Journal of Arthroplasty最新文献

{"title":"Distal Femoral Replacement for Revision Total Knee Arthroplasty in Non-Oncologic Indications: A Single-Institution Outcomes Study.","authors":"Arsh Sidhu, Lisa C Howard, Jenny He, Nv Greidanus, Ba Masri, Ds Garbuz, Michael E Neufeld","doi":"10.1016/j.arth.2025.02.033","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.033","url":null,"abstract":"<p><strong>Introduction: </strong>Distal femoral replacement (DFR) is a salvage procedure to manage massive bone loss in total knee arthroplasty (TKA). Few studies report mid-term (five to 10 years) to long-term (>10 years) outcomes of DFR for non-oncologic indications. The purpose of this study was to report the implant survival of DFRs in non-oncologic TKA for the entire cohort and by indication, as well as patient-reported clinical outcomes.</p><p><strong>Methods: </strong>We retrospectively identified all DFR performed for non-oncologic indications from 2002 to 2021 at our institution. There were three patients who had less than a 2-year follow-up who were excluded (no revisions after DFR). There were 45 DFR included who had a mean follow-up of 6.6 years (range, 2.0 to 17.2). The mean age was 75 years (range, 53 to 94), the mean body mass index was 29.2 (range, 19.2 to 52.4), and 64.4% were women. Indications for index DFR were mechanical TKA failure (40.0%), periprosthetic fracture (33.3%), and periprosthetic joint infection (26.7%). There were fourteen (31.1%) patients who underwent revision after index DFR. Reasons for the first revision were infection (seven), fracture (three), hinge dislocation (two), loosening (one), and extensor mechanism rupture (one). All DFRs were rotating hinge designs with fully cemented stems. Kaplan-Meier analysis was used to determine all-cause revision-free Survival and patient-reported outcomes were collected.</p><p><strong>Results: </strong>The revision-free survival for the entire cohort was 74.6% at five years and 60.2% at 10 years. By indication for index DFR, six of the 12 infection patients, five of the 18 mechanical failure patients, and three of the 15 fracture patients underwent revision. Differences in revision-free survival by indication were not statistically different (P = 0.221). At the final follow-up, the mean Oxford knee score was 25 (range 5 to 40), with 69% patient satisfaction.</p><p><strong>Conclusion: </strong>A DFR for non-oncological indications is associated with high revision rates. Mid-term (five to 10 years) and long-term (10 years) revision-free survival is poor, and patient satisfaction is modest. Differences in survival by indication for DFR were not statistically significant. DFR remains a valuable salvage procedure, but patients need to be counseled on the expected outcome.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434325","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":"Causes of Reoperations after Primary Total Hip Arthroplasty: A Retrospective Cohort Study Over 20 Years.","authors":"Ki-Tae Park, Dong-Hoon Lee, Joon Hwan An, Jonghwa Won, Kyung-Hoi Koo, Jung-Wee Park, Young-Kyun Lee","doi":"10.1016/j.arth.2025.02.032","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.032","url":null,"abstract":"<p><strong>Background: </strong>Reoperations following total hip arthroplasty (THA) remain a major clinical challenge, with their incidence and socioeconomic burden rising despite advances in surgical techniques and prosthesis design. This study aimed to evaluate the predominant causes of reoperations following THA over two decades at a tertiary referral hospital, comparing trends between 2004 and 2013, and 2014 and 2023.</p><p><strong>Methods: </strong>We analyzed all reoperations performed at a tertiary referral hospital between January 2004 and December 2023. A total of 515 hips (483 patients) were included after excluding multiple reoperations on the same hip. The causes of reoperation were stratified into two time periods (2004 to 2013 and 2014 to 2023) to analyze trends. The time interval from primary THA to reoperations was also evaluated.</p><p><strong>Results: </strong>The main cause of reoperation after primary THA was aseptic loosening, accounting for 52.4% of cases, followed by infection (13.2%), periprosthetic fracture (PPF) (10.7%), wear/osteolysis (8.5%), ceramic fracture (5.8%), and instability/dislocation (5.6%). The proportion of aseptic loosening decreased significantly from 62.5 to 40.4%, while the proportions of infection, PPF, ceramic fracture, and instability/dislocation increased (P < 0.001). The causes of reoperation varied according to the time interval. Instability, PPF, and infection were early causes, and wear/osteolysis and aseptic loosening were relatively later causes of reoperations.</p><p><strong>Conclusion: </strong>Aseptic loosening was the most common cause of reoperation following primary THA. However, the proportion of infection and PPF increased as a cause of reoperations, while the proportion of aseptic loosening decreased with time. Surgeons should consider that the main cause of reoperations differed according to the time interval from primary THA to reoperation.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434241","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 Effects of Simulated Cobalt-Chromium-Molybdenum Wear Particles on a Macrophage-Lymphocyte Co-Culture for Evaluating Cellular Corrosion.","authors":"Madison N Brown, Danielle M Bryant, Bailey Bond, Harrison Smith, Richard A Smith, William M Mihalko","doi":"10.1016/j.arth.2025.02.020","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.020","url":null,"abstract":"<p><strong>Background: </strong>This study examined the impact of simulated wear particles on inflammatory cell-induced corrosion (ICIC).</p><p><strong>Methods: </strong>A 30-day macrophage-lymphocyte co-culture experiment was conducted using American Society of Testing and Materials F1537 cobalt-chromium-molybdenum (CoCrMo) disks, with activators and CoCrMo particles added at none, low (1:10), medium (1:100), and high (1:500) cell-particle ratios. Supernatants collected on days 10 and 30 were analyzed for tissue necrosis factor alpha (TNFα) and interleukin 6 (IL-6) levels via enzyme-linked immunosorbent assay. Disks were examined for ICIC damage using scanning electron microscopy (SEM), and the oxygen percentage on their surfaces was analyzed with energy-dispersive X-ray spectrometry (EDS) and X-ray photoelectron spectrometry (XPS).</p><p><strong>Results: </strong>Most disks showed damage consistent with ICIC. Day 10 TNFα was higher in medium and high particle groups compared to groups without particles, while IL-6 was unexpectedly lower in those groups. On day 30, the activated medium particle group showed higher IL-6 than the non-activated group. The EDS showed no significant differences in %O (P = 0.77), but XPS results indicated significant differences (P < 0.0001) at high particle concentrations.</p><p><strong>Conclusion: </strong>Overall, the data suggested that increased TNFα reflected a heightened inflammatory response, particles might temporarily inhibit IL-6 release, and there is likely a synergistic effect between activators and particles on cellular responses.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434266","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":"Fitting the Knee to the Patient, Not the Other Way Around: A Three-Dimensional Analysis of Total Knee Arthroplasty Implant Fit.","authors":"David G Deckey, Matthew K Stein, Lauren M Atkins, Alexandra E Richards, Kevin A Wu, Cody C Wyles, Thorsten M Seyler","doi":"10.1016/j.arth.2025.02.030","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.030","url":null,"abstract":"<p><strong>Background: </strong>Despite the growing interest in alternative alignment strategies, advancement in surgical technique, and implant design, several studies have demonstrated that a large number of patients continue to be dissatisfied following total knee arthroplasty (TKA). The purpose of this study was to outline differences in three-dimensional (3D) knee morphology associated with sex and deformity of the arthritic knee and compare these to available off-the-shelf and patient-specific implants.</p><p><strong>Methods: </strong>A total of 85,604 preoperative computed tomography scans of patients undergoing TKA were analyzed. Distal femur geometry was quantified via 11 measurements taken from 3D models and landmarks. These values were then compared to the geometries of 12 common TKA implants from the American Joint Replacement Registry.</p><p><strong>Results: </strong>The average overall alignment of the studied population was found to be 3.3° varus with the average hip-knee-ankle (HKA) angle being smaller in men than women. Femoral distal offset was found to play an important role in driving both varus and valgus deformities. Nearly 40% of knees in the cohort had a distal condylar offset (DCO) and 25.6% had a posterior condylar offset (PCO) that would require beyond the traditionally acceptable 3° varus/valgus or require internal rotation when using the most common off-the-shelf (OTS) implants on the market. The range of adequate coverage across the evaluated implant systems ranged from 20 to 63%. On average, less than half (41%) of the patient population fell within the bounds considered to be a proper fit for the 12 OTS implant systems evaluated.</p><p><strong>Conclusions: </strong>To our knowledge, this study is the largest 3D analysis of osteoarthritic knees to date and identified crucial differences in knee morphology among patients undergoing TKA. These data demonstrate a consistent asymmetry of femoral geometry, despite most off-the-shelf femoral implants being symmetric. In addition, there was a larger PCO and smaller DCO, questioning the utility of a single-radius femoral design in all patients.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434327","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":"Repeat Two-Stage Exchange Arthroplasty for Recurrent Periprosthetic Joint Infection of the Hip: Sobering Results.","authors":"Aaron R Owen, Oliver B Dilger, Nicholas A Bedard, Charles P Hannon, Tad M Mabry, Daniel J Berry, Matthew P Abdel","doi":"10.1016/j.arth.2025.02.006","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.006","url":null,"abstract":"<p><strong>Introduction: </strong>A two-stage exchange arthroplasty is the standard management method of chronic periprosthetic joint infections (PJIs) of the hip in North America. However, a subset of patients become reinfected and may require a repeat two-stage exchange arthroplasty. The purpose of the present study was to assess revisions, reoperations, and risk factors for failure associated with repeat two-stage exchange arthroplasties for recurrent PJIs after total hip arthroplasty (THA).</p><p><strong>Methods: </strong>We identified 52 repeat two-stage exchange THAs completed from 2000 to 2021 at a single, high-volume academic medical center. The mean age was 61 years, 39% were women, and the mean body mass index (BMI) was 33. At the time of the repeat two-stage exchange, high-dose antibiotic spacers were used in 90% of patients (28 articulating, 19 non-articulating), and 10% had a resection arthroplasty in the interim between stages. The mean time from repeat first stage to reimplantation was 33 weeks. Kaplan-Meier survivorship estimates were calculated, and risk factors (including the McPherson staging system) were assessed. At the final follow-up, 54% of patients were on chronic antibiotic therapy. The mean follow-up was six years.</p><p><strong>Results: </strong>The 7-year survivorships free of re-revision for reinfection, any re-revision, and any reoperation were 85%, 57%, and 50%, respectively. The leading indications for re-revision were dislocation (45%) and PJI (35%). McPherson host grade C was a significant risk factor for re-revision for infection (HR [hazard ratio] 5, P = 0.04). Additionally, increased operative time at reimplantation was a risk for any reoperation (HR 1.06, P < 0.01) and reoperation for infection (HR 1.07, P < 0.01). At the final follow-up, 98% of patients had a revision THA in situ (one hip disarticulation).</p><p><strong>Discussion: </strong>Repeat two-stage exchange arthroplasty of the hip had a 7-year survivorship free of re-revision for infection that was 85%, but only 57% were free of any re-revision (most due to revision for dislocation). McPherson C hosts had a 5-fold increased risk of re-infection.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434263","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 Mark Coventry Award: Does Matching the Native Coronal Plane Alignment of the Knee (CPAK) Improve Outcomes in Primary Total Knee Arthroplasty?","authors":"Kent R Kraus, Evan R Deckard, Leonard T Buller, John B Meding, R Michael Meneghini","doi":"10.1016/j.arth.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.007","url":null,"abstract":"<p><strong>Background: </strong>The Coronal Plane Alignment of the Knee (CPAK) classification system was developed to assess personalized alignment strategies, such as kinematic alignment, in total knee arthroplasty (TKA). However, CPAK has not been studied with regard to patient-reported outcomes measures (PROMs). This study evaluated whether incidentally matching a patient's native preoperative CPAK classification with TKA implant position meaningfully impacted postoperative PROMs.</p><p><strong>Methods: </strong>A retrospective review of 2,427 primary TKAs was performed. Knees were classified using the CPAK classification on standardized preoperative and postoperative short-leg radiographs using a 5-degree adjustment for the lateral distal femoral angle based on available literature. Surgeries were performed using adjusted mechanical alignment strategies with a three-degree boundary. Patients who had a matching preoperative and postoperative CPAK were compared to all other combinations. Modern PROMs and clinically important differences were analyzed utilizing univariate and multivariate analyses.</p><p><strong>Results: </strong>There were 94.5% of native knees classified as CPAK-I to III, like published CPAK distributions. The distribution of postoperative CPAK classification was significantly different, with 25.6% of TKAs classified as CPAK-I to III (P < 0.001) and only 11.5% (N = 266) of postoperative CPAK matched the native preoperative classification. The CPAK was not associated with preoperative (P ≥ 0.208) or postoperative PROMs (P ≥ 0.085), except CPAK-I had significantly higher preoperative pain with level walking compared to CPAK-III only (P = 0.027). Patients who had matching preoperative and postoperative CPAK classes demonstrated no difference in PROMs at a median of 24 months of follow-up (P ≥ 0.143). Statistical power was ≥ 93.9%.</p><p><strong>Conclusion: </strong>Study results demonstrate that matching a patient's native knee coronal alignment classified by CPAK was not predictive of PROMs. This supports prior research that suggests TKA outcomes are multifactorial and related to complex interactions between implant position in three dimensions as well as soft-tissue balance and kinematics.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434282","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":"Computed Tomography-Based Robotics Are More Accurate than Manual Instruments in Achieving Sagittal Alignment Targets in Total Knee Arthroplasty.","authors":"Spencer H Summers, Paraic S Cagney, Tyler R Youngman, Ryan Nunley, Robert Barrack, Charles P Hannon","doi":"10.1016/j.arth.2025.02.028","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.028","url":null,"abstract":"<p><strong>Background: </strong>Implant malalignment may predispose patients to implant failure or pain following total knee arthroplasty (TKA). Previous studies indicate that robotically assisted TKA (RA-TKA) can achieve coronal alignment targets more accurately and precisely than manually instrumented TKA (M-TKA). The purpose of this study was to evaluate the accuracy of RA-TKA versus M-TKA in achieving predetermined coronal and sagittal alignment targets in TKA.</p><p><strong>Methods: </strong>A total of 201 RA-TKAs performed by three high-volume, fellowship-trained surgeons between June 2021 and June 2022 were compared to a historical control of 365 M-TKAs performed between 2013 and 2017 by the same surgeons. Coronal and sagittal component alignment were assessed using standing anteroposterior and lateral radiographs. Included measurements were femoro-tibial alignment (FTA), medial distal femoral angle (DFA), proximal tibial angle (PTA), femoral sagittal angle (FSA), tibial sagittal angle (TSA), anterior condyle offset (ACO), and posterior condyle offset ratio (PCOR). Normal and outlier ranges were determined from prior studies. The proportions of outliers were compared using univariate analyses.</p><p><strong>Results: </strong>The RA-TKA was more accurate than M-TKA in achieving all four sagittal alignment targets and two of the three coronal alignment targets. The RA-TKA group exhibited fewer radiographic outliers for DFA (zero versus 2.5%; P = 0.03), PTA (one versus 10.1%; P < 0.001), FSA (7.0 versus 15.6%; P < 0.01), TSA (5.0 versus 14.3%; P < 0.01), ACO (8.5 versus 30.6%; P < 0.01), and PCOR (1.5 versus 9.5%; P < 0.01). Patients in the RA-TKA group had a higher proportion with no radiographic outliers (58.2 versus 35.2%; P < 0.001) and a lower incidence of ≥ two outliers (5.5 versus 25%; P < 0.001) compared to the M-TKA group.</p><p><strong>Conclusion: </strong>The RA-TKA is more effective than M-TKA in achieving coronal and sagittal alignment, potentially enhancing surgical outcomes.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434324","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":"Time to Achieve Minimal Clinically Important Difference (MCID) in Robotic versus Manual Total Knee Arthroplasty: A Comparative Analysis.","authors":"Perry L Lim, Zain Sayeed, Marcos R Gonzalez, Christopher M Melnic, Hany S Bedair","doi":"10.1016/j.arth.2025.02.031","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.031","url":null,"abstract":"<p><strong>Background: </strong>Robotics in arthroplasty remains controversial due to the uncertainty of clinical outcomes in robotic total knee arthroplasty (rTKA). This study aimed to compare the time to achieve the minimal clinically important difference (MCID) between rTKA and manual TKA (mTKA).</p><p><strong>Methods: </strong>A total of 726 TKAs (416 robotic and 310 manual) were analyzed. We conducted a retrospective analysis of 726 TKAs performed between 2019 and 2022. Patient-reported outcomes were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, PROMIS Physical Function-10a (PF-10a), and Knee Injury and Osteoarthritis Outcome Score-Physical Function Short-form (KOOS-PS) scores, both preoperatively and postoperatively. Survival curves, accounting for interval censoring, were utilized to evaluate the time to achieve MCID. Statistical comparisons between groups were made using log-rank and weighted log-rank tests.</p><p><strong>Results: </strong>Comparing time to achieve MCID without interval censoring, the median time for rTKA was significantly lower than mTKA for PROMIS Global Physical (3.5 versus 3.7 months, P = 0.032) and KOOS-PS (3.7 versus 5.3 months, P = 0.002), but similar for PROMIS PF-10a (6.0 versus 6.7 months, P = 0.16). Notably, interval censoring showed similar times to achieve MCID for rTKA and mTKA in PROMIS Global Physical (0.53 to 0.54 versus 1.23 to 1.24 months, P = 0.31), PROMIS PF-10a (3.03 to 3.03 versus 2.17 to 2.17 months, P = 0.89), and KOOS-PS (1.47 to 1.47 versus 2.17 to 2.17 months, P = 0.27).</p><p><strong>Discussion: </strong>Using time to MCID methodology, the median time to achieve MCID did not differ by surgical technique. The present study offers valuable patient-centric insights into preoperative expectations management and patient education. Further prospective studies with more granular Patient-Reported Outcomes Measurement (PROM) collection are needed to evaluate the true effectiveness of robotics in arthroplasty.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434347","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":"High Early Failure Rate of a Novel Cementless Unicompartmental Knee Arthroplasty.","authors":"Todd E Bertrand, Zackary O Bryd, Keith R Berend, David A Crawford, Adolph V Lombardi","doi":"10.1016/j.arth.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.010","url":null,"abstract":"<p><strong>Background: </strong>Unicompartmental knee arthroplasty (UKA) is an accepted treatment for antero-medial osteoarthritis with low overall failure rates. In the United States, cementation remains the gold standard of implant fixation; however, multiple studies have shown potential benefits of increased survivorship with cementless fixation. The aim of this study was to evaluate clinical and radiographic outcomes of a novel cementless medial UKA implant. We hypothesized the cementless UKA would perform as well as or better than the cemented UKA.</p><p><strong>Methods: </strong>Clinical outcomes, including patient-reported outcome measures, were prospectively collected for 111 patients (127 knees) implanted with a novel cementless UKA from February 2021 to December 2022. Radiographic lucency zones surrounding the femoral and tibial components were evaluated from postoperative radiographs. Data was collected preoperatively and at standard postoperative intervals until final follow-up or implant revision. Revisions were necessary in 15 of 127 UKAs (11.8%) at a mean of 0.9 years (range, zero to two).</p><p><strong>Results: </strong>The most common revision reason was aseptic loosening (12). Kaplan-Meier survival was 84.0% (95% CI [confidence interval] ±3.98%) at 2.4 years. The Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) 12-month scores differed significantly between revision and non-revision groups (61.9, 95% CI ±13.4 versus 75.1, 95% CI ±16.9; P = 0.01). In patients revised for aseptic loosening, 11 of 12 tibial implants had progressive radiolucent lines on pre-revision imaging. Revision operative records noted minimal to no bone ingrowth on the tibial implant undersurface.</p><p><strong>Conclusions: </strong>This novel cementless medial UKA implant demonstrated a high rate of early revision, mostly for tibial-sided complications. Compared to non-revised implants, revised implants had higher rates of tibial and femoral radiolucencies on postoperative radiographs as well as lower KOOS JR 12-month scores pre-revision. When recorded in the operative record, no significant bone ingrowth was seen on the porous implant surfaces.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434329","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":"Prior Authorization in Joint Arthroplasty Surgery: Navigating Challenges.","authors":"Ramakanth Yakkanti, Catherine M Call, Charles P Hannon, Chad A Krueger, P Maxwell Courtney, Adam J Rana","doi":"10.1016/j.arth.2025.02.023","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.023","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434259","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}