Journal of Arthroplasty最新文献

{"title":"Acute Arthrotomy Dehiscence after Primary Total Knee Arthroplasty: Depth of Injury Impacts Outcome.","authors":"Colin C Neitzke, Isaiah K Selkridge, Allina A Nocon, Andrew J Hughes, Elizabeth B Gausden, Brian P Chalmers, Peter K Sculco","doi":"10.1016/j.arth.2025.05.085","DOIUrl":"https://doi.org/10.1016/j.arth.2025.05.085","url":null,"abstract":"<p><strong>Introduction: </strong>Arthrotomy dehiscence is a challenging complication following total knee arthroplasty (TKA). As early mobilization and fast-track rehabilitation protocols become increasingly popular, arthrotomy dehiscence incidence will likely increase. This study aimed to evaluate the clinical outcomes of acute, traumatic arthrotomy dehiscence, with and without superficial skin involvement, following primary TKA.</p><p><strong>Methods: </strong>A retrospective review identified 39 acute (< 90 days), surgically managed arthrotomy dehiscences following primary TKA. The arthrotomy + skin dehisced in 25 (64%) cases, while the other 14 (36%) involved the arthrotomy only. The mean time from TKA to dehiscence was longer in the arthrotomy-only cohort (31 versus 17 days, P = 0.005), as was the time from dehiscence to repair (13.1 versus 1.9 days, P < 0.0001). Failure was defined as all-cause reoperation or reoperation for periprosthetic joint infection (PJI).</p><p><strong>Results: </strong>The one-year survivorship free from all-cause reoperation was 75%. When stratified by arthrotomy type, one-year survivorship free from all-cause reoperation was 73% for the arthrotomy-only cohort versus 76% for the arthrotomy + skin cohort (P = 0.94). At six months, survivorship free from reoperation for PJI was 100% in the arthrotomy-only cohort versus 83% in the arthrotomy + skin cohort (P = 0.13). There were eight (21%) total failures, including four PJIs, all occurring in the arthrotomy + skin cohort, and four extensor mechanism complications, three of which occurred in the arthrotomy-only cohort and one in the arthrotomy + skin cohort (P = 0.28).</p><p><strong>Conclusion: </strong>Overall, arthrotomy dehiscence, regardless of superficial skin involvement, shows concerningly low one-year all-cause reoperation survivorship. Arthrotomy dehiscence with early, aggressive treatment had poor early survivorship free from reoperation for PJI. Our results suggest that surgeons should take all possible precautions to prevent infection and counsel patients regarding the risk of infection and potential extensor mechanism complications following traumatic arthrotomy dehiscence events.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188485","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":"Radiographic Progression in the Pre-Radiographic Stage of Osteonecrosis of the Femoral Head.","authors":"Wataru Ando, Takashi Sakai, Wakaba Fukushima, Masaki Takao, Hidetoshi Hamada, Nobuhiko Sugano","doi":"10.1016/j.arth.2025.05.089","DOIUrl":"https://doi.org/10.1016/j.arth.2025.05.089","url":null,"abstract":"<p><strong>Background: </strong>Early and accurate diagnosis of osteonecrosis of the femoral head (ONFH) is crucial for the success of joint-preserving treatments. Although multimodal diagnostic criteria, including radiographs, enhance diagnostic accuracy, they are limited in detecting pre-radiographic stages. Magnetic resonance imaging (MRI) is widely utilized; however, it is associated with the risk of overdiagnosis. This study aimed to characterize the pre-radiographic stage of ONFH diagnosed solely by MRI and to elucidate its progression and factors influencing it.</p><p><strong>Methods: </strong>This retrospective study included 538 newly diagnosed Stage 1 (pre-radiographic) ONFH cases with consecutive radiographic follow-ups from the registry of a nationwide hospital-based sentinel monitoring system established by the Japanese Investigation Committee between 2010 and 2018. Demographic and clinical characteristics were analyzed, and factors influencing radiographic progression were identified.</p><p><strong>Results: </strong>Among the Stage 1 ONFH, 90.1% of cases were diagnosed solely by MRI, with 79% potentially attributed to systemic corticosteroid administration. Of the 485 patients who have ONFH diagnosed solely by MRI, 156 hips (32.2 %) 56 hips (11.5%), eight hips (1.6%), and one hip (0.2 %) progressed to Stage 2, Stage 3A, Stage 3B, and Stage 4, respectively, over an average duration of 22.7 months. The remaining 264 hips (54.4%) showed no progression after a mean follow-up duration of 49.6 months. Sex, bilaterality, and type classification were significantly associated with the progression of ONFH, which was diagnosed solely by MRI.</p><p><strong>Conclusion: </strong>Although MRI is essential for detecting pre-radiographic stage ONFH, less than half of pre-radiographic ONFH cases progress to Stage 2 or higher. These findings highlight the potential for overtreatment if management decisions rely solely on MRI findings.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188486","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":"Survivorship and Complications in Revision Total Knee Arthroplasty with a Constrained Condylar Knee Implant: A Minimum 10-Year Follow-Up Study.","authors":"Arieh Greenberg, Doris Braunstein, Nada Read Abughaduma, Allen Gross, Oleg Safir, Paul Kuzyk, Jesse Wolfstadt, David Backstein","doi":"10.1016/j.arth.2025.05.088","DOIUrl":"https://doi.org/10.1016/j.arth.2025.05.088","url":null,"abstract":"<p><strong>Background: </strong>Constrained condylar knee (CCK) prostheses are commonly used in revision total knee arthroplasty (TKA) for cases requiring increased constraint due to ligamentous insufficiency. However, long-term outcomes remain underreported. This study evaluated the survivorship and complications of CCK implants over a minimum 10-year follow-up, extending up to 23 years.</p><p><strong>Methods: </strong>We retrospectively reviewed 345 revision TKA procedures with CCK implants performed from 2001 to 2014. The cohort included 190 women (55%) and 155 men (45%), with a mean age of 69 years (range, 36 to 92) and a mean follow-up of 13.5 years (range, 10 to 23.3). The primary diagnosis before initial TKA was osteoarthritis (81%). Indications for revision included aseptic loosening (23.2%), infection (22.9%), malrotation/malalignment (14.2%), and instability (13%). Femoral and tibial augments were used in 238 and 62 cases, respectively, while 25 patients required void fillers for bone defects. Kaplan-Meier survival analysis assessed implant longevity, defining failure as revision for any cause and revision due to aseptic loosening.</p><p><strong>Results: </strong>Kaplan-Meier analysis demonstrated favorable long-term survivorship. All-cause revision-free survival was 95.1% (95% CI [confidence interval]: 92.7 to 97.5) at five years and stabilized at 93.6% (95% CI: 91.0 to 96.2) from 10 years onward. Survivorship free from revision due to aseptic loosening was 98.5% (95% CI: 97.1 to 99.9) at five years and 97.9% (95% CI: 96.3 to 99.5) through 20 years. The number of knees at risk declined over time, from 314 at 10 years to 16 at 20 years. There were 25 complications that occurred at a mean of 2.9 years post-revision, with 22 requiring surgical intervention. The most common causes for revision were infection (54.5%) and aseptic loosening (31.8%). Surgical management included revision TKA (n = 7), irrigation and debridement with polyethylene exchange (n = 4), two-stage revision (n = 3), and above-knee amputation (n = 2).</p><p><strong>Conclusion: </strong>The CCK implants demonstrate favorable long-term survivorship in revision TKA at a minimum 10-year follow-up. These findings support the continued use of CCK implants in revision TKA with appropriate patient selection and careful surgical technique.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188487","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":"Formal Physical Therapy Clearance is Not Necessary for Safe Home Discharge After Primary Total Joint Arthroplasty: A Retrospective Cohort Study.","authors":"Brooke Merchant, Jaime Harris, David Sproul, Michael McCurdy, Sumon Nandi","doi":"10.1016/j.arth.2025.05.079","DOIUrl":"https://doi.org/10.1016/j.arth.2025.05.079","url":null,"abstract":"<p><strong>Background: </strong>Conventionally, physical therapy (PT) clearance is sought before total joint arthroplasty (TJA) discharge. However, PT staffing limitations may preclude same-day discharge. We developed a novel TJA discharge protocol without PT clearance. We aimed to determine if our novel protocol 1) allows safe home discharge and 2) preserves patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>A billing database was queried for primary TJA from 2020 to 2023 (n = 501). Study cohorts were per discharge protocol, conventional (n = 359) or novel (n = 142). The primary endpoint was 30-day falls. Secondary endpoints were emergency room (ER) visits, readmissions, and reoperations within 90 days, as well as same-day discharge. The PROMs were recorded six weeks postoperatively. Multivariate regressions were used to assess associations between discharge protocol and study endpoints or outcomes.</p><p><strong>Results: </strong>There was no difference in 30-day falls between novel (2.8%) and conventional (2.2%) discharge protocols (OR [odds ratio] 1.50, 95% CI [confidence interval] 0.50 to 4.53, P = 0.47). The 90-day ER visits (14.1% novel, 12.5% conventional; OR 1.22, 95% CI 0.68 to 2.18, P = 0.50), readmissions (3.5% novel, 2.2% conventional; OR 2.06, 95% CI 0.73 to 5.81, P = 0.17), and reoperations (0.7% novel, 0.8% conventional; OR 1.09, 95% CI 0.23 to 5.12, P = 0.91) did not differ between protocols. Same-day discharge was more likely (OR 3.19, 95% CI 1.94 to 5.24, P < 0.0001) with novel protocol (64.1%) than standard protocol (44.0%). We did not find differences in 6-week Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) (P = 0.76) or Surgical Satisfaction Questionnaire (SSQ-8) (P = 0.51) between protocols.</p><p><strong>Conclusion: </strong>Our novel primary TJA discharge protocol without postoperative PT clearance maximizes safe day-of-surgery discharge while maintaining patient function and satisfaction. Thus, risks of longer lengths of stay and costs of hospital occupancy are minimized.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180218","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":"Comparison of the Long-Term Clinical Results of Resurfacing Hip Arthroplasty for Japanese Patients who have Osteonecrosis versus Those who have Other Diagnoses.","authors":"Daisuke Inoue, Tamon Kabata, Yoshitomo Kajino, Yu Yanagi, Musashi Ima, Satoru Demura","doi":"10.1016/j.arth.2025.05.076","DOIUrl":"https://doi.org/10.1016/j.arth.2025.05.076","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the long-term (mean 13.5 years) clinical results of resurfacing hip arthroplasty (RHA) in Japanese patients who had osteonecrosis and compared the results with those of patients who had other diagnoses.</p><p><strong>Methods: </strong>A consecutive series of 65 hips (50 men and 15 women), with 30 in the osteonecrosis group (ON) and 35 hips in the non-osteonecrosis group (non-ON) were included. The mean follow-up period was 13.5 years (range, 10 to 20). The Japanese Orthopaedic Association(JOA)hip-scoring system was used to clinically evaluate hip function. In radiological assessment, the stem-shaft angle and inclination of the acetabular component were evaluated. Adverse reactions around the RHA were evaluated with Magnetic Resonance Imaging (MRI). Data on postoperative complications were retrieved from the medical records. Kaplan‒Meier analysis was used to compare the survival rate between the two groups.</p><p><strong>Results: </strong>Significant improvement was observed between the preoperative and final follow-up JOA hip scores in both groups. Radiological assessments revealed no major changes in either group. There were none of the hips that required revision for adverse reactions. Femoral neck fractures were observed in three cases (ON group, n = 2; non-ON group, n = 1) and aseptic loosening of the femoral or acetabular component in two cases (ON group, n = 1; non-ON group, n = 1). Additional operations were performed for three hips in the ON group and two in the non-ON group. The 15-year survival rate was 90 and 94% in the ON and non-ON groups, respectively (P = 0.53). In the ON group, the 15-year survival rate was 92% in Type C1 and 90% in Type C2 cases (P = 0.84).</p><p><strong>Conclusion: </strong>This study showed satisfactory mean 13.5 year clinical results of RHA in Japanese patients who had osteonecrosis.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183345","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":"Modular Splined Tapered Stems Through the Direct Anterior Approach: Should I Make an Accessory Incision?","authors":"Austin N Witt, Brian P Gladnick, Aamir A Bhimani, Jeremy M Gililland, Lucas A Anderson","doi":"10.1016/j.arth.2025.05.084","DOIUrl":"https://doi.org/10.1016/j.arth.2025.05.084","url":null,"abstract":"<p><strong>Background: </strong>Femoral preparation through a proximal accessory incision (PAI) has been suggested for placement of modular splined tapered stems (STS) during revision direct anterior total hip arthroplasty (THA). However, outcomes using PAIs have not been previously reported. The purpose of this study was to compare femoral revisions using a PAI with revisions in which all preparation was done through the Heuter interval, specifically looking for differences in 1) survivorship, 2) complications, and 3) patient-reported outcomes.</p><p><strong>Methods: </strong>There were 36 hips that underwent direct anterior (DA) femoral reconstruction with a STS revision stem by one of three fellowship-trained arthroplasty specialists at two orthopaedic teaching hospitals. The mean follow-up was 2.4 years. Electronic medical records were reviewed to determine if a PAI was made, to record re-revisions or major complications, and to collect demographic data and Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) scores. Continuous variables were analyzed using Student's t-test; categorical variables were analyzed using Fisher's exact test.</p><p><strong>Results: </strong>A PAI was made in 16 hips (44%). In 20 hips (56%), all femoral preparation was done through the Heuter interval. Revision-free survivorship was found in 15 of 16 hips in the PAI group, and 75% (15 of 20 hips) in the Heuter group (P = 0.2). A PAI hip sustained a major complication (dislocation) (one of 16). Conversely, six hips (six of 20 hips, 30%) in the Heuter group suffered a major complication: three infections, one intraoperative femoral fracture, and two postoperative periprosthetic fractures (P = 0.1). Postoperative HOOS, JR scores were 91.3 (PAI) and 92.6 (Heuter) (P = 0.84).</p><p><strong>Conclusion: </strong>The proximal accessory incision is safe and effective for insertion of a modular STS during DA femoral revisions, compared to all femoral preparation done through the Heuter interval. Improved in-line reaming and less femoral elevation required with the PAI may limit the necessity for larger extensile exposures and aggressive femoral releases. There was a trend toward fewer major complications in the PAI group, however, this did not reach statistical significance with the numbers available.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182397","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":"Association Between Mental Health Conditions and Revision Rates in Patients Undergoing Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Ariella J Smith, David Chang, Teresa Neeman, Joseph T Lynch Bsc, Jobe Shatrov, David Hale, Paul N Smith","doi":"10.1016/j.arth.2025.05.056","DOIUrl":"https://doi.org/10.1016/j.arth.2025.05.056","url":null,"abstract":"<p><strong>Background: </strong>The intersection of mental health and outcomes in orthopaedic surgery is an important and complex clinical topic. This systematic review and meta-analysis aimed to examine whether preoperative mental health conditions are associated with the risk of revision or mortality after primary total hip arthroplasty (THA) or total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>PubMed, OVID, Medline, Cochrane, Scopus, Web of Science, and Google Scholar were queried for studies on the association between depressive or psychotic illnesses and revision and mortality after THA or TKA. Risk of bias was assessed according to the Methodological Index for Non-randomized Studies (MINORS) criteria. There were 23 studies that met the inclusion criteria. Random effects models were used to pool hazard ratios for meta-analysis.</p><p><strong>Results: </strong>Meta-analysis revealed that patients who have depression had a 32% increased relative risk of revision when undergoing THA or TKA (pooled HR [hazard ratio] 1.32, 95% CI [confidence interval] 1.22 to 1.43). Patients who have psychotic illnesses had a 29% increased relative risk of revision (pooled HR 1.29, 95% CI 1.09 to 1.52). There were two studies that examined associations between depression or psychotic illness and mortality, with mixed findings.</p><p><strong>Conclusion: </strong>Mental health conditions such as depression and psychotic disorders are associated with increased revision risk in patients undergoing THA or TKA. The findings provide surgeons with a basis for individualized preoperative counseling and risk management.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183095","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 Multiple Drilling for Osteonecrosis of the Femoral Head: A Retrospective Cohort Study With a Minimum 10-Year Follow-Up.","authors":"Sang Yoon Kang, Hong Seok Kim, Jeong Joon Yoo","doi":"10.1016/j.arth.2025.05.083","DOIUrl":"https://doi.org/10.1016/j.arth.2025.05.083","url":null,"abstract":"<p><strong>Background: </strong>Multiple drilling techniques, a minimally invasive variation of core decompression, have shown promise for joint preservation in early-stage osteonecrosis of the femoral head (ONFH). However, long-term outcomes remain insufficiently reported. This study extends the follow-up period to 30 years, aiming to deliver a thorough evaluation of the sustained effectiveness and potential limitations of multiple drilling in the management of ONFH.</p><p><strong>Methods: </strong>This retrospective analysis reviewed the original cohort from previous research, comprising patients who underwent multiple drilling procedures for ONFH. We reviewed 134 hips treated with multiple drilling between 1992 and 1998. All hips were classified by Ficat stage (I to III), Association Research Circulation Osseous (ARCO) classification (Types 1 to 3), and necrotic lesion size, categorized as small (< 25%), medium (25 to 50%), or large (> 50%). Treatment failure was defined as the necessity for further surgical interventions or a Harris hip score below 75. Kaplan-Meier survival analysis was used to evaluate long-term outcomes.</p><p><strong>Results: </strong>At an average follow-up of 19.4 years, 70 (52.2%) hips were without additional surgery. Success rates at the final follow-up were 70, 65, and 16% for Ficat stages I, II, and III, respectively; 96, 75, and 11% for ARCO types 1, 2, and 3, respectively; and 100, 65, and 42% for small, medium, and large lesions, respectively. Most failures occurred within the first five years. Etiology had no significant effect on outcomes. Heterotopic ossification (14.9%) and one subtrochanteric fracture occurred during the follow-up.</p><p><strong>Conclusions: </strong>The extended follow-up confirms that multiple drilling remains effective for managing ONFH, particularly in smaller lesions, early-stage disease, and cases where the necrotic margin remains confined to the lateral edge of the acetabulum. These results highlight the importance of timely intervention and patient selection. Multiple drilling remains a valuable joint-preserving option, but alternative treatments should be considered for larger lesions and advanced disease stages.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183205","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":"Should We Use The Largest Femoral Head With the Smallest Acetabular Component in Primary Total Hip Arthroplasty?","authors":"Mark Wu, Brett R Bukowski, Kristin M Fruth, Robert T Trousdale, Matthew P Abdel, Tad M Mabry","doi":"10.1016/j.arth.2025.05.078","DOIUrl":"https://doi.org/10.1016/j.arth.2025.05.078","url":null,"abstract":"<p><strong>Introduction: </strong>There has been an increasing use of larger femoral head sizes to mitigate dislocation risk after total hip arthroplasty (THA). Manufacturers have created thinner, highly cross-linked polyethylene (HXLPE) liners to maximize effective head size. We investigated whether there was a survivorship penalty if the largest head was chosen at the smallest compatible acetabular component size, and as a secondary aim, we analyzed whether there was a decreased dislocation risk.</p><p><strong>Methods: </strong>We reviewed 1,860 posterior approach primary THAs with HXLPE from 2005 to 2021. Subjects were divided into three groups based on acetabular component transition points at which a larger femoral head could be used: Group 1 was 28-mm (N = 18) versus 32-mm (N = 89) heads, Group 2 was 32-mm (N = 383) versus 36-mm (N = 429) heads, and Group 3 was 36-mm (N = 806) versus 40-mm (N = 135) heads. The mean age was 66 years, 75% were women, and the mean BMI was 30. There were 48% that had ceramic heads, and 52% had metal heads. The mean follow-up was seven years.</p><p><strong>Results: </strong>There were two liner dissociations (0.1%) and no liner fractures. The 10-year survivorships free of dislocation, revision, and reoperation were 95, 95, and 93%, respectively. The 5-year survivorship free of dislocation for Group 1 was 94% for 28-mm and 99% for 32-mm heads; for Group 2, 96% for 32-mm and 99% for 36-mm heads; and for Group 3, 96% for 36-mm and 95% for 40-mm heads. Cox regression demonstrated no difference in reoperation or revision rates between head sizes in any group.</p><p><strong>Conclusions: </strong>When using HXLPE liners, pairing the largest femoral head with the smallest compatible cup for 32-mm, 36-mm, and 40-mm heads did not increase risk for liner-related complications, revisions, or reoperations. There was no difference in dislocation risk when using the larger femoral head at transitional cup sizes, though this study was underpowered to detect this difference.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182625","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 Prophage Count in Staphylococcus Periprosthetic Joint Infection is Associated with an Increase in Antibiotic Resistance Genes.","authors":"Tony H Chang, Robert Manasherob, Sankalp Mrutyunjaya, Julie D Pourtois, Aviv Hargil, Thomas S Hong, Prerna Arora, Naomi L Haddock, Daisuke Furkuawa, Derek F Amanatullah","doi":"10.1016/j.arth.2025.05.080","DOIUrl":"https://doi.org/10.1016/j.arth.2025.05.080","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infections (PJI) caused by Staphylococcus species present a significant clinical challenge, especially in the context of rising antibiotic resistance. Lysogenic phages (viruses that infect bacteria and can integrate into the bacteria's genome in the form of a prophage) have the potential to contribute to antibiotic resistance and treatment failure through the transport of genetic material between bacteria. We hypothesized that prophage presence may be associated with the presence of antimicrobial resistance genes and phenotypic resistance in Staphylococcus species associated with PJI.</p><p><strong>Methods: </strong>We examined the relationship between the presence of prophage and antibiotic resistance in Staphylococcus isolates collected from synovial fluid samples from 15 PJI patients. Bacterial isolates were assessed for antibiotic resistance and sequenced to identify prophages and antibiotic resistance genes.</p><p><strong>Results: </strong>We observed that a higher prophage count was associated with a higher number of antibiotic resistance genes, but not with phenotypic antibiotic resistance. In addition, none of the prophages identified were significantly associated with phenotypic resistance.</p><p><strong>Conclusions: </strong>These findings suggest that prophages may contribute to the spread of antibiotic resistance genes, but the impact on phenotypic resistance may be more complex, highlighting the need for further research to explore prophage profiling in PJI biofilms.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175717","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}