Arthroplasty Today最新文献

{"title":"Association Between Routine Patient-Reported Outcome Measure Utilization Among Total Joint Arthroplasty Surgeons and Clinically Meaningful Outcome Achievement","authors":"Mihir S. Dekhne MD ,&nbsp;Kyle N. Kunze MD ,&nbsp;Yu-Fen Chiu MS ,&nbsp;Elizabeth Gausden MD, MPH ,&nbsp;Catherine H. MacLean MD, PhD ,&nbsp;Alexander S. McLawhorn MD, MBA","doi":"10.1016/j.artd.2025.101767","DOIUrl":"10.1016/j.artd.2025.101767","url":null,"abstract":"<div><h3>Background</h3><div>Patient-reported outcome measures (PROMs) assess quality of care after total joint arthroplasty (TJA) and will be mandatory for reporting by 2027 under the Center for Medicare and Medicare Services. This study evaluated the impact of PROM utilization on achieving minimum clinically important differences (MCID), substantial clinical benefits (SCB), and patients’ global impression of change (PGIC) in primary TJA patients.</div></div><div><h3>Methods</h3><div>The study included 7,441 primary TJA patients (4,458 THAs, 2,983 TKAs) who completed preoperative PROMs within 180 days before surgery and postoperative PROMs 270–450 days after surgery. Surgeons were categorized as PROM users or nonusers based on responses to a survey question about how often they referenced preoperative PROMs before recommending surgery. The primary outcome was the proportion of patients achieving MCID, SCB, or reporting at least “much improved” on the PGIC at 1 year. Multiple linear regression was adjusted for patient age, sex, and BMI.</div></div><div><h3>Results</h3><div>Among TKA patients, PROM users were more likely to achieve SCB (p&lt;0.001; p=0.002), but no significant difference was found for MCID or PGIC. For THA, there were no significant differences between surgeon groups in achieving these measures.</div></div><div><h3>Conclusions</h3><div>TKA patients whose surgeons referenced PROMs were more likely to achieve SCB, suggesting potential benefits of PROM utilization in this group. The lack of effect in THA may reflect the more predictable satisfaction levels in this population.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101767"},"PeriodicalIF":1.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572685","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 Regarding Clinical Follow-Up After Total Joint Arthroplasty","authors":"Jeremy S. Frederick MD ,&nbsp;Samuel D. Mounce MD ,&nbsp;Jeffrey A. Chapek MD ,&nbsp;Caitlin E. Conley PhD ,&nbsp;Stephen T. Duncan MD ,&nbsp;David C. Landy MD, PhD","doi":"10.1016/j.artd.2025.101764","DOIUrl":"10.1016/j.artd.2025.101764","url":null,"abstract":"<div><h3>Background</h3><div>While considerable variation exists regarding patient follow-up after total joint arthroplasty (TJA), little is known regarding patient perceptions. Given the increasing need to deliver cost-efficient care, rising importance of satisfaction scores, and lengthened commutes with market consolidation, understanding patient perceptions and their predictors is important.</div></div><div><h3>Methods</h3><div>A convenience sample of 75 patients was surveyed from the waiting room of an academic arthroplasty practice serving a large geographic catchment area regarding clinic travel and TJA follow-up perceptions. The sample resembled an expected arthroplasty population with 63% women, 46% between 50 and 64 years of age, and 42% having TJA in the past 2 years.</div></div><div><h3>Results</h3><div>Median clinic travel time was 30 minutes (interquartile range, 15-75 minutes) with 15% finding this burdensome and 17% having transportation reliability concerns. Overall, 97% believed TJA follow-up necessary and 94% that it was important to their overall satisfaction with TJA. Regarding initial follow-up, 74% preferred a 2-week in-person visit, though 9% preferred a nurse phone call, and 8% a virtual visit. Demographic factors were not associated with follow-up preferences, though there were strong associations between preference for an alternative follow-up method and both increasing travel time (<em>P</em> = .04) and transportation reliability concerns (<em>P</em> = .03).</div></div><div><h3>Conclusions</h3><div>While most patients preferred 2-week in-person follow-up, one-fourth preferred an alternative. Increasing travel time and decreased transportation reliability were associated with alternative follow-up preference. As market consolidation increases, it is important that patients have appropriate access to care which may involve more flexible follow-up pathways.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101764"},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144569957","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":"Complications, Conversion, and Secondary Procedures Following Minimally Invasive Periacetabular Osteotomy: A Single-Surgeon Case Series","authors":"Mohammad H. Amer FRCS (T&O) ,&nbsp;Yash Pursun MBBS ,&nbsp;Christian Smith MBBS, BSc (Hons), MSc, PGCME, FRCS (T&O) ,&nbsp;Karadi H. Sunil Kumar MBBS, MCh (Ortho), MFSEM, FRCSEd (T&O) ,&nbsp;Ajay Malviya PhD, FRCS T&O, MSc, MRCS Ed, MS","doi":"10.1016/j.artd.2025.101766","DOIUrl":"10.1016/j.artd.2025.101766","url":null,"abstract":"<div><h3>Background</h3><div>The introduction of minimally invasive periacetabular osteotomy (PAO) has reduced complications, allowing a broader range of patients to be considered for the procedure. This study aimed to identify patient-specific risk factors for poor outcomes.</div></div><div><h3>Methods</h3><div>This retrospective case series (n = 513) used data from a local hip registration registry. Isolated PAOs with at least 1-year follow-up were included. Electronic records were reviewed to extract demographics and variables. The primary outcome was complication rate, with secondary outcomes including secondary procedures and conversion to total hip arthroplasty. Logistic regression was performed to correlate independent variables to outcomes, and Kaplan-Meier analysis assessed the survival of the native hip and cumulative complication risk.</div></div><div><h3>Results</h3><div>Complication rate was 6.2%. Higher body mass index (BMI), smoking, Tönnis grade 2, and increasing age were associated with higher odds of complications (<em>P</em> &lt; .05). The nonunion rate was 4.3%; higher BMI and age linked to increased risk (<em>P</em> &lt; .05). 10.9% of patients required a secondary procedure and cumulative risk for secondary procedures at 5 years was 11.4% and at 10 years was 17.2%. BMI correlated with the need for secondary procedures (<em>P</em> = .001). 3.7% (n = 19) required conversion to total hip arthroplasty with a mean time to conversion of 4.6 years ±2.04. The 5- and 10-year survival rates were 96.3 and 92.7%, respectively.</div></div><div><h3>Conclusions</h3><div>Minimally invasive PAO has acceptable rates of complication and conversion at mid-term follow-up. Age, BMI, smoking status, and Tönnis grade 2 are associated with inferior outcomes. Knowledge of patient-specific risk factors can help in decision-making, expectation setting, and perioperative interventions.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101766"},"PeriodicalIF":1.5,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563520","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":"Identifying Critical Evidence Gaps in Wound Closure and Incision Management After Total Hip Arthroplasty: Delphi Panel Insights","authors":"Margaret H. Ainslie-Garcia MSc ,&nbsp;Lucas A. Anderson MD ,&nbsp;Benjamin V. Bloch BSc, FRCS ,&nbsp;Tim N. Board FRCS ,&nbsp;Antonia F. Chen MD ,&nbsp;Samantha Craigie MSc ,&nbsp;Walter Danker III PhD ,&nbsp;Najmuddin Gunja PhD ,&nbsp;James Harty MD ,&nbsp;Victor H. Hernandez MD, MS ,&nbsp;Kate Lebedeva MSc ,&nbsp;Mitchell K. Ng MD ,&nbsp;Daniel Hameed MD ,&nbsp;Michael A. Mont MD ,&nbsp;Ryan M. Nunley MD ,&nbsp;Javad Parvizi MD ,&nbsp;Sean B. Sequeira MD ,&nbsp;Carsten Perka MD ,&nbsp;Nicolas S. Piuzzi MD ,&nbsp;Ola Rolfson MD, PhD ,&nbsp;Luigi Zagra MD","doi":"10.1016/j.artd.2025.101693","DOIUrl":"10.1016/j.artd.2025.101693","url":null,"abstract":"<div><h3>Background</h3><div>In total hip arthroplasty (THA), proper management of surgical incisions is essential for optimal wound healing and patient outcomes. Despite advances in surgical techniques, significant challenges remain in preventing complications and infections. This study aimed to identify evidence gaps in THA wound care, including presurgical preparation, intraoperative practices, and postsurgical complications.</div></div><div><h3>Methods</h3><div>Using a modified Delphi method, 20 expert orthopedic surgeons from Europe and North America participated in a 3-phase consensus process from April 1 to September 30, 2023. This included a preliminary questionnaire, a remote conference, and a final online survey. The panel reviewed literature and achieved agreement on 18 consensus statements regarding wound care in THA. A secondary aim was to identify critical gaps in current wound care knowledge.</div></div><div><h3>Results</h3><div>Consensus was reached on 18 statements. Key gaps were identified in the effectiveness of mesh-adhesive dressings, optimal closure methods (skin adhesives, staples, sutures), cost benefit of barbed sutures, and appropriate use of negative pressure wound therapy. These findings highlight the need for further research to validate best practices and guide standardized evidence-based protocols.</div></div><div><h3>Conclusions</h3><div>Addressing these evidence gaps is essential to improve THA wound care methods. Future studies should compare closure techniques and new technologies to develop more efficient patient-centered strategies. Bridging these gaps may reduce complications, enhance outcomes, and lower the burden of wound-related issues in THA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101693"},"PeriodicalIF":1.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535143","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 Single Perioperative Dose of Dexamethasone Is Not Associated With an Increased Risk of Infection in Patients With Hip or Knee Osteoarthritis Considered for Elective Primary Total Hip or Total Knee Arthroplasty","authors":"Samo Roškar MD ,&nbsp;Vesna Levašič MD, PhD ,&nbsp;Mateja Blas MSc ,&nbsp;Simon Kovač MD, PhD","doi":"10.1016/j.artd.2025.101761","DOIUrl":"10.1016/j.artd.2025.101761","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative dexamethasone administration has been associated with reduced postoperative nausea, pain, and enhanced recovery after total hip (THA) and knee arthroplasty (TKA). However, there is ongoing concern about the influence of glucocorticoids on periprosthetic joint infection (PJI) due to the high heterogeneity of available studies. The present study aimed to evaluate the effect of perioperative dexamethasone use on early and delayed PJI after THA and TKA in patients with primary osteoarthritis.</div></div><div><h3>Methods</h3><div>A consecutive cohort of patients from a single teaching hospital were analyzed. For each procedure, the intravenous application of 0.15 mg/kg dexamethasone in a single dose perioperatively was recorded. Additionally, patient characteristics, joint affected and the revision surgery due to infection after primary surgery were collected from the hospital registry and medical records. All patients with revision surgery for PJI were subjected to the standard protocol of perioperative diagnostics.</div></div><div><h3>Results</h3><div>Between 2017 and 2023, a total of 8905 procedures were included, 1318 with perioperative dexamethasone application and 7587 without. The patients who received perioperative dexamethasone (dexa group) were similar in age (effect size (ES) = 0.03), sex (ES = 0.002), body mass index (ES = 0.06) and American Society of Anaesthesiologists score (ES = 0.06) compared to patients who did not (non-dexa group). In total, 54 PJIs were observed, 6 of them were in dexamethasone and 48 in the non-dexamethasone group. Multivariate logistic regression showed that the use of dexamethasone was not associated with higher odds for PJI within the first 2 postoperative years (odds ratio 0.80 95% confidence interval 0.30-1.73; <em>P</em> = .603).</div></div><div><h3>Conclusions</h3><div>Our study is the first single-dose, single-hospital study with standardized PJI diagnostic procedures at revision surgery, which shows that perioperative intravenous dexamethasone has no association with an increased risk of early or delayed PJI in THA and TKA in patients with primary osteoarthritis. The present data provide evidence in support of the perioperative administration of a single dose of dexamethasone.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101761"},"PeriodicalIF":1.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522721","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":"Meta-Regression Analysis of the Association Between Acetabular Cup Positioning and Functional Outcome for Patients With Iliopsoas Impingement Syndrome After Total Hip Arthroplasty","authors":"Nikolai Ramadanov MD ,&nbsp;Maximilian Voss MD ,&nbsp;Robert Hable PhD ,&nbsp;Robert Prill PhD ,&nbsp;Marco Ezechieli MD ,&nbsp;Roland Becker MD","doi":"10.1016/j.artd.2025.101760","DOIUrl":"10.1016/j.artd.2025.101760","url":null,"abstract":"<div><h3>Background</h3><div>To examine the association between acetabular cup positioning and functional outcomes, measured with Harris Hip Score (HHS), in IPI patients after THA.</div></div><div><h3>Methods</h3><div>A literature search was conducted in PubMed, CENTRAL, Epistemonikos, and Embase up to November 30, 2024. A multilevel random-effects meta-analysis was performed with a restricted maximum likelihood heterogeneity estimator and Hartung-Knapp adjustment. Logistic regression on pooled data identified acetabular cup inclination and anteversion cut-offs associated with IPI, we performed logistic regression analysis on pooled data from the included studies.</div></div><div><h3>Results</h3><div>Ultimately, 32 studies with overall 1755 patients were included. The non-IPI subgroup (mean: 91.5; confidence interval [CI]: 88.2-94.9; I² = 98%; τ² = 48.7; <em>P</em> &lt; .01) had a higher mean post-THA HHS compared with the IPI subgroup (mean: 83.3; CI: 78.0-88.7; I² = 96%; τ² = 48.7; <em>P</em> &lt; .01). The non-IPI subgroup (mean: 42.2; CI: 40.6-43.8; I² = 97%; τ² = 10.3; <em>P</em> &lt; .01) had a lower acetabular cup inclination compared with the IPI subgroup (mean: 45.4; CI: 43.3-47.6; I² = 71%; τ² = 10.3; <em>P</em> &lt; .01) (F = 6.1; df = 1, 43; <em>P</em> = .02). There was no difference between the 2 subgroups in acetabular cup anteversion (F = 3.8; df = 1, 32; <em>P</em> = .06). There was no significant association between cup inclination (<em>P</em> = .26) or anteversion (<em>P</em> = .67) and post-THA HHS. The optimal cut-offs for cup inclination and anteversion were ≤ 44.1° and ≥ 18.7°, respectively.</div></div><div><h3>Conclusions</h3><div>Acetabular cup inclination ≤ 44.1° and anteversion ≥ 18.7° may lower IPI risk following THA. These findings represent a step toward optimizing acetabular cup positioning for a better patient outcome.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101760"},"PeriodicalIF":1.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522722","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":"Incidentally Diagnosed Asymptomatic COVID-19 Does Not Increase Total Complication Risk in Total Joint Arthroplasty","authors":"Vaibhav R. Tadepalli MD ,&nbsp;Jasraj S. Raghuwanshi BS ,&nbsp;Wendy Novicoff PhD ,&nbsp;James A. Browne MD ,&nbsp;Ian M. Duensing MD","doi":"10.1016/j.artd.2025.101745","DOIUrl":"10.1016/j.artd.2025.101745","url":null,"abstract":"<div><h3>Background</h3><div>Impacts of asymptomatic perioperative coronavirus disease 2019 (COVID-19) on total knee (TKA) and hip arthroplasty (THA) outcomes remains unknown.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed asymptomatically screened COVID-19 cases undergoing primary TKA or THA between 2020 and 2022. Ninety-day complications, inpatient resources, repeat hospitalizations, and functional outcomes were measured for COVID-19 patients and age- and sex-matched controls. The sample size was determined based on a priori power analysis. Statistics consisted of 2 sample <em>t</em>-tests or Fisher’s exact test based on variable type with α = 0.01 to correct for multiple comparisons.</div></div><div><h3>Results</h3><div>Of 1914 TKA and 1424 THA patients, 20 and 28 with asymptomatic COVID-19 were compared to 75 and 105 controls, respectively. While there was no statistically significant increase in relative risk for major (TKA <em>P</em> = .04|THA <em>P</em> = .12) or thromboembolic (TKA <em>P</em> = .21|THA <em>P</em> = .04) complications, the COVID-19 group experienced mortality, ischemic stroke, pulmonary embolism, and deep vein thrombosis. There was no significant difference in admission length (TKA <em>P</em> = .29|THA <em>P</em> = .22), physical therapy (TKA <em>P</em> = .36|THA <em>P</em> = .36), labs (TKA <em>P</em> = .57|THA <em>P</em> = .82), nonhome discharge (TKA <em>P</em> = 1|THA <em>P</em> = 1), or mobility (TKA <em>P</em> = .18|THA <em>P</em> = .21).</div></div><div><h3>Conclusions</h3><div>The current study suggests that, while perioperative risk of asymptomatic COVID-19 does not meet the threshold for statistical significance, arthroplasty surgeons should be aware of potential mortality and morbidity and engage in shared decision-making regarding deferral of surgery, especially for patients with other comorbidities.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101745"},"PeriodicalIF":1.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522723","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":"Robotic Guided Knee Arthroplasty - Group Learning Curve and Early Outcomes","authors":"Max Gordon MD,&nbsp;Gurion Rivkin MD,&nbsp;Alex Greenberg MD,&nbsp;Leonid Kandel MD,&nbsp;Meir Liebergall MD,&nbsp;Itay Perets MD","doi":"10.1016/j.artd.2025.101746","DOIUrl":"10.1016/j.artd.2025.101746","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have reported initial and proficiency phases of the learning curve among individual surgeons when robotic-assisted total knee arthroplasty (raTKA) into their practices. The purpose of this study was to assess the number of raTKA cases needed to achieve proficiency in the operative time (OT) across a group of surgeons.</div></div><div><h3>Methods</h3><div>A retrospective analysis comparing raTKA to manual Total Knee Arthroplasty (mTKA) was performed at a single-site comprised of 6 orthopaedic surgeons. The first 90 patients who underwent raTKA at the institution divided chronologically into 3 groups of 30 each and compared to 30 previous mTKA cases. Tourniquet time was used as the measure for OT, range of motion (ROM) was measured preoperatively and at 2 and 6 weeks postoperative.</div></div><div><h3>Results</h3><div>Average OT was significantly shorter in the mTKA group in comparison with all the raTKA groups. A statistically significant difference was found in OT when comparing the succeeding raTKA groups (mean time of 97.6, 86.6, and 76.7 min <em>P</em> value&lt;.001). The change in ROM at 6 weeks postoperative was found to be greater in the first raTKA group in comparison to the second raTKA group (mean of 0.9° vs −17.1°; <em>P</em> = .04) and the mTKA group (mean of 0.9° vs −7.9°; <em>P</em> = .04). However, when controlling for preoperative ROM and performing surgeon, there was no difference in ROM at 6 weeks postoperative between defined time periods (<em>P</em> = .78). No difference was found when comparing rate of complications (<em>P</em> value&gt;.05).</div></div><div><h3>Conclusions</h3><div>When evaluating the group learning curve, this study showed average shorter operating time with every 30 cases (mean time of 97.6; 86.6- and 76.7-min <em>P</em> value&lt;.001) and no difference in complication rate (<em>P</em> value&gt;.05). These findings suggest continued proficiency over time; however, adoption of the technology is associated with longer OTs.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101746"},"PeriodicalIF":1.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522720","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":"Does Alignment Technique in Medially Stabilized Total Knee Arthroplasty Affect the Patellofemoral Joint Biomechanics and Patient-reported Outcomes at 1 Year? A Prospective Registry-based Cohort Study","authors":"Samuel W. King BM BCh, MRCSEd ,&nbsp;Nicolas Silvestrini PhD ,&nbsp;Anne Lübbeke MD, DSc ,&nbsp;Hemant Pandit DPhil, FRCS (Tr & Orth) ,&nbsp;Hermes H. Miozzari MD, PD","doi":"10.1016/j.artd.2025.101750","DOIUrl":"10.1016/j.artd.2025.101750","url":null,"abstract":"<div><h3>Background</h3><div>Current femoral components may produce a nonanatomical trochlea position with kinematic alignment (KA). This study compared effects of alignment on patellar tilt and patient-reported outcomes in medially stabilized total knee arthroplasty (MS-TKA).</div></div><div><h3>Methods</h3><div>MS-TKA patients from a prospective registry-based consecutive cohort were subdivided by alignment technique and patella resurfacing status. Impact of alignment technique stratified by patellar resurfacing on 1-year patellar tilt was investigated with analysis of variance. For alignment technique impact stratified by patellar resurfacing on 1-year Western Ontario and McMaster Universities Arthritis Index (WOMAC), analysis of covariance including preoperative WOMAC pain and function scores as covariates were performed. Spearman's rank correlation was computed for patellar tilt vs WOMAC pain and function at 1 year.</div></div><div><h3>Results</h3><div>295 MS-TKAs were included: mechanical alignment in 168 (56.9%), patella resurfaced in 137 (46.4%), mean age 68.0 years, mean body mass index 30.6 kg/m². More women had nonresurfaced patellae (74.3%; <em>P</em> = .011), otherwise baseline demographics, radiological parameters, WOMAC, and lateral release rates were similar between groups. At 1 year, patellar tilt was higher for KA vs mechanical alignment (7.31 vs 5.90; <em>P</em> = .028) in both resurfaced and nonresurfaced TKA. No effect of alignment on baseline-adjusted WOMAC at 1 year was found in both resurfaced and nonresurfaced TKA. One-year patellar tilt did not correlate with WOMAC pain (r_s = −0.004; <em>P</em> = .954) or function (r_s = 0.016; <em>P</em> = .832).</div></div><div><h3>Conclusions</h3><div>Despite greater patellar tilt at 1year with KA, this study suggests alignment technique in MS-TKA does not adversely impact patella-femoral joint in a clinically significant manner, leading to similar patient-reported outcomes regardless of patellar resurfacing status.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101750"},"PeriodicalIF":1.5,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481751","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":"Mesh Reconstruction of Extensor Mechanism for Fracture Nonunion of the Patella in an Osteoarthritic Knee","authors":"Sandra Hiu-Tung Wan MBBS (HK),&nbsp;Raymond Ching Hin Yau MBBS (HK), FHKCOS, FHKAM (Orthopaedic Surgery), FRCSEd (Ortho),&nbsp;Lawrence Chun Man Lau MBChB, FRCSEd (Orth), FHKCOS, FHKAM (Orthopaedic Surgery), PhD,&nbsp;Henry Fu MBBS (HK), MMedSc (HK), FRCSEd (Orth), FHKCOS, FHKAM (Orthopaedic Surgery),&nbsp;Kwong Yuen Chiu MBBS (HK), FRCSEd (Orth), FHKCOS, FHKAM (Orthopaedic Surgery),&nbsp;Ping Keung Chan MBBS, MRCSEd, FHKCOS, FHKAM (Orthopaedic Surgery), FRCSEd (Orth)","doi":"10.1016/j.artd.2025.101747","DOIUrl":"10.1016/j.artd.2025.101747","url":null,"abstract":"<div><div>For extensor mechanism deficiency in the osteoarthritic knee, mesh reconstruction of the extensor mechanism is an accessible option. Studies have shown that its rates of infection and graft failure are noninferior compared to allograft reconstruction. This case report presents a 51-year-old patient who presented with chronic fracture nonunion of the inferior pole of the patella, associated with pain, extension lag, and osteoarthritis. Since the anterior knee was previously treated with partial-thickness skin graft, soft tissue reconstruction was performed prior to mesh reconstruction of the extensor mechanism and total knee arthroplasty so as to allow later mobilization of underlying muscles. The two-staged operation resulted in improved range of motion, pain levels, and walking tolerance, highlighting the importance of preoperative planning.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101747"},"PeriodicalIF":1.5,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481754","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}