 mm ± 0.61 mm, <em>P</em> &lt; .001) with mean differences of 1.67 mm and 0.34 mm, respectively. Adherence to the planned thickness was higher in RA-TKA (72.26% vs 16.09%) and variance was significantly lower (0.37 vs 1.39, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>RA-TKA demonstrated greater accuracy and precision in achieving planned polyethylene thickness, suggesting improved execution of the surgical plan and more consistent gap balancing. Prospective studies should determine whether these differences translate to superior clinical outcomes.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102097"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148635960","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":"Unexpected Metal Ion Elevation and Adverse Tissue Reactions in Trident II Dual Mobility Constructs With Ceramic Heads","authors":"Henry Somerby BA,&nbsp;Carmelo Burgio MD,&nbsp;Gabrielle Dykhouse BS,&nbsp;Edward Grabov BS,&nbsp;Aarti Shenoy PhD,&nbsp;Daniel Ramirez MD,&nbsp;Jonathan Vigdorchik MD,&nbsp;Gwo-Chin Lee MD,&nbsp;Peter Sculco MD","doi":"10.1016/j.artd.2026.102105","DOIUrl":"10.1016/j.artd.2026.102105","url":null,"abstract":"<div><div>Dual mobility (DM) constructs reduce dislocation risk in total hip arthroplasty. The Trident II system accepts a cobalt-chromium liner to create a DM bearing. However, dissimilar metal at the cup–liner interface raises concerns for corrosion. This case series describes six cementless primary Trident II DM total hip arthroplasty patients who experienced gradual onset of hip pain with low-grade inflammatory symptoms and elevated serum cobalt. All patients underwent revision surgery for metallic debris reaction. Preoperative magnetic resonance imaging revealed local tissue reaction, and intraoperative findings confirmed corrosion at the cup–liner interface. Surviellance through serum metal ion testing and magnetic resonance imaging may prevent soft tissue damage and facilitate timely revision. As DM systems evolve, further investigation is warranted to evaluate safety.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102105"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737425","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":"Discordance Between Hip-Specific PROMs and Lumbar Symptoms After Total Hip Arthroplasty in Patients With Prior Lumbar Fusion","authors":"Robert E. Carrier DO,&nbsp;Daisy A. Ference MD,&nbsp;Gabriella N. Capote BS,&nbsp;Victor H. Hernandez MD, MS,&nbsp;Michele R. D’Apuzzo MD,&nbsp;Colin A. McNamara MD","doi":"10.1016/j.artd.2026.102081","DOIUrl":"10.1016/j.artd.2026.102081","url":null,"abstract":"<div><h3>Background</h3><div>Hip-specific patient-reported outcome measures (PROMs) are used to assess patient recovery after total hip arthroplasty (THA), but their efficacy in patients with prior lumbar spinal fusion (LSF) remains less clear. This study evaluated the discordance between improvements in hip-specific PROMs and persistent lumbar-related symptoms in patients with prior LSF who underwent THA.</div></div><div><h3>Methods</h3><div>We performed a single-center retrospective study of patients with prior LSF who underwent THA from January 2015 to October 2025. Multiple PROMs, including PROMIS-10, HOOS Jr., University of California Los Angeles Activity Score, and EQ-5D, were analyzed using paired Wilcoxon signed-rank tests. Lumbar-related symptoms were assessed by structured chart review and treated as binary variables.</div></div><div><h3>Results</h3><div>Overall, 54 total cases from 47 unique patients were identified, including 41 total cases in the primary cohort. Paired baseline and 3-month PROMs were available for 18 total cases. Significant improvements occurred in HOOS Jr. (+27.66, <em>P</em> &lt; .001), PROMIS pain (−3.06, <em>P</em> &lt; .01), PROMIS physical (+6.06, <em>P</em> &lt; .01), and EQ-5D overall health (+17.0, <em>P</em> = .012). However, despite these improvements in multiple PROMs, lumbar-related symptoms still persisted at baseline, 3 months, 6 months, 1 year, and 2 years in 20.0%, 14.3%, 13.3%, 33.3%, and 25.0% of patients, respectively.</div></div><div><h3>Conclusions</h3><div>THA was associated with significant and meaningful early hip-specific functional improvements in patients with prior LSF. However, lumbar-related symptoms frequently persisted in many patients. This discordance suggests that hip-specific PROMs may incompletely capture postoperative recovery with hip-spine syndrome. However, these findings should be interpreted as exploratory and hypothesis-generating.</div></div><div><h3>Level of Evidence</h3><div>Level IV, Therapeutic study.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"40 ","pages":"Article 102081"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148738125","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":"Impact of Preoperative Osteoporotic Medications on Total Hip Arthroplasty Outcomes","authors":"Sophia S. Antonioli MD ,&nbsp;Garrett Ruff MD ,&nbsp;Nicole Leung MD ,&nbsp;Amy Patel MD ,&nbsp;Ran Schwarzkopf MD, MSc ,&nbsp;Anna Cohen-Rosenblum MD","doi":"10.1016/j.artd.2026.102026","DOIUrl":"10.1016/j.artd.2026.102026","url":null,"abstract":"<div><h3>Background</h3><div>Osteoporosis (OP) is a common comorbidity in patients undergoing total hip arthroplasty (THA) and is a known risk factor for poor postoperative outcomes such as periprosthetic fracture (PPF). The impact of preoperative OP medications in patients with OP undergoing THA remains unclear. This study aimed to compare THA outcomes by OP diagnosis and preoperative bone strengthening medication usage.</div></div><div><h3>Methods</h3><div>This was a retrospective review of primary elective THAs from June 2011-January 2024. Patients were stratified by OP diagnosis and OP medication usage, then propensity matched in a 1:2:3 ratio by age, sex, body mass index, and comorbidities. The resulting cohorts: (1) OP and medication usage for at least 1 year preoperatively and within 7 years of the procedure (n = 296), (2) OP and no medication usage (n = 592), and (3) no diagnosis of OP and no medication usage (n = 888) were then compared for postoperative outcomes.</div></div><div><h3>Results</h3><div>Patients in cohort 1 were more likely to visit the emergency department (<em>P</em> = .043) or be readmitted for a surgical complication (<em>P</em> = .007) within 90 days. They were more likely to undergo posterior approach than cohorts 2 and 3 (<em>P</em> = .016), had the highest occurrence of cemented femoral stems (38.2%, <em>P</em> &lt; .001), and had a higher incidence of revision for PPF (3.4%, vs 0.8% [cohort 2] and 1.2% [cohort 3], <em>P</em> = .009). Of the 12 revisions due to periprosthetic femoral fracture in cohorts 1 and 2 combined, 11 (91.7%) occurred around an uncemented implant.</div></div><div><h3>Conclusions</h3><div>Osteoporotic patients on OP medications did not have improved outcomes after THA compared with nonmedicated osteoporotic patients or those without a diagnosis of OP. PPF in osteoporotic patients overwhelmingly occurred around uncemented femoral implants. Surgeons should use caution when operating on osteoporotic patients, regardless of utilization of preoperative medications, and strongly consider using cemented femoral implants to decrease the risk of PPF.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 102026"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148184676","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":"Arthroscopic Treatment of Patellar Clunk Syndrome After Total Knee Arthroplasty","authors":"Maxwell C. Alley MD ,&nbsp;W. Doug Werry MD ,&nbsp;Charles A. Guerra BS ,&nbsp;Hadley Winslow BS ,&nbsp;Margaret Hedeman BA ,&nbsp;Alan Shi MD ,&nbsp;Brian T. Samuelsen MD ,&nbsp;Philip H. Aurigemma MD ,&nbsp;Mark J. Lemos MD","doi":"10.1016/j.artd.2026.102047","DOIUrl":"10.1016/j.artd.2026.102047","url":null,"abstract":"<div><h3>Background</h3><div>Patellar clunk syndrome is a complication of total knee arthroplasty. Surgical treatment with arthroscopic irrigation and debridement and lysis of adhesions is often required when conservative treatment fails. This study examines patient improvement following arthroscopic treatment of patellar clunk.</div></div><div><h3>Methods</h3><div>This single-surgeon case series uses a posterior-stabilized implant design. We performed a retrospective review of all patients from September 2013 to November 2020 treated for patellar clunk syndrome with arthroscopic debridement. Patient variables analyzed included knee flexion/extension angle and symptoms, including pain and mechanical symptoms. Analysis used paired t-tests with an alpha level of 0.05.</div></div><div><h3>Results</h3><div>Fifty procedures were examined. Mean patient age was 61.4 years (standard deviation [SD] = 8.57 years), and 64% were female. Before arthroscopy, the mean maximum knee extension (KE) of the affected side was 0.85° (SD = 3°), and the mean maximum knee flexion (KF) was 120.5° (SD = 9.4°). At the last follow-up, the mean maximum KE was 0.36° (SD = 1.3°), and the mean maximum KF was 123.1° (SD = 9.4°). Paired t-tests comparing preoperative and postoperative KF and KE were <em>P</em> = .138 and <em>P</em> = .487, respectively. All patients reported less pain, and 90% (45/50) reported mechanical symptom improvement.</div></div><div><h3>Conclusions</h3><div>Arthroscopic treatment of symptomatic patellar clunk syndrome is safe and effective: almost all included patients experienced symptom relief, with a slight improvement in KF. This was a retrospective cohort study with a level of evidence of III.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 102047"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148184777","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":"Reduction in Operative Time After Implementation of Computer-Assisted Navigation in Direct Anterior Total Hip Arthroplasty With Consideration of Learning Curve","authors":"Roy F. Small DO,&nbsp;Michelle Drouin PhD,&nbsp;Mindy Flanagan PhD,&nbsp;Manda Coupe BA,&nbsp;Jay Fiechter MD,&nbsp;Christopher N. Johnson DO","doi":"10.1016/j.artd.2025.101892","DOIUrl":"10.1016/j.artd.2025.101892","url":null,"abstract":"<div><h3>Background</h3><div>Computer-assisted navigation (CAN) in total hip arthroplasty (THA) is associated with improved component positioning accuracy. However, its impact on operative efficiency remains uncertain and may be influenced by the learning curve during adoption. This study evaluates the effect of a computerized hip navigation system on operative time and surgical complications.</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review of 300 consecutive direct anterior THAs by a single surgeon: 150 using conventional overlay, followed by 150 after implementation of CAN. After applying exclusion criteria, 292 cases remained. Demographic and perioperative variables were collected. Generalized linear modeling adjusted for covariates (body mass index, age, American Society of Anesthesiologists class) to assess relationship between surgical technique and operative time. Postoperative complications were compared between groups.</div></div><div><h3>Results</h3><div>CAN was associated with significant reduction in operative time. Compared to conventional THA (covariate-adjusted mean: 47.63 minutes), operative time was 2.65 minutes shorter during the learning phase, identified via statistical analysis as the first 100 CAN cases. Post-learning phase, mean operative time further decreased to 40.42 minutes, 7.21 minutes less than conventional THA (<em>P</em> &lt; .001). Body mass index was positively associated with increased operative time; age showed a modest inverse relationship. No significant difference in complication rates was observed between conventional and CAN groups (<em>P</em> = .54).</div></div><div><h3>Conclusions</h3><div>Implementation of CAN was associated with significantly decreased operative time after a brief learning curve, without an increase in complications. Findings support safe adoption of CAN in direct anterior THA and suggest enhanced operative efficiency, aligning with the demands of value-based care and increasing surgical volumes.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 101892"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370189","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}