Arthroplasty Today最新文献

{"title":"Who is Completing Patient-Reported Outcome Measures following Total Hip Arthroplasty? An Investigation of Completion Characteristics to Inform the Age of Mandatory Reporting Rates","authors":"Catherine M. Call MD ,&nbsp;Zoë A. Walsh MPH ,&nbsp;Aliyah A. Olaniyan MS ,&nbsp;George Babikian MD ,&nbsp;Brian J. McGrory MD, MS ,&nbsp;Adam J. Rana MD","doi":"10.1016/j.artd.2025.101763","DOIUrl":"10.1016/j.artd.2025.101763","url":null,"abstract":"<div><h3>Background</h3><div>The Centers for Medicare and Medicaid Services has mandated at least 50% institutional compliance of patient-reported outcome–based performance measures (PRO-PMs) for Medicare fee-for-service patients undergoing inpatient, elective total joint arthroplasty. The purpose of this study was to evaluate characteristics of patients undergoing primary total hip arthroplasty to identify risk factors for patient-reported outcome measures (PROMs) noncompletion using the Hip Dysfunction and Osteoarthritis Joint Replacement Outcome Score as a marker PROM.</div></div><div><h3>Methods</h3><div>A retrospective review was performed of patients undergoing primary total hip arthroplasty at a single large academic center between January 2013 and August 2020. Demographics, operative variables, hospital outcomes, and PROMs were compared between patients achieving and not achieving PRO-PM requirements and multivariable analysis was performed.</div></div><div><h3>Results</h3><div>A total of 5691 patients were included; 2547 patients did not complete either PROM, 2201 completed the preoperative PROM within 90 days of surgery, and 943 completed the PROM preoperatively and at 365 ± 60 days postoperatively. Demographics and outcomes between groups varied; patients not completing the PROM more often had a length of stay &gt;48 hours (<em>P</em> &lt; .001) and any complication (q = 0.07); these associations remained significant with adjusted multivariable analyses.</div></div><div><h3>Conclusions</h3><div>PRO-PM completion is necessary for compliance with the new Centers for Medicare and Medicaid Services mandate. We report on the characteristics of patients completing and not completing a marker PROM as well as risk factors for noncompletion from the era before this mandate, before substantial efforts were undertaken to increase response rate, to provide an organic overview of the patients at risk for noncompletion to guide further initiatives.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101763"},"PeriodicalIF":1.5,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632332","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":"Second-Generation Onlay Patellofemoral Prostheses: 14-Year Outcomes Redefining Isolated Patellofemoral Osteoarthritis Management","authors":"Pablo Ramos Guarderas ,&nbsp;Gonzalo Arteaga Guerrero ,&nbsp;Medardo Vargas Morante ,&nbsp;Pablo Ramos Murrillo ,&nbsp;Carlos Peñaherrera Carrillo ,&nbsp;Francisco Endara Urresta ,&nbsp;Daniel Ramos Murillo ,&nbsp;Alejandro Barros Castro ,&nbsp;Paul Vaca Perez","doi":"10.1016/j.artd.2025.101735","DOIUrl":"10.1016/j.artd.2025.101735","url":null,"abstract":"<div><h3>Background</h3><div>Isolated patellofemoral osteoarthritis is a frequent source of anterior knee pain in middle-aged patients. Second-generation onlay patellofemoral prostheses were developed to address limitations of earlier designs and improve clinical outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of 231 patients (mean age 52.2 years) who underwent patellofemoral arthroplasty with a second-generation onlay implant between 2009 and 2023. Clinical outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index and Kaplan–Meier survival analysis. Radiological evaluation included signs of loosening, progression of tibiofemoral osteoarthritis, and patellar alignment.</div></div><div><h3>Results</h3><div>At a mean follow-up of 9.3 years (range: 2–14), Western Ontario and McMaster Universities Osteoarthritis Index scores improved significantly from 92.14 to 8.40 (<em>P</em> &lt; .001). The implant survival rate was 96.6% at the final follow-up. Early clinical gains were significantly influenced by implant type, while long-term outcomes were associated with patient-specific factors such as body mass index and activity level. Radiological progression of tibiofemoral disease was observed in 6.1% of patients.</div></div><div><h3>Conclusions</h3><div>Second-generation onlay patellofemoral prostheses yield sustained functional improvement and low complication rates when used in carefully selected patients. These findings support their use as a reliable solution for isolated patellofemoral osteoarthritis.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101735"},"PeriodicalIF":1.5,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632330","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 Hip Arthroplasty Among Superobese Patients: Proceed With Caution","authors":"Sagar Telang MD ,&nbsp;Ryan Palmer MD ,&nbsp;Brian C. Chung MD ,&nbsp;Jacob R. Ball MD ,&nbsp;Kurt Hong MD PhD ,&nbsp;Jay R. Lieberman MD ,&nbsp;Nathanael D. Heckmann MD","doi":"10.1016/j.artd.2025.101770","DOIUrl":"10.1016/j.artd.2025.101770","url":null,"abstract":"<div><h3>Background</h3><div>Morbid obesity, defined as body mass index (BMI) ≥40 kg/m², increases perioperative risk following total hip arthroplasty (THA). However, limited contemporary data exists on outcomes of superobese patients (BMI ≥50 kg/m²) following primary THA. Using a large modern cohort, this study seeks to quantify the risk of infection and surgical, medical, and thromboembolic complications among superobese THA patients.</div></div><div><h3>Methods</h3><div>The Premier Healthcare Database was queried to identify all primary elective THA patients between 2016 and 2021. All superobese patients were compared to a normal BMI cohort (BMI 18.5-24.9 kg/m²). Univariate analysis and multivariable regression were utilized to assess differences in primary outcomes, including 90-day infectious, surgical, medical, and thromboembolic complications.</div></div><div><h3>Results</h3><div>Twenty-one thousand, thirty-five THA patients were identified; 888 patients (4.2%) had a BMI ≥50 kg/m², while 20,147 patients (95.8%) had a BMI 18.5-24.9 kg/m². On multivariable analysis, superobese patients demonstrated an increased risk of infectious and surgical complications, including periprosthetic joint infection (adjusted odds ratio [aOR]: 7.23, 95% confidence interval (CI): 3.95-13.24, <em>P</em> &lt; .001), sepsis (aOR: 4.24, 95% CI: 2.19-9.23, <em>P</em> &lt; .001), and wound dehiscence (aOR 7.61, 95% CI: 3.90-14.85, <em>P</em> &lt; .001). The risk of pulmonary embolism (aOR 4.32, 95% CI: 1.75-10.64, <em>P</em> = .001), acute respiratory failure (aOR: 2.31, 95% CI: 1.32-4.05, <em>P</em> = .003), acute renal failure (aOR: 3.15, 95% CI: 2.19-4.52, <em>P</em> &lt; .001), and hospital readmission (aOR: 2.31, 95% CI: 1.75-3.07, <em>P</em> &lt; .001) were similarly elevated within the superobese cohort.</div></div><div><h3>Conclusions</h3><div>Superobese patients face markedly increased risk for infection and surgical, medical, and thromboembolic complications following primary THA. Our findings emphasize the importance of preoperative risk stratification, optimization, and patient counseling in this high-risk cohort.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101770"},"PeriodicalIF":1.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614130","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":"Association Between Total Joint Arthroplasty and Surgical Complications in Patients With Valvular Heart Replacement: An Observational Study","authors":"Amir Human Hoveidaei MD, MSc ,&nbsp;Sina Esmaeili MD ,&nbsp;Homina Saffar MD ,&nbsp;Aref Ghanaatpisheh MD ,&nbsp;Fatemeh Zarepour MD ,&nbsp;Amirhossein Shirinezhad MD ,&nbsp;Henry Tout Shu MD ,&nbsp;Janet D. Conway MD, FAAOS","doi":"10.1016/j.artd.2025.101765","DOIUrl":"10.1016/j.artd.2025.101765","url":null,"abstract":"<div><h3>Background</h3><div>Valvular heart replacement (VHR) is associated with increased cardiac complications and mortality risk in patients undergoing noncardiac surgery. There are limited data on total joint arthroplasty outcomes in patients with a prior history of VHR.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we identified patients who underwent elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) between 2010 and 2022 using the PearlDiver national database. Patients with a history of VHR were matched with a control group using propensity score matching. Statistical analyses were conducted using R statistical software.</div></div><div><h3>Results</h3><div>We identified 874 patients with THA and 1162 patients with TKA. No significant difference in surgical or medical complications was observed in THA patients with a history of VHR compared to the matched control group, regardless of the time interval between procedures. In contrast, for TKA patients, VHR was associated with a higher incidence of periprosthetic joint infection (odds ratio [OR] = 1.54; 95% confidence interval [CI]: 1.02-2.33; <em>P</em> = .049), particularly when performed within 3 months before TKA (OR = 4.71; 95% CI: 1.04-15.48). Additionally, patients who underwent VHR 3 to 6 months before TKA had a significantly higher incidence of cerebrovascular accident (OR = 2.61; 95% CI: 1.20-5.24; <em>P</em> = .011).</div></div><div><h3>Conclusions</h3><div>VHR was not associated with an increased risk of complications following THA. However, about TKA patients, a history of VHR was linked to a higher risk of periprosthetic joint infection, and an increased incidence of cerebrovascular accident in those who had VHR 3 to 6 months prior. Future studies are needed to develop strategies for reducing complications.</div></div><div><h3>Level of Evidence</h3><div>III (Retrospective cohort).</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101765"},"PeriodicalIF":1.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632331","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":"Exploring ChatGPT’s Efficacy in Orthopaedic Arthroplasty Questions Compared to Adult Reconstruction Surgeons","authors":"Benjamin Nieves-Lopez BS ,&nbsp;Clayton Wing MD ,&nbsp;Bryan D. Springer MD ,&nbsp;Keith T. Aziz MD","doi":"10.1016/j.artd.2025.101772","DOIUrl":"10.1016/j.artd.2025.101772","url":null,"abstract":"<div><h3>Background</h3><div>Chat Generative Pre-trained Transformer (ChatGPT) is a language model designed to conduct conversations utilizing extensive data from the internet. Despite its potential, the utility of ChatGPT in orthopaedic surgery, particularly in arthroplasty, is still being investigated. This study assesses ChatGPT’s performance on arthroplasty-related questions in comparison to an Adult Reconstruction Fellow and a Senior level attending.</div></div><div><h3>Methods</h3><div>A total of 299 questions from the Adult Reconstruction self-assessment on OrthoBullets were evaluated using ChatGPT 4. Performance was analyzed across different question categories and compared with the performance of an Adult Reconstruction Fellow and Senior level attending arthroplasty surgeon with a <em>Chi</em>-square test. Further comparisons were performed to assess ChatGPT’s accuracy rate on image-based questions. Statistical significance was set to a <em>P</em> value ≤ .05.</div></div><div><h3>Results</h3><div>ChatGPT achieved a 66.9% accuracy rate compared to 84.3% and 85.3% obtained by the Fellow and Attending, respectively. No significant differences in performance were observed across question categories. ChatGPT demonstrated better results in text-only compared to image-based questions. Although not statistically significant, ChatGPT showed the highest accuracy rate in questions that included both an X-ray and a clinical picture.</div></div><div><h3>Conclusions</h3><div>ChatGPT performed inferior to an Adult Reconstruction Fellow and Attending and it provided more accurate answers when prompted with text-only questions. These findings suggest that while ChatGPT can serve as a useful supplementary resource for arthroplasty topics, it cannot substitute for the clinical judgment required in detailed assessments. Further research is necessary to optimize and validate the use of artificial intelligence in medical education and patient care.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101772"},"PeriodicalIF":1.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614045","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":"Site of Service Changes Have Resulted in Increased Opioid Prescriptions for Primary Total Hip and Knee Patients in Michigan, a Michigan Arthroplasty Registry Collaborative Quality Initiative Quality Study","authors":"Harjot Uppal MD ,&nbsp;David Markel MD ,&nbsp;Giresse Melone MD ,&nbsp;Simarjeet Puri MD ,&nbsp;Lisheng Chen PhD ,&nbsp;Tae Kim MHSA ,&nbsp;Brian Hallstrom MD ,&nbsp;Richard Hughes PhD ,&nbsp;Elizabeth Dailey MD","doi":"10.1016/j.artd.2025.101771","DOIUrl":"10.1016/j.artd.2025.101771","url":null,"abstract":"<div><h3>Background</h3><div>The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) successfully changed opioid prescribing patterns by instituting guidelines for total hip (THAs) and knee arthroplasties (TKAs). Given Medicare changes, cases are moving to ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). We aimed to assess whether these sites adopted the well-proven opioid recommendations.</div></div><div><h3>Methods</h3><div>Using data from the Michigan Arthroplasty Registry Collaborative Quality Initiative, all opioid-naïve (no prescription within 30 days) patients undergoing primary total joint arthroplasty between July 1, 2021, and June 30, 2022, were identified. Of the 12,962 THAs: 11.0% (1425) were in ASCs, 5.2% (674) in HOPDs, and 84% (10,863) in hospitals. Of the 20,092 primary TKAs: 10.3% (2064) were in ASCs, 4.5% (906) in HOPDs, and 85.2% (17,122) in hospitals.</div></div><div><h3>Results</h3><div>The cohorts were statistically different, with unhealthier patients within the hospital population. For THAs and TKAs, ASCs had the highest mean oral morphine equivalents at discharge, 239 (±109.9) and 307.4 (±151.9), compared to hospitals and HOPDs (<em>P</em> &lt; .05). Overall, HOPDs had the lowest oral morphine equivalent for THA (<em>P</em> &lt; .05), while HOPDs and Hospitals had similar levels for TKAs (<em>P</em> = .27). ASCs had the lowest compliance rate for both THA (56%) and TKA(69%) compared to HOPDs (89%, 80%) and hospitals (83%, 87%) (<em>P</em> &lt; .05), respectively.</div></div><div><h3>Conclusions</h3><div>ASC and HOPDs patients are selected for the ability to be discharged home. Yet opioid-naïve total joint arthroplasty patients at Michigan ASCs received more opioids at discharge compared to patients undergoing the same procedures at HOPDs and hospitals.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101771"},"PeriodicalIF":1.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605980","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":"Osteoarthritis and Total Joint Arthroplasty in Housing-Insecure Patients at a Safety Net Hospital in a Major Urban City","authors":"Abbott Gifford BA ,&nbsp;Kelechi Nwachuku MD ,&nbsp;Lisa Bonsignore-Opp MD ,&nbsp;Paul Toogood MD, MS ,&nbsp;Derek Ward MD","doi":"10.1016/j.artd.2025.101773","DOIUrl":"10.1016/j.artd.2025.101773","url":null,"abstract":"<div><h3>Background</h3><div>Osteoarthritis is the leading cause of disability among older adults in the United States. People experiencing homelessness (PEH) face worse health outcomes and higher rates of musculoskeletal diseases than housed individuals. Despite this burden, PEH often lack access to orthopaedic care. This project examines surgical outcomes among PEH and investigates where in the care process barriers to access may exist.</div></div><div><h3>Methods</h3><div>New patient visits to the Zuckerberg San Francisco General Hospital Arthroplasty Clinic in 2022 were examined to establish a retrospective cohort. Patients were grouped by housing status, and data on demographics, disease severity, and comorbidities were collected. Analysis was performed using descriptive statistics and logistic regression. Presentation rate was calculated among clinic-presenting PEH and compared to a similarly captured population of patients on the San Francisco Health Plan.</div></div><div><h3>Results</h3><div>Of 250 patients, 4 were unhoused and 41 were unstably housed. PEH and housing insecurity had worse Kellgren–Lawrence scores, higher rates of substance use, mental illness, HIV, and hepatitis C virus than stably housed patients. There were no differences in surgical progression, emergency department visits, readmission, reoperation, or follow-up. Significantly fewer PEH presented to clinic compared to those on the San Francisco Health Plan (X² = 11.37, <em>P</em> = .0007).</div></div><div><h3>Conclusions</h3><div>No differences in progression to surgery or surgical outcomes were found between housing groups. PEH accessed arthroplasty services less frequently than housed individuals. These findings suggest that PEH from the study population may be good surgical candidates and have limited access, but conclusions are limited by a short study follow-up.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101773"},"PeriodicalIF":1.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605979","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":"Fewer Pills for Fewer Problems: Strategies for Reducing Postoperative Opioid Prescribing Following Total Joint Arthroplasty","authors":"Catherine M. Call BA ,&nbsp;Mary Noyes BA ,&nbsp;Kamli N.W. Faour BA ,&nbsp;Diane Jeselskis BSN ,&nbsp;Adam J. Rana MD","doi":"10.1016/j.artd.2025.101758","DOIUrl":"10.1016/j.artd.2025.101758","url":null,"abstract":"<div><div>Opioid overprescribing is a concern within the field of arthroplasty, and a growing body of evidence suggests surgeons can prescribe smaller quantities of opioids for orthopaedic postoperative pain management without compromising patient care. Current literature indicates prescribing trends in arthroplasty are shifting in response. Our institution has prioritized quality improvement projects focused on multimodal pain control for patients undergoing total joint arthroplasty procedures in an active attempt to reduce postoperative narcotic use. We highlight tips for instituting similar initiatives based on our institution’s experience, including communication strategies, the importance of establishing the expectation for postoperative pain management by the orthopaedic surgery team, and the role for postoperative pill counts. Future initiatives aimed to facilitate these changes, including the upcoming legislation the Nonopioids Prevent Addiction in the Nation Act, are discussed.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101758"},"PeriodicalIF":1.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144588067","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":"Effects of the Flip Technique on Measurement Accuracy of the Acetabular Cup Position Using a Portable Hip Navigation System With Patients in the Lateral Decubitus Position","authors":"Hiromasa Tanino MD, PhD,&nbsp;Ryo Mitsutake MD, PhD,&nbsp;Hiroshi Ito MD, PhD","doi":"10.1016/j.artd.2025.101769","DOIUrl":"10.1016/j.artd.2025.101769","url":null,"abstract":"<div><h3>Background</h3><div>Accurate cup placement is performed for achieving satisfactory outcomes after total hip arthroplasty. Portable hip navigation systems are novel intraoperative tools for accurate cup placement. Several factors have been reported to affect their accuracy, including the flip technique, in which the pelvic reference plane is registered in the supine position and the patient is subsequently repositioned to the lateral decubitus position for surgery. The effectiveness of the flip technique remains a subject of debate. Therefore, this study assessed and compared the accuracy of cup position measurements using an inertial portable hip navigation system in the lateral decubitus position.</div></div><div><h3>Methods</h3><div>Measurement accuracy was assessed in 78 hips. The accuracy of the system was compared with and without the flip technique, employing an identical method for registering the pelvic reference plane. Cup angles displayed on the system during surgery were compared with those measured postoperatively.</div></div><div><h3>Results</h3><div>Measurement errors with and without the flip technique were 3.7° ± 2.8° and 2.8° ± 2.6° for cup abduction (<em>P</em> = .029) and 2.9° ± 2.5° and 3.9° ± 2.9° for cup anteversion (<em>P</em> = .037). The system achieved measurement errors within 10° in 97 and 98% of hips for cup abduction (<em>P</em> = .636), and 99 and 96% of hips for cup anteversion (<em>P</em> = .364) with and without the flip technique.</div></div><div><h3>Conclusions</h3><div>This system provided reliable intraoperative measurements of cup positions, irrespective of the use of the flip technique. However, cup abduction measurements were more accurate without the flip technique, while cup anteversion measurements were more accurate with the flip technique.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101769"},"PeriodicalIF":1.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572686","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":"A Cone Stacked on a Cone Within a Cone: A Technique for Reconstructing Proximal Third Tibial Shaft Fractures During Revision Total Knee Arthroplasty","authors":"Stefano Ghirardelli MD ,&nbsp;Peter Sculco MD ,&nbsp;Jeffrey O'Donnell MD ,&nbsp;Daniel Buchalter MD ,&nbsp;Elizabeth Gausden MD ,&nbsp;Brian Chalmers MD ,&nbsp;Thomas Sculco MD","doi":"10.1016/j.artd.2025.101762","DOIUrl":"10.1016/j.artd.2025.101762","url":null,"abstract":"<div><div>Bone loss in revision total knee arthroplasty is an increasing challenge, especially as younger active patients undergo primary procedures. Treatment options for severe tibial bone loss include cement, allograft, metal augments, metaphyseal cones, sleeves, and megaprostheses. Novel combinations of these have enabled complex limb salvage without resorting to megaprostheses or amputation. This case report presents a technique utilizing three cones—configured in both cone-in-cone and cone-on-cone fashion—to bypass and stabilize a metadiaphyseal fracture during revision total knee arthroplasty. We outline the indications for selecting each construct and explain how to achieve axial and rotational stability in different bone zones using patient-specific cones. This approach provides an alternative to traditional reconstruction methods in complex cases with significant bone loss and periprosthetic fracture.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101762"},"PeriodicalIF":1.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579331","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}