Journal of Arthroplasty最新文献

{"title":"Minimum 10-Year Outcomes of Double-Tapered Cemented Stems with Line-to-Line Cementing: A Comparative Study of Collared and Collarless Stems.","authors":"Hiroakira Terakawa, Yuya Kawarai, Junichi Nakamura, Shigeo Hagiwara, Seiji Ohtori, Satoshi Iida","doi":"10.1016/j.arth.2025.03.040","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.040","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the clinical and radiological outcomes of stems using the line-to-line technique with a minimum follow-up of 10 years.</p><p><strong>Methods: </strong>A retrospective comparative study was conducted on 282 consecutive primary total hip arthroplasties (244 patients) using two cemented stem types at a single institution by a single surgeon from 1996 to 2011. Clinical and radiological assessments and stem survival analysis were performed.</p><p><strong>Results: </strong>There were no significant differences in hip function outcomes or complication rates between the groups. The 10-year stem survival rate for any revision was 97.0% (95% CI [confidence interval]: 93.6 to 99.6) in stem group A and 99.0% (95% CI: 94.6 to 99.9) in stem group B, respectively (P = 0.279). Both groups had a 100% survival rate for aseptic loosening. Stem subsidence was more in stem group B (P < 0.001). Cortical hypertrophy occurred in 28.9 and 19.8% of the two groups, respectively, with good clinical outcomes in affected patients.</p><p><strong>Conclusion: </strong>The 10-year clinical and radiological outcomes for stems using the line-to-line technique were excellent, with no revisions required for aseptic loosening.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671667","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":"Limited Satisfaction and Increased Risk with Intra-Articular Corticosteroid Injections in Patients Who Have Hip Osteoarthritis Needing Total Hip Arthroplasty.","authors":"Allan K Metz, Joshua P Rainey, Brenna E Blackburn, Adam J Taylor, Christopher L Peters","doi":"10.1016/j.arth.2025.03.037","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.037","url":null,"abstract":"<p><strong>Background: </strong>The value of intra-articular corticosteroid injections (CSI) in the treatment of hip osteoarthritis has come into question due to concerns regarding efficacy and complication profile. This study aimed to assess patient satisfaction after CSI for hip osteoarthritis and the association of CSI with potential complications following subsequent total hip arthroplasty (THA).</p><p><strong>Methods: </strong>A survey was sent to 510 patients who received at least one CSI at our institution before THA. Data collected included reduction in visual analog scale (VAS) pain scores, duration of relief, patient satisfaction, and if the patient would elect to receive another CSI. A retrospective review of 1,090 THA patients at our institution was performed to evaluate the association of CSI to potential complications following THA. Chi-square, Fisher Exact, and logistic regression were used for comparison between groups. A total of 104 patients who had injections in 129 hips responded (response rate 20.4%); There were 45.8% of patients who had one injection per hip, with a mean of 2.2 injections per hip (range, one to 10).</p><p><strong>Results: </strong>Patients reported a mean reduction in VAS pain scores of 5.2 (SD = 3.2), with the average relief lasting 6.2 weeks (SD = 8.4). Of note, 16.5% reported no satisfaction after CSI, and 44.4% stated they would not undergo CSI again. Of the 1,090 THA patients that were retrospectively reviewed, 247 patients (22.7%) received a CSI before THA; this was associated with an increased rate of septic revision (2.0 versus 0.5%, OR [odds ratio] = 4.98, P = 0.014). There were no significant differences in aseptic revision rates (P = 0.28).</p><p><strong>Conclusions: </strong>Almost half of the patients who received a CSI before THA would not do so again, with average pain relief lasting approximately six weeks. Given the increased risk of septic revision for those who underwent CSI before THA, this draws further concern regarding the value of CSI before THA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671665","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":"Patellar Reconstruction with a Trabecular Metal-Backed Component and Screw Fixation: A Preliminary Case Series.","authors":"Scott A Galey, Jesus M Villa, Michael J Canfield, Carlos A Higuera, Aldo M Riesgo","doi":"10.1016/j.arth.2025.03.016","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.016","url":null,"abstract":"<p><strong>Introduction: </strong>Limited patellar bone stock in revision total knee arthroplasty (TKA) may compromise fixation. Trabecular metal (TM)-backed components have been proposed to obtain long-term fixation. However, current fixation techniques (i.e., sutures) have limitations. Thus, we sought to evaluate survivorship of porous TM-backed patellar components affixed with a novel method of mini-fragment screw fixation in the setting of limited patellar bone stock.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of all TM-backed patellae affixed with mini-fragment screws during revision TKA by the senior authors from March 25, 2020 to May 20, 2022 (22 patellae, 21 patients). Demographics, TM-backed patellae survivorship, radiological status (loosening) of surviving patellae, and TKA reoperations were evaluated. The average follow-up was three years (range, 1 to 4).</p><p><strong>Results: </strong>At the latest follow-up, and despite a high prevalence (82%) of a history of periprosthetic joint infection (PJI), previous revisions (mean, 3.2), and limited preoperative patellar thickness (mean, 7.6 mm), only one TM-backed patella was removed due to infection. All surviving patellae were radiologically stable. There were nine TKAs reoperated: one for supracondylar fracture and PJI; another for patellar subluxation/PJI/ruptured tendon; four for PJI; one for femoral component loosening; another for femoral component loosening and PJI; and one for a defect in the medial parapatellar arthrotomy. Nevertheless, intraoperatively, TM-backed patellar components were deemed well fixed and were retained.</p><p><strong>Conclusion: </strong>The TM-backed patellar components affixed with mini-fragment screws have excellent short-term survivorship in the setting of limited bone stock. Further investigations with longer follow-ups and better levels of evidence are needed to ascertain the mid- and long-term outcomes of this particular construct.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665257","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":"Same Day Discharge Periacetabular Osteotomy: A Matched Cohort Analysis.","authors":"Alexandra Marshall, Ariane Parisien, Reza Ojaghi, Stéphane Poitras, Paul E Beaulé","doi":"10.1016/j.arth.2025.03.036","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.036","url":null,"abstract":"<p><strong>Introduction: </strong>Timely access for young patients who have hip dysplasia can be challenging due to health system resource limitations such as operating room access and hospital beds. This study evaluated the safety and effectiveness of same-day discharge (SDD) peri-acetabular osteotomy (PAO).</p><p><strong>Material and methods: </strong>There were 59 consecutive patients (mean age 30 years; range, 17 to 50; 60% women) scheduled for SDD. There were 47 outpatients matched with 47 inpatients based on age and a body mass index (BMI). Outpatients had a mean age of 28 years (range, 17 to 46) and BMI of 25.6 (range, 18.9 to 37.1), compared to inpatients between 2015 and 2020 (mean age 28 years, range, 16 to 44; BMI 25.9, range, 19.4 to 34.7). All patients received general anesthesia with multimodal pain management. In the outpatient group, 46.8% had adjunct procedures, compared to 34.0% in the inpatient group. Outcomes included revisits to the emergency department (ED), readmissions, and adverse events (using the modified Sink Dindo Classification). There were six outpatients (12.8%) who stayed in the hospital for more than 24 hours, with three planned and three having failed to be discharged the same day, averaging a length of stay of 10.13 hours (5.65 to 23.8). The mean length of stay for inpatients was 3.03 days (range, 1.03 to 11.8). None of the unmatched patients had a same-day discharge. Mean outpatient blood loss was 523 mL (range, 200 to 900), and surgery time was 111.9 minutes (range, 70.8 to 169.2), compared to 643 mL (range, 200 to 1,500) and 121.2 minutes (range, 75 to 259.8) for inpatients. There were two outpatients and three inpatients who returned to the ED within seven days. At 90 days, both groups had one readmission: a patient who had a wound dehiscence requiring irrigation and debridement and a patient who had an inferior epigastric bleed requiring embolization in outpatient and inpatient groups, respectively.</p><p><strong>Conclusion: </strong>Early experience with SDD PAOs shows comparable safety to inpatient PAOs. Optimizing patient education and perioperative management will help facilitate outpatient PAO programs in other centers.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665354","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":"Long-Term Outcomes of Third-Generation Ceramic-on-Ceramic Bearings in Cementless Primary Total Hip Arthroplasty: A 25-Year Survival Analysis.","authors":"Alexander F Heimann, Gabrielle N Swartz, Sandeep S Bains, Jeremy A Dubin, Reza Katanbaf, Ronald E Delanois, Stephen B Murphy","doi":"10.1016/j.arth.2025.03.029","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.029","url":null,"abstract":"<p><strong>Background: </strong>The demand for total hip arthroplasty (THA) in younger patients, particularly those under 65 years, has increased markedly in recent years. Ceramic-on-ceramic (CoC) bearings offer promising benefits, including reduced wear and osteolysis, with excellent short- to mid-term survival. However, long-term data on their performance in younger populations remains limited. This study aimed to investigate 1) overall implant survival, 2) complications and reasons for revision, and 3) patient-reported outcomes at long-term follow-up after primary THA with third-generation CoC bearings.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 231 patients (294 hips) who underwent cementless THA with third-generation CoC bearings between May 1999 and September 2004. The mean age at surgery was 50 years (range, 17 to 76). Clinical and radiographic outcomes were assessed at a minimum follow-up of 10 years, and the mean follow-up was 17 years (range, 10 to 25). Overall, 87 patients (108 hips, 38%) were lost to follow-up, leaving a total of 145 patients (186 hips) for further analysis. Kaplan-Meier survival analysis was used to estimate implant survival, with implant revision for any reason defined as a primary endpoint. Complications, reasons for revision, and patient-reported outcomes (Merle d'Aubigné-Postel [MDP] score) were also evaluated.</p><p><strong>Results: </strong>Kaplan-Meier analysis demonstrated an implant survival rate of 93% at 25 years. At long-term follow-up, 12 hips (6.5%) required revision for bearing failure (six hips), acetabular component failure (four hips), or femoral component failure (two hips). There were six cases of hip squeaking (3.2%) reported, none requiring revision. Functional outcomes improved significantly, with mean MDP scores rising from 10.7 preoperatively to 17.6 at the final follow-up. Radiographic evaluations showed no cases of osteolysis or loosening.</p><p><strong>Conclusion: </strong>Third-generation CoC bearings in cementless THA offer excellent long-term survival, low complication rates, and good to excellent functional outcomes, highlighting their durability and performance over a 25-year period.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665254","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":"Collection of Patient-Reported Outcome Measures: Comparing Paper to Online Data Collection Among Knee Arthroplasty Patients.","authors":"Nicholas R Olson, Henry Ho, Nancy L Parks, Robert H Hopper, Charles A Engh","doi":"10.1016/j.arth.2025.03.018","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.018","url":null,"abstract":"<p><strong>Background: </strong>At our institution, patient-reported outcome measures were completed on paper forms until 2021, when we began sending emails to knee arthroplasty patients so they could complete surveys electronically. This study evaluated our transition from paper-based to electronic collection of the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR).</p><p><strong>Methods: </strong>We compared 276 knee arthroplasty procedures performed from March 2020 through June 2020 that were eligible to complete paper KOOS JR surveys with 490 knee arthroplasty procedures performed from March 2022 through June 2022 that were eligible to complete electronic surveys. Survey completion rates at preoperative and 1-year follow-up were evaluated as well as the relative frequency of patients achieving a KOOS JR score increase of 20-points or more. Multivariate regressions were used to assess the potential influence of covariates including age at surgery, sex, body mass index, type of insurance, surgery site, and the distance patients traveled to our institution.</p><p><strong>Results: </strong>Response rates for preoperative surveys completed within 90 days of surgery increased from 53% (146 of 276) with paper to 83% (406 of 490) with electronic surveys, while one-year follow-up response rates improved from 38% (105 of 276) to 65% (320 of 490). Multivariate analyses indicated that only the survey type (paper or electronic) was associated with response rates. Electronic data collection also reduced incomplete (13 to 0.4%) and unnecessary (38 to 0.4%) surveys. The annual cost of data collection decreased from $140,696 with paper-based forms to $105,742 with electronic surveys. However, patients achieving a significant clinical benefit declined from 81% (42 of 52) with paper to 64% (176 of 276) with electronic surveys (P = 0.02).</p><p><strong>Conclusion: </strong>Compared to paper forms, electronic data collection at our institution increased follow-up rates and improved data quality at lower costs, but the relative frequency of patients reporting a significant clinical benefit decreased.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665279","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 Selective Use of Acetabular Screws in Routine Primary Total Hip Arthroplasty is Non-Inferior to Habitual Screw Use.","authors":"G A Sheridan, L Y H Low, A J Hughes, P M Courtney, A Sidhu, T MacDonell, L C Howard, M E Neufeld, D S Garbuz, B A Masri","doi":"10.1016/j.arth.2025.03.034","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.034","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to assess if selective screw insertion can achieve low rates of acetabular component loosening and whether this approach to screw usage is non-inferior to habitual screw insertion.</p><p><strong>Methods: </strong>This was a retrospective international multi-center cohort study assessing 4,707 acetabular components for primary total hip arthroplasties (THAs) at mean follow-up of 6.5 years. There were 3,855 acetabular components in the selective no-screw (SNS) group, 734 in the selective with-screw (SWS) group, and 118 in the habitual (H) group. The primary outcome was all-cause aseptic revision. Secondary outcomes were all-cause revision and revision for aseptic acetabular loosening.</p><p><strong>Results: </strong>The rate of aseptic revision in the selective user group was 0.89% (41 of 4,589) and 1.7% (two of 118) in the habitual user group (P = 0.467). The aseptic revision rate for SNS, SWS, and H groups was 0.7, 1.5, and 1.6%, respectively (P = 0.71). The all-cause revision rate for SNS, SWS, and H groups was 0.7, 1.5, and 4.2%, respectively (P = 0.001). The revision rate for cup loosening was 0.02% (one of 3,855) in the SNS group, 0.2% (two of 734) in the SWS group, and 0.8% (one of 118) in the H group (P = 0.002). The cumulative screw length (CSL) had no effect on the aseptic revision rate (P = 0.52).</p><p><strong>Conclusion: </strong>Acetabular components with no screws (SNS) had the lowest rate of all-cause revision, aseptic revision, and revision for acetabular loosening. If screws are inserted, there is no significant difference in results depending on the number of screws inserted or the cumulative screw length. A selective approach to screw insertion is non-inferior to habitual screw insertion and may achieve superior rates of aseptic revision and acetabular loosening.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665357","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":"Hospital Transfers for Hip Fracture Patients Are Associated with Higher Cost and Mortality.","authors":"Kate Hutchison, Genevieve Rollier, Hsin-Fang Li, Erica Wells, Kimberly Workman, Paul J Duwelius, Elizabeth G Lieberman","doi":"10.1016/j.arth.2025.03.035","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.035","url":null,"abstract":"<p><strong>Background: </strong>Transferring hip fracture patients may increase morbidity and cost. The purpose of this study was to examine time to surgery, outcomes, and cost in patients undergoing operative management of displaced femoral neck fractures (DFNF), comparing those admitted through the emergency department (ED) and those transferred from outside hospitals.</p><p><strong>Methods: </strong>A retrospective review of surgically managed DFNF patients (age ≥ 65 years) at a single institution between May 29, 2020, and December 29, 2022, was performed. Patients were categorized into two groups: \"ED arrivals\" and \"transfers.\" Demographics, time from presentation to surgery, hospital length of stay (LOS), discharge disposition, 1-year readmission, reoperation, and mortality, and total cost of care were collected and compared. We identified 459 patients (ED = 422, 92.0%, Transfer = 37, 8.0%). There was no difference in age, sex, body mass index (BMI), or American Society of Anesthesiologists (ASA) status.</p><p><strong>Results: </strong>Median time from ED to operating room was higher in the transfer group (41.6 versus 23.2 hours, P < 0.0001). Transfer and ED patients had similar LOS (5.9 versus 6.0 days, P = 0.29) and similar rates of discharge to skilled nursing facility (66.1 versus 62.2%, P = 0.39). There was a higher rate of 1-year mortality (27.0 versus 13.5% for ED, P = 0.03) in transfer patients but no difference in 1-year readmission or reoperation. Adjusting for demographics, transfer patients had 2.6 higher odds of 1-year mortality than ED patients (OR [odds ratio] = 2.59 (1.13 to 5.94) P = 0.03). The cost of care was higher for transfer patients ($23,521 versus $13,980, P < 0.0001).</p><p><strong>Conclusions: </strong>Transferring DFNF patients was associated with delayed time to surgery, increased 1-year mortality, and higher costs. Transferring patients is a logistical reality for many conditions; however, efforts should be made to provide efficient, safe, and cost-effective care.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665282","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":"Revision Total Knee Arthroplasty for Juvenile Idiopathic Arthritis: Implant Survivorship and Clinical Outcomes the Second Time Around.","authors":"Ryan Cheng, Francesca R Coxe, Yu-Fen Chiu, Hannah Szapary, Katherine Hwang, Antonia F Chen, Stuart Goodman, Vivek M Shah, Mark P Figgie, Jason L Blevins","doi":"10.1016/j.arth.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.019","url":null,"abstract":"<p><strong>Background: </strong>Juvenile idiopathic arthritis (JIA) is a rare disease that oftentimes requires treatment with total knee arthroplasty (TKA). While studies have examined the outcomes of primary TKA for this cohort, the literature on 10- and 20-year revision TKA implant survivorship and clinical outcomes is limited.</p><p><strong>Methods: </strong>A multi-center retrospective review identified 63 patients who underwent 70 revision TKAs between June 1, 1987, and September 30, 2020. The primary and secondary outcomes of interest were long-term implant survivorship and clinical outcomes, respectively. Patient-reported outcomes were assessed between April 1, 2020, and December 31, 2022. The average age was 47 years (range, 21 to 75). The mean follow-up was 12 years (range, 1.2 to 32.8) for both implant survivorship and patient-reported outcomes.</p><p><strong>Results: </strong>Implant survivorship for revision TKA in JIA patients was 86% (95% Confidence Interval (CI): 77 to 94) at five years, 75% (95% CI: 65 to 86) at 10 years, and 70% (95% CI: 59 to 81) at 20 years. The mean Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) score was 72.8 ± 16.1 points, with 53% (18 of 34 patients, 21 of 38 TKAs) reaching the KOOS JR patient acceptable symptom state (PASS) threshold. Risk factors for re-revision included the use of constrained prostheses (Hazards Ratio (HR): 6.0, 95% CI [1.3 to 28.6], P = 0.025). The most common reasons for re-revision were implant loosening/instability (eight TKAs, 40%), pain/synovitis (eight TKAs, 40%), and infection (four TKAs, 20%).</p><p><strong>Conclusion: </strong>Revision TKA implant survivorship for JIA patients is modest at 10 years and 20 years after surgery. Patient-reported outcomes were similar to those previously reported for revision TKA. Re-revision risk increased with higher levels of constraint. Surgeons should be aware of these outcomes and risk factors when counseling and treating these patients the second time around.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665301","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":"Vancouver B Fractures After Using Cementless Femoral Fixation: A Single Center Experience.","authors":"Zachary A Mosher, Alexander V Strait, Nicholas R Olson, Jared A Wolfe, Henry Ho, Robert H Hopper, William G Hamilton","doi":"10.1016/j.arth.2025.03.024","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.024","url":null,"abstract":"<p><strong>Background: </strong>Cementless stems have been the predominant type of femoral component used for total hip arthroplasty (THA) in the United States for several decades. However, recent literature has reported an increased periprosthetic fracture (PPFx) rate and complications associated with these components, particularly among older patients. This study evaluated the incidence and outcome of Vancouver B PPFx after primary THA using cementless stems.</p><p><strong>Methods: </strong>A single institution's database was used to identify 12,400 primary THAs performed from 2009 through 2023. The mean age at surgery was 64 years, and 57% of THAs were performed among women. All postoperative PPFx were identified, and those classified as Vancouver B were evaluated for treatment method and secondary reoperations.</p><p><strong>Results: </strong>Among 72 postoperative PPFx, 34 were classified as Vancouver B for an overall rate of 0.27% (34 of 12,400). The median time from THA to Vancouver B PPFx was 33 days. Patients over 75 years of age at surgery had a higher rate of Vancouver B PPFx (0.6%, 13 of 2,094) compared to patients 18 to 75 years of age at surgery (0.2%, 21 of 10,306, P < 0.001). Type C3 triple-taper collared titanium stems had a lower fracture rate (0.1%, four of 4,748) compared to Type A flat taper stems (0.7%, 23 of 3,105, P < 0.001). In patients over 75 at surgery, Type C3 stems had a lower fracture rate (0.3%, three of 923) compared to Type A stems (1.5%, seven of 472, P = 0.04). There were 28 patients who had Vancouver B fractures (82%) who underwent reoperation. Secondary reoperations were performed among 25% (seven of 28) of THAs, and three of these involved periprosthetic joint infection.</p><p><strong>Conclusion: </strong>Consistent with other reports, the Vancouver B PPFx rate was higher in patients over the age of 75 at surgery. At our institution, Type C3 triple-taper collared titanium stems lowered the PPFx fracture rate in all age groups, including those over age 75 at surgery. Secondary reoperations remain highly morbid to patients.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665360","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}