Journal of Arthroplasty最新文献

{"title":"Is Inflammatory Arthritis an Absolute Indication for Patellar Resurfacing in Total Knee Arthroplasty?","authors":"Bryant M Song, Caleb A Ford, Andrew M Schneider, Ryan M Nunley, Robert L Barrack, Ilya Bendich","doi":"10.1016/j.arth.2026.04.094","DOIUrl":"https://doi.org/10.1016/j.arth.2026.04.094","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory arthritis (IA) has been considered an absolute indication for patellar resurfacing (PR) in total knee arthroplasty (TKA), yet limited contemporary data exists to support this. The purpose of this study was 1) to compare outcomes of TKA without PR for IA and osteoarthritis (OA) and 2) to compare outcomes of TKA for IA with and without PR.</p><p><strong>Methods: </strong>A retrospective review of all primary TKAs at an academic institution between March 2017 to May 2024 was performed. We identified 348 TKAs without PR performed for IA. This cohort was matched by demographics to 348 TKAs without PR performed for OA. A secondary comparison of 38 TKAs for IA with PR (IA-PR) during the same period was performed. Outcomes included reoperation, revision, patella-related complications, and presence of anterior knee pain (AKP). The mean follow-up was 24 months. T-tests and Fisher's exact tests were performed.</p><p><strong>Results: </strong>Among TKA without PR, 20 (5.7%) IA and 13 (3.7%) OA underwent reoperation (P = 0.28); two (0.6%) in each group underwent revision (P = 1.0). There were no differences in aseptic (3.4 IA versus 2.6% OA; P = 0.66), patella-related (1.4 IA versus 0.9% OA, P = 0.73), or septic (2.3 IA versus 1.1% OA; P = 0.38) reoperations. There were four (1.1%) IA versus zero OA TKAs underwent secondary PR (P = 0.12). Among TKA without PR, there was no difference in AKP between IA (4.9%) and OA (7.8%) (P = 0.16). Among TKA for IA with and without PR, there was no difference in AKP (4.9 IA versus 5.3% IA-PR; P = 0.58). The PR group had more aseptic reoperations (3.4 IA versus 13.2% IA-PR; P = 0.02) and revisions (0.6 IA versus 13.2% IA-PR; P < 0.01), but similar patella-related complications (1.4 IA versus 2.6% IA-PR, P = 0.47).</p><p><strong>Conclusion: </strong>In TKA without PR for IA compared to OA, there were no differences in reoperations, revisions, patella-related complications, or AKP. Additionally, PR did not improve outcomes in IA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Hip Arthroplasty in Legg-Calve-Perthes Disease: Mean Nine-Year Outcomes of 201 Hips.","authors":"Diego J Restrepo, Aaron G Chen, Sergio F Guarin Perez, Ta-Wei Tai, Robert T Trousdale, Tad M Mabry, Rafael J Sierra","doi":"10.1016/j.arth.2026.04.111","DOIUrl":"https://doi.org/10.1016/j.arth.2026.04.111","url":null,"abstract":"<p><strong>Background: </strong>Legg-Calvé-Perthes (LCPD) disease is an uncommon, but challenging indication for total hip arthroplasty (THA). We aim to report one of the largest single-center contemporary series of THA associated with this condition.</p><p><strong>Methods: </strong>We reviewed 201 THAs for LCPD performed at a single institution between 2000 and 2020. The mean age at surgery was 47 years, the mean body mass index was 32 and 74% were men. Bearing surfaces included ceramic-on-highly-cross-linked polyethylene(C-HXLPE) in 95 hips (47%), metal-on-HXLPE in 83 hips (41%), ceramic-on-ceramic(CoC) in 17 hips (9%), and metal-on-metal(MoM) in six hips (3%). All acetabular components were cementless. Cementless and cemented femoral stems were used in 188 (93%) and 14 hips (7%), respectively. The mean follow-up was nine years (range, two to 22).</p><p><strong>Results: </strong>At 15 years, survivorships free of aseptic revision, any revision, and any reoperation were 99, 98, and 95% respectively. Indications for revision were infection (n=2), postoperative fracture (n=1), and metallosis (n=1). There were no significant differences in survivorship between hips with prior surgical treatment of LCPD (n=8) and those without (n=153). Complications occurred in 30 hips, most commonly sciatic neuropraxia (n=10) and intraoperative fracture (n=9). Preoperatively, patients had a mean leg-length discrepancy of 18mm shorter on the operative limb. Postoperatively, the operative limb was lengthened by a mean of 15mm. There was no difference in mean lengthening between patients who had sciatic neuropraxia and those who did not (12 versus 15mm; P=0.365). There were seven neuropraxias resolved, while three patients had persistent deficits at the latest follow-up. The mean Harris hip score (HHS) improved preoperatively from 55 to 92 at 10-year follow-up (P<0.0001).</p><p><strong>Conclusion: </strong>At 15 years, patients who had LCPD undergoing contemporary THA showed excellent survivorship free of revision and reoperation. Surgeons should be aware that complications were not uncommon, especially sciatic neuropraxia and intraoperative fractures.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nanotechnology-Based Device Reduces Pain and Immediate Opioid Requirements, and Facilitates Earlier Discharge from the Hospital Following Total Knee Arthroplasty: A Randomized Placebo-Controlled Trial.","authors":"Brian A Klatt, Michael O'Malley, Akbota Ayazbekova, Hsing-Hua Sylvia Lin, Senthilkumar Sadhasivam, Jacques E Chelly","doi":"10.1016/j.arth.2026.04.083","DOIUrl":"https://doi.org/10.1016/j.arth.2026.04.083","url":null,"abstract":"<p><strong>Background: </strong>Opioids are often used to control pain following total knee arthroplasty (TKA). Opioid-sparing pain relief tools are needed in the current setting of the opioid crisis. This prospective randomized placebo-controlled study assessed the ability of a nanotechnology-based device (NBD) to reduce pain and opioid consumption following TKA.</p><p><strong>Methods: </strong>A total of 156 patients were included (79 in the active NBD group and 77 in the sham NBD group). In the recovery room, patients enrolled were randomized (1:1) to either an active NBD or sham group and were asked to wear the NBD 12 hours a day for two weeks. Patients were followed for six weeks following surgery to determine the effectiveness of active NBD to reduce pain, opioid use, hospital length of stay (LOS), use, postoperative nausea and vomiting (PONV), risk of opioid misuse, and knee range of motion.</p><p><strong>Results: </strong>The use of active NBD was associated with a 26% reduction in opioid consumption during the first 24 hours before discharge (25.6 in the active NBD versus 34.4 mg in the sham group, P = 0.015) and a 19% shorter LOS (20.8 versus 25.7 hours, P = 0.006). The active NBD group showed a 14% reduction in pain at rest score at week one and a reduction of 30% in postoperative nausea and vomiting (PONV) and 41% in use of rescue antiemetics compared to the sham NBD group.</p><p><strong>Conclusion: </strong>This randomized placebo-controlled study demonstrates that the use of NBD is significantly associated with an immediate reduction in postoperative opioid use, PONV, use of rescue antiemetics, and LOS. However, additional large multicenter prospective studies are needed to confirm and scale the clinical and economic benefits of NBD following TKA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Relaxed- and Flexed-Seated Radiographs for Assessing Spino-Pelvic Mobility in Total Hip Arthroplasty.","authors":"Andreas Fontalis, Humza Osmani, Maël Guerra-Perron, Fabio Mancino, Warran Wignadasan, Pierre Putzeys, Fares S Haddad","doi":"10.1016/j.arth.2026.04.101","DOIUrl":"https://doi.org/10.1016/j.arth.2026.04.101","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the comparative value of relaxed- and flexed-seated lateral radiographs in assessing spino-pelvic mobility in patients undergoing total hip arthroplasty (THA).</p><p><strong>Methods: </strong>A prospective cohort of 200 consecutive patients undergoing primary THA for osteoarthritis underwent preoperative standing, relaxed-seated, and flexed-seated lateral radiographs using a standardized protocol. There were 10 patients who were excluded for incomplete imaging, leaving 190 for analysis. The mean age was 66 years (range, 35 to 90), and the mean Body Mass Index (BMI) was 28.0 (range, 20.1 to 41.0). Measurements included sacral slope (SS), lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT). Patients were also classified according to the hip-spine-classification.</p><p><strong>Results: </strong>The mean PI was 52.7° ± 12°. The mean standing SS was 36.4°, decreasing to 15.1° in the relaxed-seated and increasing to 29.1° in the flexed-seated position. Based on standing-to-relaxed-seated change, 14.2% were classified as stiff (types 1B/2B). Using standing-to-flexed-seated views, stiffness increased to 52.6%. Reclassification between seated postures occurred in 39.5% of patients, predominantly from mobile (1A/2A) to stiff (1B/2B) phenotypes. Flatback deformity (PI-LL greater than 10°) was present in 28.4% and associated with a higher stiffness rate on flexed-seated imaging (63 versus 27.8%). The sacral slope correlation between relaxed and flexed postures was moderate (r = 0.48).</p><p><strong>Conclusion: </strong>Flexed-seated radiographs classify a greater proportion of patients as having reduced spino-pelvic mobility compared with relaxed-seated imaging, with reclassification observed in a substantial proportion of cases. The two postures show only moderate correlation, indicating that relaxed-seated imaging does not reliably predict flexed-seated behavior. These findings highlight that spino-pelvic assessment is posture-dependent and suggest a role for flexed-seated imaging in selected patients, although the impact on component positioning and clinical outcomes requires further study.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Metaphyseal versus Diaphyseal Stems in Conversion Total Hip Arthroplasty after Intramedullary Nailing.","authors":"Joshua P Rainey, Nikhil Vallabhaneni, Sierra Levene, Brenna E Blackburn, Jeremy M Gililland, Michael J Archibeck","doi":"10.1016/j.arth.2026.04.102","DOIUrl":"https://doi.org/10.1016/j.arth.2026.04.102","url":null,"abstract":"<p><strong>Introduction: </strong>Diaphyseal-engaging stems are conventionally used in conversion total hip arthroplasty (cTHA) after prior intramedullary nailing (IMN) to bypass screw holes and previously instrumented metadiaphyses. However, it remains unclear if cementless metaphyseal or standard cemented stems can also provide satisfactory fixation in this scenario. This study compared the early outcomes of cTHA using three femoral stem designs: metaphyseal cementless, diaphyseal cementless, and standard cemented.</p><p><strong>Methods: </strong>A retrospective review of 80 patients who underwent cTHA after prior IMN at a single academic center from 2014 to 2024 was conducted. Patients received either a metaphyseal press-fit stem, a standard-length cemented stem, or a diaphyseal-engaging stem. The 90-day complications were recorded, including any reoperation, periprosthetic joint infection (PJI), periprosthetic femoral fracture, or dislocation. An \"at-risk\" subgroup analysis of stem tips that were within four centimeters proximal of the interlock hole was also conducted. Patients who received metaphyseal stems were younger (56 versus 77 versus 72 years, P < 0.001) and had lower Charlson Comorbidity Index (1.5 versus 4.0 versus 2.2, P = 0.019) scores compared to those who received cemented stems or diaphyseal stems.</p><p><strong>Results: </strong>There were no significant differences in 90-day complication rates observed among the three stem groups (P = 0.10). Notably, no postoperative periprosthetic fractures occurred in any group (P = 1.000). There were no differences in reoperation (P = 0.232), PJI (P = 1.00), or dislocation (P = 0.61) rates between the three groups. The \"at-risk\" subgroup analysis of 15 patients demonstrated no significant differences among the three groups for any complication and, notably, had no postoperative periprosthetic fractures.</p><p><strong>Conclusion: </strong>Metaphyseal-engaging stems and standard cemented stems in cTHA after IMN demonstrated similar outcomes to diaphyseal stems and may be reasonable options in cTHA after IMN in select patients.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postmortem Analysis of Osseointegration in Cementless Acetabular Components After Total Hip Arthroplasty: A Multimodal Study.","authors":"Braden V Saba, Benjamin Schaffler, Bruno Martins de Souza, Olivia Schaffer, Cameron Fallah, Noor Alhaddad, Michael Montague, Jan Fritz, Robert Hopper, Charles A Engh, Lukasz Witek, Ran Schwarzkopf","doi":"10.1016/j.arth.2026.04.090","DOIUrl":"https://doi.org/10.1016/j.arth.2026.04.090","url":null,"abstract":"<p><strong>Introduction: </strong>Press-fit acetabular components achieve long-term fixation through osseointegration, yet the extent of bone ingrowth necessary for durable stability in well-functioning implants remains unclear. Postmortem retrievals provide a unique opportunity to directly assess the bone-cup interface in clinically successful total hip arthroplasties (THAs). This study evaluated osseointegration and biomechanical fixation strength in deceased-donor acetabular components to better define the characteristics of stable long-term fixation.</p><p><strong>Methods: </strong>Cadaver pelvis specimens containing uncemented THAs from a single institution were evaluated. There were 29 acetabular components that underwent axial pull-out testing using a universal testing machine. A total of seven of these were additionally processed for histologic evaluation, including dehydration, acrylic embedding, thin-sectioning, staining, and digital imaging. Osseointegration was quantified by bone-area fraction occupancy (%BAFO), representing the proportion of bone occupying the porous thread spaces of the cup.</p><p><strong>Results: </strong>All 29 specimens failed through fracture of the ilium rather than at the bone-cup interface, indicating that the mechanical integrity of the osseointegrated construct exceeded that of the surrounding bone under axial tension. Among the seven histologically analyzed components, %BAFO ranged from 4.2 to 27.0% (mean 15.1%), despite all implants being clinically stable at the time of death. There were no significant linear correlations observed between %BAFO and time implanted, fracture load, or body mass index. A significant quadratic relationship between %BAFO and age was identified, peaking near 81 years.</p><p><strong>Conclusions: </strong>Cementless acetabular components exhibited strong fixation despite modest osseointegration, with failure occurring through host bone on axial testing. Durable biological fixation appears achievable with limited, but mechanically favorable bone ingrowth.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Chitranjan S. Ranawat Award: Surgeon-Performed, Intraoperative Adductor Canal Blocks are Non-inferior to Anesthesiologist-Performed Adductor Canal Blocks in Total Knee Arthroplasty.","authors":"Brent Benavides, Arianne Charlebois, Geoffrey Dervin, George Grammatopoulos","doi":"10.1016/j.arth.2026.04.105","DOIUrl":"https://doi.org/10.1016/j.arth.2026.04.105","url":null,"abstract":"<p><strong>Background: </strong>For total knee arthroplasty (TKA) performed in an ambulatory setting, reliable analgesia is essential for same-day discharge (SDD). Although adductor canal blocks (ACBs) are effective, access to anesthesiologist-performed ACBs (aACBs) may be limited by regional anesthesia availability in resource-constrained centers. Even when expertise exists, lack of perioperative workflow integration can reduce efficiency, prolong procedural time, and increase costs. The objective of this study was to evaluate whether surgeon-performed ACBs (sACBs) are non-inferior to aACBs regarding time to discharge, perioperative outcomes, and patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>A prospective randomized controlled trial of 200 SDD TKA patients was conducted. Participants were randomized to receive preoperative aACB or intraoperative sACB. The primary outcome was time from spinal anesthetic reversal to discharge. The secondary outcomes included Numeric Pain Rating Scale (NPRS), 24-hour morphine milliequivalent (MME) use, SDD failure, 24-hour readmission, and PROMs at baseline and two weeks postoperatively. Power analysis used a representative SDD TKA sample detecting a 15% difference in the primary outcome (power 80%, α = 0.05).</p><p><strong>Results: </strong>Time to discharge was not different in sACB compared to aACB: 209.5 minutes (range, 10 to 510) compared to 231.1 (range, 59 to 455), P = 0.06. Secondary outcomes showed no significant differences: NPRS at Baseline - 4.3 (aACB) versus 4.3 (sACB), P = 0.87, and NPRS at Discharge - 2.4 (aACB) versus 2.9 (sACB), P = 0.07. The 24-hour opioid consumption was 35.8 MME (aACB) versus 43.6 (sACB), P = 0.31. There were no 24-hour readmissions. There were 13 patients who failed SDD: 8 (aACB) versus 5(sACB), P = 0.42.</p><p><strong>Conclusions: </strong>The sACBs were non-inferior to aACBs for outpatient TKA. An sACB represents a safe alternative that may reduce reliance on limited anesthesia resources. With standardized perioperative integration, sACB may improve operating room efficiency and reduce costs.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who Fails? Identifying Risks for Aseptic Loosening After Cementless Total Knee Arthroplasty.","authors":"Zachary Fuller, Manjot Singh, Abhiram Dawar, Gnaneswar Chundi, Jeremiah Thomas, Jorden Urias, Alan H Daniels, Jared Preston","doi":"10.1016/j.arth.2026.04.099","DOIUrl":"https://doi.org/10.1016/j.arth.2026.04.099","url":null,"abstract":"<p><strong>Introduction: </strong>Cementless total knee arthroplasty (TKA) is increasingly used in younger, active patients, yet aseptic loosening remains a leading cause of failure. While biomechanical factors have been explored, large-scale data identifying patient- and surgery-specific risk factors are limited. This study aimed to identify independent predictors of aseptic loosening in cementless TKA.</p><p><strong>Methods: </strong>We queried a national insurance claims database for adults who underwent uncemented TKA from 2010 to 2022 with ≥ two years of follow-up. Demographic, clinical, and intraoperative variables were compared between patients who had and did not have aseptic loosening in a cohort of 26,651 cases (mean age 64 years; 56.5% women; mean Charleston Comorbidity Index (CCI) 1.9. In total, 1,063 patients (4.0%) developed aseptic loosening within two years. Multivariable logistic regressions identified independent risk factors.</p><p><strong>Results: </strong>Multivariable regressions showed increased risk of aseptic loosening with younger age (odds ratio (OR) 1.01, P = 0.014), higher CCI (OR 1.04, P = 0.027), osteoporosis (OR 1.41, P < 0.001), rheumatoid arthritis (OR 1.22, P = 0.029), depression (OR 1.27, P < 0.001), anemia (OR 1.38, P < 0.001), corticosteroid use (OR 1.39, P = 0.024), and preoperative arthroscopy (OR 1.56, P < 0.001). Computer navigation assistance (OR 0.46, P < 0.001) and bisphosphonate use (OR 0.39, P = 0.024) were protective.</p><p><strong>Discussion: </strong>Aseptic loosening after cementless TKA is influenced by patient comorbidities and perioperative factors such as osteoporosis, anemia, rheumatoid arthritis, and prior arthroscopy, while bisphosphonate use and computer navigation appear protective against loosening. Despite limitations inherent to retrospective claims data, these findings highlight the importance of preoperative risk stratification and individualized care.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cefazolin Alone Versus Vancomycin Plus Cefazolin for Intravenous Prophylaxis in Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"CaiMin Yang, CaiLing Peng, Jin Yan, Jie Chen, HaiYing Mao","doi":"10.1016/j.arth.2026.04.060","DOIUrl":"https://doi.org/10.1016/j.arth.2026.04.060","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) remains a devastating complication following total joint arthroplasty, leading to substantial morbidity and increased healthcare costs. Cefazolin is the standard agent for perioperative antibiotic prophylaxis. However, the rising prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has prompted the use of dual prophylaxis with vancomycin and cefazolin. The efficacy and safety of this combined strategy remain controversial.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered on the international prospective register of systematic reviews (ID CRD420251077695). A comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library was performed. Randomized controlled trials and observational studies directly comparing cefazolin alone with combined vancomycin and cefazolin as intravenous prophylaxis in patients undergoing total joint arthroplasty were included. The primary outcome measures were PJI and SSI (surgical site infection), and secondary outcome measures were AKI (acute kidney injury).</p><p><strong>Results: </strong>Eight studies including 1,041,058 patients met the inclusion criteria. Dual prophylaxis was associated with a higher risk of SSI (odds ratio [OR] =1.39; 95% confidence interval [CI] = 1.23 to 1.58), but a lower risk of PJI (OR = 0.64; 95% CI = 0.46 to 0.91). There was no significant difference in risk of AKI between regimens (OR = 1.30; 95% CI = 0.76 to 2.20), although substantial heterogeneity was observed among studies reporting renal outcomes.</p><p><strong>Conclusions: </strong>Routine addition of vancomycin to cefazolin does not reduce overall SSI rates and may increase superficial infections. However, it may decrease PJI risk without significantly increasing AKI. These findings support a selective, risk-stratified prophylactic strategy rather than universal dual antibiotic therapy in total joint arthroplasty.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors Associated with Osteonecrosis of the Femoral Head after Undergoing Lumbar Decompression and Fusion.","authors":"Mark M Cullen, Niall H Cochrane, Theresa A Benvenuti, Samuel S Wellman, Michael P Bolognesi, Thorsten M Seyler, Sean P Ryan","doi":"10.1016/j.arth.2026.04.106","DOIUrl":"https://doi.org/10.1016/j.arth.2026.04.106","url":null,"abstract":"<p><strong>Introduction: </strong>Osteonecrosis of the femoral head (ONFH) after spinal fusion is poorly characterized. This study sought to identify factors associated with ONFH following lumbar, lumbo-sacral, or lumbo-pelvic fusion. We hypothesized that abnormal postoperative spino-pelvic alignment and modifiable intraoperative factors may increase ONFH risk. Furthermore, we felt these factors may reduce survivorship free from total hip arthroplasty (THA) after lumbar fusion.</p><p><strong>Methods: </strong>We retrospectively reviewed 9,380 lumbar fusion patients from 2013 to 2021 at a single institution. There were 50 patients who had concern for ONFH who were identified and matched by age and sex to 100 fusion patients who did not have ONFH. Exclusion criteria included preoperative ONFH and lack of standing radiographs. Of the 50 ONFH patients, 21 met inclusion criteria, and of the 100 matched controls, 69 met criteria. Variables assessed included spino-pelvic parameters, corticosteroid use, smoking, surgical approach, pelvic fixation, American Society of Anesthesiologists classification, intraoperative hypotension, and postoperative Pelvic Incidence-Lumbar Lordosis alignment (PI-LL). Statistical analyses included t-tests, Chi-square tests, logistic regressions, and survival analyses.</p><p><strong>Results: </strong>Postoperative overcorrection (PI-LL less than -10°) significantly increased the odds of ONFH (odds ratio (OR): 17.05 (1.85 to 156.97); P = 0.01). Intraoperative hypotension (P = 0.22), anterior approaches (P = 0.52), and pelvic fixation (P = 0.35) were not associated with increased ONFH risk. Overcorrected patients also demonstrated worse THA-free survival at one year (hazard ratio (HR): 24.71 (1.55 to 395.30); P = 0.02) and five years (HR: 9.67 (2.46 to 38.06); P = 0.001) compared with matched and undercorrected groups.</p><p><strong>Conclusion: </strong>Postoperative spino-pelvic overcorrection is strongly associated with femoral head ONFH and inferior THA-free survivorship after lumbar fusion. In contrast, hypotension, anterior approaches, and pelvic fixation were not significant contributors. Careful restoration of sagittal alignment may reduce ONFH risk and improve long-term hip outcomes following spinal fusion.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}