Arthroplasty Today最新文献

{"title":"Post-Paralytic Knee Arthropathy Following Spinal Ependymoma Resection Treated With Bilateral Hinged Total Knee Arthroplasty","authors":"Jessica Nelson MD,&nbsp;Austin Post MD,&nbsp;Michael Miller MD","doi":"10.1016/j.artd.2026.102058","DOIUrl":"10.1016/j.artd.2026.102058","url":null,"abstract":"<div><div>Post-paralytic knee arthropathy (PPKA) is a rare and underrecognized cause of progressive joint degeneration, driven by chronic muscle imbalance that leads to abnormal joint mechanics and loading patterns. We report the first known case of bilateral PPKA following spinal ependymoma resection treated with staged hinged total knee arthroplasty (H-TKA). The patient developed severe, progressive deformities over 18 years with preserved sensation, distinguishing this condition from Charcot arthropathy, which is characterized by rapid joint destruction and profound sensory loss. Staged H-TKA restored alignment, improved stability, relieved pain, and enabled functional recovery. This case highlights the unique modern pathophysiology of PPKA and supports H-TKA as a viable treatment option.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 102058"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148184678","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":"Soft Tissue Coverage Options Following Total Hip Arthroplasty: What to Do When a Wound Breaks Down","authors":"Katharine D. Harper MD ,&nbsp;Eric Maiorino MD","doi":"10.1016/j.artd.2026.102057","DOIUrl":"10.1016/j.artd.2026.102057","url":null,"abstract":"<div><div>Wound complications following total hip arthroplasty are a challenging issue facing surgeons, with rates reported anywhere from 1 to 12% of patients. There currently exists a paucity of literature detailing the options for surgeons who encounter soft tissue defects or closure difficulties following total hip arthroplasty. With the increasing popularity of using the anterior and lateral approaches for more complex arthroplasty revisions and reconstructions, detailing options for soft tissue coverage options may prove valuable. This article will provide an overview of soft tissue coverage options for the anterior, posterior, and alternate approaches, and when a plastic surgeon should be consulted for assistance.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 102057"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148184776","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":"Distal Femoral Triangle Combined With Distal Adductor Canal Block Offers Superior Analgesia and Functional Recovery After Total Knee Arthroplasty Compared to Adductor Canal Block and iPACK: A Randomized Clinical Trial","authors":"Prapairat Hemmaraj MD ,&nbsp;Pathompong Choowit MD ,&nbsp;Pongkrit Niamhoon MD ,&nbsp;Tiraporn Khuhalerd PT ,&nbsp;Suppachai Lawanaskol MD ,&nbsp;Artit Laoruengthana MD","doi":"10.1016/j.artd.2026.102050","DOIUrl":"10.1016/j.artd.2026.102050","url":null,"abstract":"<div><h3>Background</h3><div>The distal femoral triangle block may provide better coverage of the saphenous nerve and the nerve to vastus medialis compared to the adductor canal block (ACB). Furthermore, anesthetic injection into the distal ACB may spread into the popliteal fossa, potentially alleviating posterior knee pain. Therefore, we aimed to evaluate the efficacy of the combined distal femoral triangle block and distal ACB (dFdA) for pain management following total knee arthroplasty (TKA).</div></div><div><h3>Methods</h3><div>Patients (N = 70) were randomized to dFdA or ACB+iPACK groups. Primary outcomes were the numerical rating scale (NRS) for post-TKA pain during rest and movement, and total morphine consumption (TMC). Secondary outcomes included the timed up and go test (TUG), two-minute walk test (2MWT), active knee flexion, and five-times sit-to-stand test.</div></div><div><h3>Results</h3><div>The dFdA group demonstrated significantly lower NRS for anterior knee pain during 6-48 hours and posterior knee pain during 6-18 hours post-TKA, both at rest and during movement, compared with the ACB+iPACK group. The dFdA group exhibited significantly reduced TMC at 24 ([interquartile range 4-6] vs [interquartile range 6-15], <em>P</em> = .003) and 48 hours (<em>P</em> = .022). The dFdA group had significantly superior TUG at 24 hours (59.2 vs 85.6 seconds) and 48 hours (48.3 vs 66.6 seconds), and 2MWT performance at 24 hours (17.6 vs 12.1 meters) post-TKA. Procedure time of dFdA was shorter (8.2 vs 12.7 min, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>The dFdA demonstrates superior analgesic efficacy and could be a good alternative approach to enhance recovery for current clinical pathways of TKA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 102050"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148158309","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":"Mid-Year Roundup: So You are Saying There’s a Chance…","authors":"Brett R. Levine MD, MS","doi":"10.1016/j.artd.2026.102093","DOIUrl":"10.1016/j.artd.2026.102093","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 102093"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370249","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":"Survivorship and Clinical Outcomes up to Six Years After Combined Patellofemoral and Unicondylar Knee Arthroplasty","authors":"Johannes Holz MD ,&nbsp;Dagmar Linnhoff PhD ,&nbsp;Stefan Schneider MD ,&nbsp;Sarah Villinger PhD ,&nbsp;Anja-Verena Behling PhD","doi":"10.1016/j.artd.2026.102053","DOIUrl":"10.1016/j.artd.2026.102053","url":null,"abstract":"<div><h3>Background</h3><div>Due to improved technique and design, bicompartmental knee arthroplasty consisting of patellofemoral joint and unicondylar knee arthroplasty has become a promising alternative to total knee arthroplasty. Advantages include preserving natural knee biomechanics, reducing complication rates, shortening hospital stays, and facilitating faster rehabilitation. This study aimed to assess the survivorship and clinical outcomes for combined medial unicondylar and patellofemoral arthroplasty up to 6 years.</div></div><div><h3>Methods</h3><div>Data on survivorship and patient-reported outcome measures (PROMs) were analyzed retrospectively for 47 patients (mean age: 58.2 years [range: 45 – 78]; mean body mass index: 31.3 kg/m² [range: 22.8 – 47.3]; 66% female). The PROMs included pain (visual analog scale), knee functionality (Knee Injury and Osteoarthritis Outcome Score for Joint Replacement), mental and physical health (Veterans RAND 12-Item Health Survey), and patient satisfaction (Knee Society Score). Survivorship was analyzed using a survivorship life table, while changes in PROMs from preoperatively to the follow-up (FU) time points were assessed via paired t-tests.</div></div><div><h3>Results</h3><div>Of the 47 patients enrolled, 7 were lost to FU. The 97.8% survival rate remained consistent throughout the 6-year FU period, following 1 device-related revision within the first 2 years. There was a significant improvement in pain, knee functionality, and patient satisfaction from preoperative to the 1-, 3-, and 5/6-year FUs (<em>P</em> &lt; .0001). Physical health significantly improved for all FU time points (<em>P</em> &lt; .0001), while mental health trended toward improvement throughout the FU period.</div></div><div><h3>Conclusions</h3><div>The combined unicondylar and patellofemoral arthroplasty procedure has been shown to achieve excellent survivorship and clinical results up to 6 years after surgery. This makes it an attractive alternative to total knee arthroplasty for patients with medial condylar and patellofemoral knee osteoarthritis.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"Article 102053"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151548","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":"The Effect of the COVID-19 Orthopaedic Joint Surgery \"Restart\" on Patient Outcomes in Michigan.","authors":"Harjot Uppal, Simarjeet Puri, Brian Hallstrom, Michael A Masini, Heather Chubb, Thomas Zheng, David C Markel","doi":"10.1016/j.artd.2026.102044","DOIUrl":"10.1016/j.artd.2026.102044","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic significantly decreased elective total joint arthroplasty volume in Michigan. Depending on local ordinances, elective procedures were completely shut down for periods. We hypothesized that decreased volume and surgical gaps would impact outcomes once procedures restarted. This study compared outcomes of total hip and knee arthroplasty (TJA) following the COVID-19 pandemic restart.</p><p><strong>Methods: </strong>This study utilized the Michigan Arthroplasty Registry Collaborative Quality Initiative database to analyze outcomes for TJA compared to the previous uninterrupted year to investigate the effects of the pandemic on TJA outcomes.</p><p><strong>Results: </strong>As expected, there was a significant reduction in surgical volume for both total hip arthroplasty and total knee arthroplasty during the initial surge of COVID-19 cases in Michigan. There was a significant increasing shift toward performing TJA at ambulatory surgery centers and hospital outpatient departments. There was a significantly higher discharge home with use of home care services for both hips and knees. There was a slightly elevated rate of deep vein thrombosis among TJA patients within the early fall of 2020, which normalized to prepandemic levels by the fall. No other significant differences were noted.</p><p><strong>Conclusions: </strong>Overall, outcomes were similar after the resumption of TJA following the COVID-19 pandemic. Perhaps this is a test of the overall training of orthopaedic surgeons performing total hip arthroplasty/total knee arthroplasty and the application of well-established pathways. The pandemic likely promulgated the ongoing move for site of service change.</p>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"39 ","pages":"102044"},"PeriodicalIF":2.1,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370245","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 is Safe and Effective in Reducing Blood Loss and Transfusion Rates in Nearly all Patients Undergoing Total Hip and Knee Arthroplasty","authors":"Joshua P. Rainey MD,&nbsp;Yale A. Fillingham MD,&nbsp;Charles P. Hannon MD, MBA","doi":"10.1016/j.artd.2025.101868","DOIUrl":"10.1016/j.artd.2025.101868","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"38 ","pages":"Article 101868"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147612525","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":"Pay It Forward, Please","authors":"Brett R. Levine MD, MS (Editor-in-Chief)","doi":"10.1016/j.artd.2026.102015","DOIUrl":"10.1016/j.artd.2026.102015","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"38 ","pages":"Article 102015"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147612524","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":"Effect of Greater Trochanteric Fractures on Patient Reported Outcomes After Direct Anterior Total Hip Arthroplasty","authors":"Daniel R. Baka BS ,&nbsp;Cayla M. Kalani BS ,&nbsp;Jong Hyun Choi MD ,&nbsp;Nicholas D’Antonio MD ,&nbsp;Pietro M. Gentile BS ,&nbsp;Matthew L. Brown MD","doi":"10.1016/j.artd.2026.101954","DOIUrl":"10.1016/j.artd.2026.101954","url":null,"abstract":"<div><h3>Background</h3><div>Total hip arthroplasty (THA) via the direct anterior approach (DAA) is favored for avoiding gluteal muscle disruption and promoting faster recovery. A known complication of DAA is greater trochanteric fracture (GTFX). This study compared patient-reported outcomes (PROs) between patients who sustained GTFX and those who did not following THA using DAA.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of patients who underwent THA via DAA. Primary outcomes included Mental and Physical Patient-Reported Outcomes Measurement Information System scores, Hip Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), and Forgotten Joint Score. Secondary outcomes included ambulation status, disposition, length of stay, complications, emergency department visits, and return to the operating room within 1 year. Patients without at least baseline and 6-month or 1-year PROs were excluded.</div></div><div><h3>Results</h3><div>Ninety-two THAs were analyzed; 13 patients (14%) sustained a GTFX. Baseline characteristics and preoperative PROs were similar between groups. At 6 months, the GTFX group had significantly lower HOOS JR scores (68.5 ± 18.1) compared to the non-GTFX group (79.8 ± 18.0; <em>P</em> = .0472). No significant differences in PROs were observed at 1-year. Two patients (15%) with GTFX and 2 (3%) without GTFX returned to the operating room (<em>P</em> = .0943). No other significant differences in secondary outcomes were noted.</div></div><div><h3>Conclusions</h3><div>GTFX following THA via DAA are associated with worse HOOS JR scores at 6 months, suggesting a temporary delay in recovery. However, these differences resolve by 1 year, indicating GTFX may not impact long-term functional outcomes.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"38 ","pages":"Article 101954"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081706","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":"Technology-assisted Total Hip Arthroplasty: A Contemporary Analysis of Regional Trends, National Trends, and 90-day Outcomes in a Nationwide Cohort","authors":"Amy Y. Zhao BA ,&nbsp;Alex Gu MD ,&nbsp;Gireesh Reddy MD ,&nbsp;Bryant M. Song MD ,&nbsp;Ilya Bendich MD, MBA ,&nbsp;Andrew M. Schneider MD","doi":"10.1016/j.artd.2025.101949","DOIUrl":"10.1016/j.artd.2025.101949","url":null,"abstract":"<div><h3>Background</h3><div>Technology-assisted total hip arthroplasty (THA)—including computer-navigated and robotic-assisted techniques—has emerged as a strategy to enhance component alignment and potentially improve postoperative outcomes. Although prior studies have described increasing utilization, contemporary trends and associated complication rates remain underexplored.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using a large national database to identify patients who underwent primary elective THA between 2010 and 2023. Patients were stratified into conventional vs technology-assisted THA groups, with the latter defined by the use of computer navigation or robotic assistance. Annual utilization trends were evaluated using linear regression, and 90-day postoperative complications were compared using multivariate logistic regression after adjusting for demographic, clinical, and regional factors.</div></div><div><h3>Results</h3><div>Among 1,062,597 patients undergoing primary elective THA, 4% received technology-assisted procedures. Utilization increased from 1.2% in 2010 to 12% in 2023—a 927% relative increase. Regional variation was notable, with highest utilization in the Northeast and the lowest in the Midwest. Technology-assisted THA was associated with lower odds of 90-day complications (5.36% vs 6.26%; adjusted odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.75-0.80), particularly reduced odds of dislocation (OR: 0.64; 95% CI: 0.60-0.69) and periprosthetic joint infection, though with higher odds of wound dehiscence (OR: 1.15; 95% CI: 1.07-1.23).</div></div><div><h3>Conclusions</h3><div>Utilization of technology-assisted THA has increased substantially across the United States, accompanied by improved short-term outcomes, most notably decreased dislocation. These findings support the potential clinical benefits of surgical technology in THA, while underscoring the need for ongoing evaluation of long-term results.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"38 ","pages":"Article 101949"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081707","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}