Arthroplasty Today最新文献

{"title":"Characteristics and Risk Factors of Atypical Periprosthetic Femoral Fractures Following Total Hip Arthroplasty: A Systematic Review and Meta-Analysis","authors":"Ayomide Michael Ade-Conde ,&nbsp;Ahmad Hamade MD ,&nbsp;Omar Al-Mohrej MBBS, (Hons), MSc ,&nbsp;Vickas Khanna MD, MHA, FRCSC ,&nbsp;James Yan MD, FRCSC","doi":"10.1016/j.artd.2026.102048","DOIUrl":"10.1016/j.artd.2026.102048","url":null,"abstract":"<div><h3>Background</h3><div>Atypical periprosthetic femoral fractures (APFFs) are a challenging, albeit uncommon, complication after total hip arthroplasty (THA). This systematic review will evaluate the characteristics and risk factors associated with APFFs following THA.</div></div><div><h3>Methods</h3><div>A systematic search of EMBASE, MEDLINE, CENTRAL, and CINAHL was performed from inception to October 6, 2025, for studies reporting APFFs after THA. Patient, surgical, and radiographic data were extracted. Random-effects meta-analyses pooled proportions and odds ratios (ORs).</div></div><div><h3>Results</h3><div>Eight studies comprising 1072 THA patients with periprosthetic fractures were included. APFFs accounted for 120/1072 fractures (11.2%), with a pooled proportion of 11% (95% confidence interval [CI], 7%-18%; I² = 90.2%). Patients with APFFs were predominantly female (91.1%), with a mean age of 76.5 years. Bisphosphonate exposure was common (88%; 95% CI, 71%-96%; I² = 0%) and more likely in APFFs than typical periprosthetic fractures (OR, 6.7; 95% CI, 3.1-14.4; I² = 2.1%). The mean interval from THA to APFF was 8.4 years. Where reported, most APFFs were Vancouver B (85.3%). Fixation was common (67.9%), with a mean union of 8.8 months. APFFs had higher complication odds after initial management than typical periprosthetic fractures (OR, 6.5; 95% CI, 2.2-19.2; I² = 0%).</div></div><div><h3>Conclusions</h3><div>Long-term bisphosphonate use may increase APFF risk after THA. These fractures typically occur late and have characteristic clinical and radiographic features. APFFs represent a high-risk subtype of periprosthetic fracture that requires careful surveillance and thoughtful surgical management. As THA volumes rise, prospective studies and standardized diagnostic criteria are needed to clarify incidence and inform prevention.</div></div><div><h3>Level of Evidence</h3><div>Level III, Systematic review.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 102048"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148241743","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":"Did You Know: Formal Physical Therapy is Not Always Necessary After Total Joint Arthroplasty","authors":"Sumon Nandi MD, MBA,&nbsp;Hari P. Bezwada MD","doi":"10.1016/j.artd.2025.101942","DOIUrl":"10.1016/j.artd.2025.101942","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 101942"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370234","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":"Successful Management of Achromobacter-Associated Periprosthetic Joint Infections After Total Knee Arthroplasty: A Case Series of Ten Knees in Six Patients","authors":"Rahul Singla MBBS, MS ,&nbsp;Pulak Vatsya MBBS, MS ,&nbsp;Vrishank Malhotra MBBS ,&nbsp;Ashish Chauhan MBBS, MS ,&nbsp;Gaurav Garg MBBS, MS ,&nbsp;Rajesh Malhotra MBBS, MS, FRCS","doi":"10.1016/j.artd.2026.102055","DOIUrl":"10.1016/j.artd.2026.102055","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infections (PJIs) following total knee arthroplasty (TKA) are often caused by common pathogens; however, rare organisms like <em>Achromobacter</em> species pose unique diagnostic and therapeutic challenges. This case series evaluates 10 <em>Achromobacter</em>-related PJIs among 6 patients.</div></div><div><h3>Methods</h3><div>A prospective single-center case series of patients aged greater than 18 years with culture-confirmed Achromobacter PJI was conducted at a New Delhi tertiary care center beginning July 2023. Diagnosis was established using European Bone and Joint Infection Society criteria. Data collection included demographic details, comorbidities, diagnostics, microbiology, surgical interventions, and outcomes. Management was individualized based on infection severity and patient factors.</div></div><div><h3>Results</h3><div>Five female and 1 male patient [mean age: 61.83 years] presented with ten infected TKAs. Four developed bilateral infections. Most patients presented with sinus tracts; 2 immunocompetent patients had an indolent course. Diagnosis was confirmed using automated continuously monitored blood culture system (n = 3), conventional culture (n = 2), and matrix-assisted laser desorption/ionization time-of-flight (n = 1). Four patients (6 knees) had <em>Achromobacter xylosoxidans</em>, 2 patients (4 knees) had <em>Achromobacter denitrificans</em>. One patient with initial bilateral <em>A xylosoxidans</em> infection developed reinfection with the <em>A denitrificans</em> strain in the left knee. Five patient had significant comorbidities. Initial debridement, antibiotics, and implant retention (performed prior to referral) failed in 3 cases. Five patients (9 knees) underwent two-stage revision. One patient (1 knee) underwent single-stage revision and One patient required resection arthroplasty.Following prolonged targeted antibiotic therapy, none of the patients had signs of infection at final follow-up.</div></div><div><h3>Conclusions</h3><div><em>Achromobacter</em>-related PJIs are rare but aggressive. Successful management requires accurate diagnosis, tailored surgical, and prolonged targeted antimicrobial therapy.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 102055"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148184778","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":"Conversion Total Hip Arthroplasty From a Long Cephalomedullary Nail Through the Direct Anterior Approach","authors":"Wyatt H. Buchalter BS,&nbsp;Geordie C. Lonza MD,&nbsp;William K. Crockatt MD,&nbsp;Carl L. Herndon MD,&nbsp;Roshan P. Shah MD, JD,&nbsp;H. John Cooper MD,&nbsp;Jeffrey A. Geller MD,&nbsp;Alexander L. Neuwirth MD,&nbsp;Nana O. Sarpong MD, MBA","doi":"10.1016/j.artd.2026.102056","DOIUrl":"10.1016/j.artd.2026.102056","url":null,"abstract":"<div><div>Conversion total hip arthroplasty after prior open hip surgery can present with challenges. The direct anterior approach on a standard operating room table allows for the ease of use of fluoroscopy to facilitate hardware removal and implant positioning, accurate determination of leg lengths, and improved operative efficiency. We present a surgical technique to demonstrate a safe and effective method for performing conversion total hip arthroplasty with removal of a long cephalomedullary nail and subsequent conversion through a direct anterior approach on a standard operating room table.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 102056"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148184775","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":"Optimizing Daily Surgical Scheduling Improves Operative Time Consumption: A Retrospective Study","authors":"Aazad Abbas MD,&nbsp;Imran Saleh MASc,&nbsp;Paul Wong MD, MSc, FRCSC,&nbsp;Jeremie Larouche MD, MSc, FRCSC,&nbsp;Jihad Abouali MD, FRCSC,&nbsp;Sam Park MD, MASc, FRCSC,&nbsp;Timothy C.Y. Chan PhD,&nbsp;Vahid Sarhangian PhD,&nbsp;Jay Toor MD, MBA, FRCSC","doi":"10.1016/j.artd.2025.101926","DOIUrl":"10.1016/j.artd.2025.101926","url":null,"abstract":"<div><h3>Background</h3><div>Arthroplasty cases represent some of the highest volume and resource-intensive orthopaedic procedures. Most cost containment efforts have focused on restricting access to operating room (OR) time rather than improving efficiency through scheduling optimization. However, approaches such as bin-packing optimization (BPO) can be used to generate more efficient schedules. This study compares manual scheduling with BPO to evaluate their impact on OR efficiency. Our hypothesis is that BPO scheduling produces more efficient OR schedules compared to manual scheduling.</div></div><div><h3>Methods</h3><div>Data were collected retrospectively for a mid-sized hospital performing elective orthopaedic surgery (majority hip and knee arthroplasty). Data included operative time, overtime, and number of OR days. BPO model was used to simulate an optimized schedule and compared to the historic manual schedule by comparing the number of OR days required to complete the same surgical volume. The primary outcome was the total number of OR days required.</div></div><div><h3>Results</h3><div>All surgeons experienced a median 10% reduction (range: 9.2%–18.3%) in OR days required using BPO schedules (mean 183 days) vs historical scheduling (mean 207 days). Daily OR configurations differed from historical ones in 87% of cases, and the number of configurations per surgeon dropped from an average of 6 to 4.</div></div><div><h3>Conclusions</h3><div>BPO increased OR throughput by 10% without increasing operative time. This suggests potential for reduced costs, shorter wait lists, and improved surgeon satisfaction for hip and knee arthroplasty. Future work should incorporate predictive modeling using patient- and procedure-specific data.</div></div><div><h3>Level of Evidence</h3><div>III – Retrospective study.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 101926"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370199","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":"Temporal Analysis of Patients Eligible for Randomized Controlled Trials in Total Hip Arthroplasty","authors":"Brynn P. Charron MD, MSc ,&nbsp;Ethan Pieterman ,&nbsp;Brent Charron ,&nbsp;Elia Arbana MD ,&nbsp;Brent A. Lanting MD, MSc","doi":"10.1016/j.artd.2026.101995","DOIUrl":"10.1016/j.artd.2026.101995","url":null,"abstract":"<div><h3>Background</h3><div>There has been a shift in the demographics of patients undergoing elective lower extremity joint arthroplasties in recent years. This study aimed to assess whether research has kept pace with changing demographics through analyzing inclusion and exclusion criteria of randomized controlled trials (RCTs) relevant to total hip arthroplasties (THAs).</div></div><div><h3>Methods</h3><div>Cross-sectional analysis of RCTs studying primary THAs indexed on <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> was performed. Trial characteristics regarding inclusion and exclusion criteria of 706 studies initiated between 1994-2023 were analyzed. Sample size, type of intervention, year of study initiation, length of study, and inclusion/exclusion criteria were evaluated.</div></div><div><h3>Results</h3><div>An increasing number of THA-based RCTs were initiated over the study period (1994-2004: 5.18 studies/y, 2021-2023: 36.7 studies/y). The majority of included RCTs had an upper age exclusion criterion (1994-2004: 65.9%, 2021-2023: 53.6%). Body mass index (BMI) restrictions have become more common than previously (1994-2004: 5.3%, 2021-2023: 29.1%); however, the range has expanded to include higher BMI limits. The most common exclusion criteria based upon health comorbidities included psychiatric health and cognitive impairment (36.4%), neurologic and neuromuscular dysfunction (32.6%), and systemic infections (31.4%).</div></div><div><h3>Conclusions</h3><div>Regarding elective primary THA, it is recognized that the age and BMI of patients have shifted substantially over recent decades. This study revealed that restrictions on participant age continue to be prevalent. Although the average BMI of patients undergoing elective THA is rising, BMI is increasingly being implemented as an exclusion criterion. Critical assessment of inclusion and exclusion criteria for all studies, especially RCTs, given their associated cost and potential impact, requires further attention in orthopaedics.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 101995"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148158332","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":"Hospital-Wide Safety Performance Affects Complication Rates After Primary Total Hip and Knee Arthroplasty","authors":"Audrey R. Byrne BA,&nbsp;Wyatt H. Buchalter BS,&nbsp;Alexander S. Dash MD, MS,&nbsp;Lauren H. Redler MD,&nbsp;Nattaly E. Greene MD,&nbsp;Nana O. Sarpong MD, MBA","doi":"10.1016/j.artd.2026.102060","DOIUrl":"10.1016/j.artd.2026.102060","url":null,"abstract":"<div><h3>Background</h3><div>Outcomes following total hip arthroplasty and total knee arthroplasty (THA/TKA) are influenced not only by surgical techniques but also by infrastructure in broader hospital systems. The association of hospital-wide patient safety performance with arthroplasty-specific complication rates remains incompletely understood.</div></div><div><h3>Methods</h3><div>We performed a retrospective hospital-level analysis of the Centers for Medicare &amp; Medicaid Services Complications and Deaths–Hospital dataset spanning April 1, 2021, through June 30, 2024. Hospitals reporting both the risk-adjusted arthroplasty complication rate (COMP_HIP_KNEE) and the Patient Safety Indicator composite (PSI-90) were included. Hospitals reporting fewer than 25 arthroplasty cases were excluded. PSI-90 was analyzed as both a continuous variable and stratified into quartiles. Weighted linear regression evaluated the association between PSI-90 and arthroplasty complication rates, with weighting by procedural volume. Unweighted regression was performed as a sensitivity analysis.</div></div><div><h3>Results</h3><div>A total of 1551 hospitals met inclusion criteria. Mean risk-adjusted THA/TKA complication rates increased across worsening PSI-90 quartiles, from 3.5% in the best safety quartile to 3.7% in the worst quartile (<em>P</em> &lt; .001). In weighted linear regression analyses, worse hospital-wide safety performance was significantly associated with higher arthroplasty complication rates; each 1-unit increase in PSI-90 corresponded to a 0.47 percentage-point increase in complication rate (<em>P</em> &lt; .001). Findings remained significant in unweighted sensitivity analyses (β = 0.26; <em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>Worse hospital-wide safety performance is associated with higher complication rates following primary THA and TKA. These findings suggest that arthroplasty outcomes are influenced not only by procedure-specific factors but also by broader institutional safety systems.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 102060"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148184674","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":"Patient Perceptions of Robotic-Assisted Hip and Knee Arthroplasty Among Orthopaedic Outpatient Attendees: A Cross-Sectional Survey in an Irish Tertiary Center","authors":"Conor Farrell MB, BCh, BAO, MCh ,&nbsp;Orla Hennessy MB, BCh, BAO, MCh, MRCS ,&nbsp;Dunamis Akinyemi MB, BCh, BAO ,&nbsp;Angela Faustino MB, BCh, BAO ,&nbsp;Fiachra Rowan MD, FRCS(Orth), FFSEM ,&nbsp;May S. Cleary MB, BCh, BAO, MCh, FRCS(Orth)","doi":"10.1016/j.artd.2026.102062","DOIUrl":"10.1016/j.artd.2026.102062","url":null,"abstract":"<div><h3>Background</h3><div>Robotic-assisted arthroplasty has been introduced to improve the precision and reproducibility of implant positioning in joint replacement surgery. While clinical and economic evaluations continue to expand, little is known about patient perceptions of this technology, and no Irish data currently exist. This study evaluates patient awareness, attitudes, and expectations regarding robotic-assisted joint replacement in an Irish tertiary orthopaedic center.</div></div><div><h3>Methods</h3><div>A cross-sectional paper-based survey was administered to adult patients attending elective orthopaedic outpatient clinics between August and November 2025. The questionnaire assessed awareness, perceived risks and benefits, willingness to undergo robotic-assisted surgery, and views on surgeon vs robot control using yes/no questions and 0–10 Likert scales. Descriptive and comparative analyses were performed.</div></div><div><h3>Results</h3><div>A total of 117 patients participated. Awareness of robotic-assisted arthroplasty was modest, with 38.5% reporting prior knowledge of the technology. Most patients (87.2%) wished to be informed if a robot were involved in their operation, yet only 11.1% would change surgeons to access robotic-assisted surgery. Awareness significantly influenced expectations: those who had heard of robotics anticipated better outcomes (6.5 ± 1.8 vs 5.0 ± 2.1, <em>P</em> &lt; .001), less postoperative pain (4.8 ± 1.5 vs 5.7 ± 1.8, <em>P</em> = .006), and lower risk (4.7 ± 2.1 vs 5.8 ± 2.3, <em>P</em> = .019) than those unaware. Perceptions of invasiveness, operative time, cost, recovery, and robot independence did not significantly differ. Age did not influence awareness or perception across any domain.</div></div><div><h3>Conclusions</h3><div>This first Irish study demonstrates low awareness and mixed optimism toward robotic arthroplasty. Prior awareness is associated with more favorable expectations, while trust in the surgeon remains central.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 102062"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148184675","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":"Total Knee Arthroplasty in the Presence of Congenital Heart Disease: An Under-Recognized Risk","authors":"Seyed Morteza Kazemi MD ,&nbsp;Ava Parvandi MD ,&nbsp;Amir-Mohammad Asgari MD ,&nbsp;Pooya Hosseini-Monfared MD ,&nbsp;Donya Rezazadeh Eidghahi MD ,&nbsp;Sepehr Rezazadeh Eidghahi MD ,&nbsp;Mahdi Mohammaditabar MD ,&nbsp;Shayan Amiri MD ,&nbsp;Alireza Mirahmadi MD, MPH","doi":"10.1016/j.artd.2026.102063","DOIUrl":"10.1016/j.artd.2026.102063","url":null,"abstract":"<div><h3>Background</h3><div>Adults with congenital heart disease (CHD) increasingly present for noncardiac surgery. Total knee arthroplasty (TKA) induces significant hemodynamic and thromboembolic stress and, in patients with intracardiac shunts such as patent foramen ovale (PFO) or atrial septal defect (ASD), may precipitate paradoxical embolism and other under-recognized complications.</div></div><div><h3>Methods</h3><div>A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, Embase, and Web of Science were searched from inception to December 2024. Peer-reviewed original studies reporting outcomes of TKA in patients with CHD were eligible. Two reviewers independently screened studies, extracted data, and appraised methodological quality using the Joanna Briggs Institute tools. Given the heterogeneity and predominance of case-based evidence, findings were synthesized narratively.</div></div><div><h3>Results</h3><div>Eleven case reports (1996-2023) involving 11 patients met the inclusion criteria. Most patients were female (72.7%), with a mean age of 67.3 years (range, 52-84). PFO was the most frequent lesion (81.8%), followed by ASD (18.2%). Symptom onset was commonly early: 36.4% occurred perioperatively and 36.4% within the first 2 postoperative days. Neurological manifestations predominated (72.7%), with respiratory symptoms (27.3%) and limb ischemia (9.1%) less frequent. Transesophageal echocardiography confirmed the diagnosis in 72.7% of cases. Paradoxical cerebral embolism/stroke was the principal complication; pulmonary embolism (18.2%) and venous thromboembolism (9.1%) were also reported.</div></div><div><h3>Conclusions</h3><div>TKA in patients with CHD, particularly PFO or ASD, may be complicated by early paradoxical embolic events. New neurological deficits or unexplained hypoxemia warrant urgent evaluation for intracardiac shunting. Higher-quality studies are needed to guide screening and prevention strategies.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 102063"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148241738","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":"Seasonal, Regional, and Clinical Factors Associated With Manipulation Under Anesthesia Following Total Knee Arthroplasty: A PearlDiver Study","authors":"Tera A. Scott MS ,&nbsp;Randall R. Rainwater BS ,&nbsp;Louis S. Steen BS ,&nbsp;Simon C. Mears MD, PhD ,&nbsp;C. Lowry Barnes MD ,&nbsp;Jeffrey B. Stambough MD ,&nbsp;Benjamin M. Stronach MD","doi":"10.1016/j.artd.2026.102030","DOIUrl":"10.1016/j.artd.2026.102030","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative stiffness after total knee arthroplasty (TKA) can necessitate manipulation under anesthesia (MUA) when conservative treatments fail. While younger age and female sex have been linked to MUA risk, the impact of enviro nmental factors and systemic comorbidities is less defined. This study evaluates both patient-specific and environmental factors influencing MUA rates. We hypothesized that regional and seasonal variability influence MUA incidence and that a history of fibrotic or inflammatory pathologies would increase postoperative MUA risk.</div></div><div><h3>Methods</h3><div>Using the PearlDiver database, we retrospectively analyzed patients who underwent TKA and had active records within 90 days postoperatively (n = 1,703,407). Factors assessed included region, season, demographics (age, sex, Charlson Comorbidity Index), and various comorbidities. Multivariate regression evaluated associations between MUA and predictor variables, while chi-square assessed variation by region, season, and comorbidity. Statistical significance was set at α = 0.001.</div></div><div><h3>Results</h3><div>MUA incidence declined from 3.12% in 2011 to 2.61% in 2022. Among the 49,594 patients (2.91%) who underwent MUA, higher risk was associated with younger age, female sex, and lower Charlson Comorbidity Index scores. Musculoskeletal pathologies like arthrofibrosis, knee instability, patellar tendonitis, and previous ligamentous injury also independently increased MUA risk (<em>P</em> &lt; .001). MUA rates were highest in the Midwest (3.22%, <em>P</em> &lt; .001) and winter (3.07%, <em>P</em> &lt; .001), and lowest in the South (2.65%, <em>P</em> &lt; .001) and summer (2.82%, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Younger age and female sex were the strongest predictors of MUA following TKA. While geographic region and season showed statistically significant associations, their impact was comparatively modest, emphasizing that patient-specific demographic factors remain the primary drivers of MUA risk.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 102030"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148184677","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}