Arthroplasty Today最新文献

{"title":"AI-Generated Graduate Medical Education Content for Total Joint Arthroplasty: Comment","authors":"Hinpetch Daungsupawong PhD, Viroj Wiwanitkit MD","doi":"10.1016/j.artd.2024.101500","DOIUrl":"10.1016/j.artd.2024.101500","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101500"},"PeriodicalIF":1.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427487","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":"Medial Patellar Instability Following Total Knee Arthroplasty","authors":"Joseph P. Barbera MD,&nbsp;Nancy L. Parks MS,&nbsp;Kevin B. Fricka MD","doi":"10.1016/j.artd.2024.101522","DOIUrl":"10.1016/j.artd.2024.101522","url":null,"abstract":"<div><div>Although lateral patellar instability has been discussed as a complication following total knee arthroplasty (TKA), there are no published reports of medial patellar instability. We present a case of a 72-year-old female patient with a remote history of medializing tibial tubercle osteotomy who underwent TKA complicated by a medial dislocation of the patella. Management consisted of lateral retinaculum imbrication, revision of the patellar component, and lateralizing tibial tubercle osteotomy in the setting of appropriate rotation of the tibial and femoral components. It is important to be aware of medial patellar instability as well as potential treatment options as this is a rare complication that can occur following TKA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101522"},"PeriodicalIF":1.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427479","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":"Routine Postoperative Hemoglobin and Hematocrit Tests Are Unnecessary Following Primary Total Hip and Knee Arthroplasty","authors":"Daniel J. Howgate MBChB, PhD, FRCS (Tr&Orth) ,&nbsp;Roman P. Austin BS ,&nbsp;Joshua S. Bingham MD ,&nbsp;Mark J. Spangehl MD ,&nbsp;Henry D. Clarke MD","doi":"10.1016/j.artd.2024.101502","DOIUrl":"10.1016/j.artd.2024.101502","url":null,"abstract":"<div><h3>Background</h3><div>Acute blood loss and transfusion are recognized risks factors of total hip (THA) and total knee arthroplasty (TKA). This study aimed to investigate the clinical value of immediate postoperative hemoglobin and hematocrit (H&amp;H) tests following primary elective THA and TKA.</div></div><div><h3>Methods</h3><div>This retrospective observational study was undertaken at a single academic hospital. Medical records were reviewed for a consecutive series of patients undergoing primary elective THA and TKA over a 12-month period. Patient demographic data; the use of preoperative anticoagulants; preoperative and postoperative blood test results; and the incidence of postoperative allogenic blood transfusion (ABT) were collected. The primary outcome measure was the incidence of postoperative ABT prescribed in response to the immediate postoperative H&amp;H result.</div></div><div><h3>Results</h3><div>Overall, 367 eligible patients were included, with 167 THA (46%) and 200 TKA (54%) cases. Only 3 patients (0.8%) received a postoperative ABT; none on the day of surgery or on postoperative day 1. Immediate postoperative H&amp;H tests were drawn in 246 patients (67%), but it did not influence clinical decision-making with regards to transfusion. No significant differences in ABT were observed in relation to patient age, sex, body mass index, operation (THA or TKA), or the use of preoperative anticoagulation medication. The incidence of ABT was significantly higher in patients with a combined preoperative hemoglobin &lt;12.5 g/dL and hematocrit &lt;40.0% (<em>P</em> = .003).</div></div><div><h3>Conclusions</h3><div>The incidence of postoperative blood transfusion following primary elective THA and TKA was low at 0.8%. Postoperative H&amp;H tests were drawn in most patients but did not influence clinical management. Immediate postoperative hematological monitoring is unnecessary for most low-risk patients following uncomplicated primary elective THA and TKA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101502"},"PeriodicalIF":1.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427046","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":"Dalbavancin Use in Bone and Joint Infections","authors":"Liam P. Alderson BS ,&nbsp;Srivani Sanikommu MD ,&nbsp;Simon C. Mears MD, PhD ,&nbsp;C. Lowry Barnes MD ,&nbsp;Benjamin M. Stronach MD ,&nbsp;Jeffrey B. Stambough MD ,&nbsp;Jennifer McDonald RPh ,&nbsp;Traci Motes APRN ,&nbsp;Brett Bailey PharmD ,&nbsp;Ryan K. Dare MD","doi":"10.1016/j.artd.2024.101505","DOIUrl":"10.1016/j.artd.2024.101505","url":null,"abstract":"<div><h3>Background</h3><div>Dalbavancin (DAL) off-label use for treating bone and joint infections has increased especially as long-term intravenous access is not needed. Little is known about the effectiveness and safety of its use.</div></div><div><h3>Methods</h3><div>This retrospective, single-center, descriptive study included adults treated with DAL for bone or joint infections over a 4-year period (2019-2023). Patient demographics, infection type and location, pre-DAL antibiotic and surgical treatments, indication for DAL, and clinical outcomes were collected. Risk factor analysis for 1-year infection recurrence was performed.</div></div><div><h3>Results</h3><div>There were 58 patient encounters of bone and/or joint infections treated with DAL. The majority of patients were treated for osteomyelitis (81.0%) followed by native (8.6%) and peri-prosthetic (10.4%) joint infection. Fifty (86.2%) patients underwent surgical intervention, and 17 (68%) of the 25 patients with infected hardware had full hardware removal. The most common pathogen identified was <em>Staphylococcus aureus</em> (41; 70.7%), with methicillin-resistant <em>Staphylococcus aureus</em> isolated in 23 (40.0%) cases. Ten (17.2%) patients had recurrence within 1 year. Hardware removal was found to significantly decrease the risk of infection recurrence (<em>P</em> = .026). None of the peri-prosthetic joint infection patients had infection recurrence within 1 year.</div></div><div><h3>Conclusions</h3><div>Our findings support DAL as an effective treatment for bone and joint infection when combined with surgical debridement and hardware removal. Failure to remove infected hardware significantly increased the risk of infection recurrence within 1 year. Randomized controlled trials are needed to further support DAL as a novel treatment for orthopedic infections.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101505"},"PeriodicalIF":1.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427474","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":"Glucagon-Like Peptide-1 Receptor Agonist Use is Not Associated With Increased Complications After Total Knee Arthroplasty in Patients With Type-2 Diabetes","authors":"Kevin Y. Heo BS ,&nbsp;Rahul K. Goel MD ,&nbsp;Andrew Fuqua BS ,&nbsp;Jeffrey S. Holmes MD ,&nbsp;Brian T. Muffly MD ,&nbsp;Greg A. Erens MD ,&nbsp;Jacob M. Wilson MD ,&nbsp;Ajay Premkumar MD, MPH","doi":"10.1016/j.artd.2024.101506","DOIUrl":"10.1016/j.artd.2024.101506","url":null,"abstract":"<div><h3>Background</h3><div>Glucagon-like peptide-1 (GLP-1) agonists have emerged as a powerful diabetic treatment adjunct; however, its effects on outcomes following total knee arthroplasty (TKA) are not well known. The purpose of this study was to compare the risk of complications after TKA in patients with type-2 diabetes who were on GLP-1 agonists with those who were not.</div></div><div><h3>Methods</h3><div>In total, 34,696 type 2 diabetes patients undergoing primary TKA between 2016 and 2021 were retrospectively reviewed utilizing a large national database. Propensity score matching was employed to match patients on GLP-1 agonists to controls at a 1:1 ratio (n = 2388 each). Multivariable logistic regression was utilized to examine 90-day and 1-year TKA outcomes between cohorts.</div></div><div><h3>Results</h3><div>Controls had higher odds of extended hospital stays (≥3 days) (odds ratio 1.29, <em>P</em> &lt; .001). However, surgical complication rates at 90-days including surgical site infection and prosthetic joint infection were not significantly different. Similarly, no differences were seen in medical complications. There were also no significant differences in rates of all-cause revision TKA and aseptic revision TKA at 1 year postoperatively.</div></div><div><h3>Conclusions</h3><div>This study found that GLP-1 agonist use was not associated with increased medical or surgical complication rates in patients with diabetes undergoing TKA and was associated with lower rates of extended hospital stays after surgery. Given the potential for increased glycemic control and weight loss in patients using GLP-1 agonists, more data are needed to delineate the potential role of GLP-1 agonists in preoperative optimization of patients with diabetes prior to joint arthroplasty to minimize postoperative complications.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101506"},"PeriodicalIF":1.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427475","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":"Acetabular Hydatid Cyst in a Teenage Girl: A Rare Manifestation and Successful Long-Term Management With Combined Surgical and Anthelmintic Approaches","authors":"Mohammadreza Razzaghof MD, MPH ,&nbsp;Mohammad Soleimani MD, MPH ,&nbsp;Mohammad Poursalehian MD ,&nbsp;Mohammadreza Barzegar MD ,&nbsp;Sirous Jafari MD ,&nbsp;Seyed Mohammad Javad Mortazavi MD","doi":"10.1016/j.artd.2024.101521","DOIUrl":"10.1016/j.artd.2024.101521","url":null,"abstract":"<div><div>Hydatid disease is a zoonotic infestation caused by the <em>Echinococcus</em>, with extremely rare bone involvement. We present a case of acetabular hydatid cyst in a 16-year-old girl who initially underwent wide surgical excision, adjuvant ablation, and local administration of anthelminthic agent followed by systemic anthelmintic therapy. After 5 years, due to the development of degenerative joint disease and as infection was suspected intraoperatively, a 2-stage total hip arthroplasty was performed. The patient’s prosthesis remained stable and well fixed, and she is now fully functional at the 12-year follow-up. The consideration of hydatid disease in the differential diagnosis of destructive bone lesions, particularly in endemic areas, is crucial for timely detection and effective treatment. This case report highlights the challenges in the surgical treatment of periacetabular bone hydatidosis.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101521"},"PeriodicalIF":1.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427481","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":"Recurrent Guillain-Barré Syndrome After Subsequent Total Knee Arthroplasties","authors":"Laith Z. Abwini DO ,&nbsp;Dhara Rana DO ,&nbsp;Joanna Crincoli DO ,&nbsp;Firth G. Bowden PharmD ,&nbsp;Fred McAlpin III DO","doi":"10.1016/j.artd.2024.101518","DOIUrl":"10.1016/j.artd.2024.101518","url":null,"abstract":"<div><div>Guillain-Barré syndrome (GBS) is an acute immune-mediated inflammatory demyelinating polyneuropathy characterized by symmetrical limb weakness and areflexia. GBS is typically monophasic but may recur in 1%-7% of patients. Many etiologies exist for GBS; one rare associated etiology is surgery, most notably orthopaedic, abdominal, and cardiac surgery. Here, we present a 76-year-old male who developed postsurgical GBS after a right total knee arthroplasty (TKA), 11 years after developing GBS following a left TKA. The patient developed worsening ascending paralysis and, ultimately, respiratory failure requiring tracheostomy. This study reports a rare case of recurrent postsurgical GBS after TKA, possibly triggered by general anesthesia or tourniquet use. Early recognition of postsurgical GBS is imperative to avoid patient mortality.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101518"},"PeriodicalIF":1.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427483","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":"Accelerometer-Navigated Revision Total Knee Arthroplasty: A Technique for Successful Gap Balancing","authors":"Matthew E. Wells DO ,&nbsp;Richard L. Purcell MD","doi":"10.1016/j.artd.2024.101510","DOIUrl":"10.1016/j.artd.2024.101510","url":null,"abstract":"<div><div>Accelerometer-based navigation (OrthAlign) is the first computer-assisted surgical navigation system approved for use in the setting of revision total knee arthroplasty (TKA) in the United States. The senior author has used this technology in the revision setting for several years and developed the individualized, reproducible technique. The 4 goals during revision TKA are to (1) gain adequate exposure for the safe explanation of prior implants, (2) address any resultant bone loss, (3) restore the joint line via distal femur metal augmentation, and (4) ensure adequate stability through gap-balancing techniques and increasing the constraint of the revision implants as needed. This technique guide illustrates how accelerometer-based navigation (OrthAlign) can achieve these goals in the revision TKA setting.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101510"},"PeriodicalIF":1.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427043","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":"Surgical Tips and Tricks for the Anterior-Based Muscle-Sparing Approach During Total Hip Arthroplasty","authors":"Gideon Jia Wei Cheok MBBCh, BAO (Ire), MRCS (Eng), GDSM (S’pore),&nbsp;Ing How Moo MBBS, MRCS (Ire), MMed (Ortho), FRCS Ortho (Edin)","doi":"10.1016/j.artd.2024.101514","DOIUrl":"10.1016/j.artd.2024.101514","url":null,"abstract":"<div><div>In orthopaedic surgery, the advancement of surgical techniques aims to enhance patient outcomes and minimize postoperative complications. A notable innovation in this field is the anterior-based muscle-sparing (ABMS) approach to total hip arthroplasty, also known as ABLE or Rottinger approach. ABMS modifies the Watson-Jones approach, using the intermuscular plane between the tensor fascia lata and the gluteus medius to access the hip joint without detaching abductor muscles. This technique offers several benefits including muscle preservation, decreased pain, faster recovery, and lower dislocation rates, similar to the direct anterior approach. However, ABMS distinguishes itself by its lower infection rate, reduced nerve injury risk, easier femoral exposure, and compatibility with various implants. Large-scale studies have confirmed its safety and effectiveness. While mastering the ABMS technique requires some learning, this article provides a concise description of the technique, along with practical insights gained from surgical experience to support safe and effective execution.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101514"},"PeriodicalIF":1.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427042","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":"Robotic Arm–Assisted Total Knee Arthroplasty Results in Smaller Femoral Components and Larger Tibial Baseplates Than the Manual Technique","authors":"Jenna Bernstein MD ,&nbsp;Matthew Hepinstall MD ,&nbsp;Claire Donnelley MD ,&nbsp;Vinaya Rajahraman BS ,&nbsp;Daniel Waren MSPH ,&nbsp;Ran Schwarzkopf MD ,&nbsp;Daniel Wiznia MD","doi":"10.1016/j.artd.2024.101414","DOIUrl":"10.1016/j.artd.2024.101414","url":null,"abstract":"<div><h3>Background</h3><div>Robotic systems for total knee arthroplasty (TKA) may utilize computed tomography three-dimensional modeling and intraoperative ligamentous balancing data to assist surgeons with implant size and position. This study evaluated the effect of such robotic systems on implant selection.</div></div><div><h3>Methods</h3><div>We reviewed 645 TKAs performed with a single prosthetic design at 2 academic medical centers between 2016 and 2022. A robotic system was utilized in 304 TKAs, 341 were conventionally instrumented. Implant sizing was compared between cohorts. Multivariate analyses assessed for confounding and effect modification on the basis of demographics.</div></div><div><h3>Results</h3><div>The 2 cohorts exhibited no significant differences in age (<em>P</em> = .33), weight (<em>P</em> = .29), or race (<em>P</em> = .24). The robotic-arm cohort had fewer women (58.9% vs 66.7% <em>P</em> = .04) and was taller on average (66.3 in vs 65.0 in <em>P</em> &lt; .001). Mean polyethylene liner thickness was larger in the manual cohort (10.3 robotic and 10.6 manual; <em>P</em> &lt; .00). On multivariate analysis, robotic-arm TKAs had larger tibial components (<em>P</em> &lt; .001) and smaller femoral components (<em>P</em> = .017).</div></div><div><h3>Conclusions</h3><div>Robotic-arm assisted TKA with computed tomography–based three-dimensional planning was associated with a larger mean tibial component size and a smaller mean femoral component size when compared to conventionally instrumented TKAs. Observed differences likely reflect differences in the data informing implant size selection; effects on clinical outcomes warrant further study.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"29 ","pages":"Article 101414"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530788","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}