Journal of Arthroplasty最新文献

{"title":"Efficacy of Perioperative Basal-Bolus Insulin Therapy on Blood Glucose Variability in Non-Insulin-Dependent Type 2 Diabetes Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial.","authors":"Haiwei Tang, Yahao Lai, Enze Zhao, Weinan Zeng, Kai Zhou, Zongke Zhou","doi":"10.1016/j.arth.2025.07.048","DOIUrl":"https://doi.org/10.1016/j.arth.2025.07.048","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is a common orthopaedic procedure, but perioperative glycemic control remains challenging for patients who have diabetes. While preoperative optimization is ideal, it is not always feasible. Blood glucose variability has emerged as an important indicator of glycemic control, with fluctuations potentially more harmful than sustained hyperglycemia. This study aimed to evaluate the efficacy of different insulin regimens on perioperative blood glucose variability in non-insulin-dependent type 2 diabetes patients undergoing TKA.</p><p><strong>Methods: </strong>We conducted a randomized controlled trial with 120 non-insulin-dependent type 2 diabetes patients scheduled for TKA between November 2023 and October 2024. Patients were randomized to receive basal-bolus insulin (BBI) therapy, sliding scale insulin (SSI) therapy, or continue oral hypoglycemic drugs preoperatively. Postoperative blood glucose variability, insulin resistance, β-cell activity, wound complications, and other clinical outcomes were compared between groups.</p><p><strong>Results: </strong>The BBI group demonstrated significantly lower postoperative blood glucose variability compared to the SSI and oral hypoglycemic groups (15.6 ± 2.9% versus 20.7 ± 5.0% versus 24.6 ± 7.0%, respectively). Additionally, the BBI group showed lower levels of insulin resistance and β-cell activity. However, no significant differences were observed in postoperative inflammatory markers among the three groups.</p><p><strong>Conclusion: </strong>This study provides evidence that perioperative basal-bolus insulin therapy can effectively reduce blood glucose variability and insulin resistance in non-insulin-dependent type 2 diabetes patients undergoing TKA. These findings contribute to optimizing perioperative glycemic management strategies for this patient population.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719091","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":"Cementing Liners into Well-Fixed Acetabular Components in Revision Total Hip Arthroplasty: A Mean 7.7-Year Follow-Up.","authors":"Zhaoxi Xue, Zhipeng Ding, Wenbo Mu, Wentao Guo, Boyong Xu, Li Cao","doi":"10.1016/j.arth.2025.07.047","DOIUrl":"https://doi.org/10.1016/j.arth.2025.07.047","url":null,"abstract":"<p><strong>Background: </strong>In revision total hip arthroplasty (THA), surgeons may encounter a well-fixed acetabular component that requires liner revision, particularly when a compatible liner is unavailable or the original locking mechanism is damaged. Cementing a new liner into the well-fixed cup may be an option. There are currently limited reports on this technique, consisting of small cohort studies or those with only only early outcomes. This study aimed to evaluate the clinical outcomes at a mean follow-up of 7.7 years of liners cemented into well-fixed acetabular components.</p><p><strong>Methods: </strong>We retrospectively reviewed 62 revision THAs in which liners were cemented into well-fixed acetabular components. The average follow-up period was 7.7 years. The mean age at the time of revision THA was 54 years, with 67.7% of the patients being women. The most common indications for surgery included liner wear in 33 hips, dislocation in 14 hips, and early-stage periprosthetic joint infection (PJI) in 13 hips.</p><p><strong>Results: </strong>The survivorship free from re-revision for any reason was 88.7% (95% CI [confidence interval] = 81.0 to 97.0). The most common complication was dislocation, occurring in seven patients, with three of these requiring re-revision. This was followed by PJI in three patients, and there was one patient in whom the liner dissociated from the acetabular component. Patients who underwent previous revisions were more prone to re-revision (P<0.001), and those who underwent revision due to dislocation were at a higher risk of postoperative dislocation (P = 0.038).</p><p><strong>Conclusions: </strong>Cementing a liner into a well-fixed acetabular component during revision THA provides favorable clinical outcomes at mean 7.7-year follow-up. Patients undergoing revision due to dislocation face a higher risk of postoperative dislocation. Additionally, patients who had a history of previous revisions tend to have a higher risk of re-revision.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719089","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":"Hemiarthroplasty Versus Total Hip Arthroplasty for Femoral Neck Fracture in the Elderly: An Analysis from the American Joint Replacement Registry.","authors":"Harold I Salmons, Patrick C Donnelly, Daniel K Guy, Matthew P Abdel","doi":"10.1016/j.arth.2025.07.043","DOIUrl":"https://doi.org/10.1016/j.arth.2025.07.043","url":null,"abstract":"<p><strong>Introduction: </strong>Debate persists regarding management of displaced femoral neck fractures in elderly patients with either total hip arthroplasty (THA) or hemiarthroplasty (HA). We investigated the United States (US) experience by comparing revision risk following THA or HA using the American Joint Replacement Registry (AJRR) in elderly femoral neck fractures.</p><p><strong>Methods: </strong>Between 2012 and 2020, we identified 65,958 patients within the AJRR who were treated for a femoral neck fracture with arthroplasty. All were Medicare beneficiaries aged 65 years and older with a minimum potential follow-up of two years. The mean age was 82 years, and 69% were women. Total hip arthroplasty was utilized in 12,537 (19%). Hemiarthroplasty was used in 53,421 (81%), of which 58% were bipolar constructs. Dual-mobility constructs were used in 11% of THAs. Femoral components were cemented in 38%. A Cox proportional hazards model and a competing risk analysis were performed. Analytic groups included THA, THA with dual-mobility, bipolar HA, and unipolar HA. The mean follow-up was five years.</p><p><strong>Results: </strong>The 5-year cumulative risk of any revision was 3.2%. There were no significant differences in revision risk when comparing bipolar HA to unipolar HA, standard THA, or dual-mobility THA. Revision risk was not statistically different between unipolar HA and THA or dual-mobility THA. Older age and the use of cemented femoral components were associated with a reduced risk of revision (P < 0.0001), while patients with a higher comorbidity index sustained more revisions (P < 0.05).</p><p><strong>Conclusion: </strong>Elderly patients who have displaced femoral neck fractures in the United States have a similar risk of revision whether they are treated with a THA or HA. However, this does not account for surgeon bias, host-related factors, and other technical features such as approach, limb length, and offset. Surgeons should base the procedure on the patient's functional demands and comorbidities.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719092","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":"Inpatient Medicare Total Hip Arthroplasties have Distinct Characteristics and are Less Likely to Achieve Substantial Clinical Benefit for Hip Disability and Osteoarthritis Outcome Score for Joint Replacement: Implications for Centers for Medicare and Medicaid Services Patient-Reported Outcome Measures Policy.","authors":"Ignacio Pasqualini, Khaled A Elmenawi, Shujaa T Khan, Alison K Klika, Chao Zhang, Nicolas S Piuzzi","doi":"10.1016/j.arth.2025.07.045","DOIUrl":"https://doi.org/10.1016/j.arth.2025.07.045","url":null,"abstract":"<p><strong>Background: </strong>The Centers for Medicare & Medicaid Services (CMS) has mandated the collection of patient-reported outcome measures (PROMs) after total hip arthroplasty (THA). However, this policy's performance and its representativeness of the entire Medicare THA population remain unclear. This study aimed to 1) report PROMs completion rates for Medicare THA patients, and 2) compare the inpatient and outpatient Medicare THA patients in terms of demographics and achievement of substantial clinical benefit (SCB).</p><p><strong>Methods: </strong>A prospective cohort of Medicare patients ≥ 65 years undergoing primary THA (n = 7,950) between 2016 to 2022 from a single healthcare system was analyzed. The PROMs completion rates, demographics, 1-year Hip Disability and Osteoarthritis Outcome Scores-Joint replacement (HOOS JR), and SCB-JR were compared.</p><p><strong>Results: </strong>Completion rates for PROMs were similar (∼80%) for inpatient and outpatient THAs across all CMS-mandated variables. However, 1-year HOOS-JR completion rates were lower at 51% for inpatients and 63% for outpatients. Inpatient Medicare patients represented 38.5% of the THA cohort. These were older (median age 72 versus 71 years, P < 0.001), had higher BMI (29.0 versus 28.3, P<0.001), lower education levels (14 versus 15 years, P < 0.001), with higher comorbidities (CCI one versus zero, P < 0.001), compared to outpatients. Inpatients had worse baseline HOOS JR scores (39.9 versus 46.7, P < 0.001) and were less likely to achieve SCB (80.1 versus 84.1%, P < 0.001). On adjusted analysis, outpatient status was associated with 29% lower odds of failure to achieve SCB (OR [odds ratio] 0.71, 95% CI [confidence interval] 0.60 to 0.84, P < 0.001).</p><p><strong>Conclusion: </strong>At our institution, CMS-mandated variable capture rates exceeded the minimum requirements. As CMS begins public reporting, the differing demographics, higher comorbidity burden, and worse PROMs among inpatient versus outpatient Medicare THA patients must be acknowledged. Collecting PROMs from both groups is crucial for representativeness, but the cost and logistical challenges require further research to ensure feasibility and sustainability.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719093","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":"Do the Long-Term Functional Outcomes and Revision Rates of Total Hip Arthroplasty in Obese and Morbidly Obese Patients Justify Restricting Their Access to Surgery?","authors":"Hua Shin Tan, Deborah Snell, Jinny Willis, Christopher M A Frampton, Gary J Hooper","doi":"10.1016/j.arth.2025.07.044","DOIUrl":"https://doi.org/10.1016/j.arth.2025.07.044","url":null,"abstract":"<p><strong>Background: </strong>A prospective observational study with retrospective analysis of the data was carried out on 8,089 patients who underwent total hip arthroplasty (THA) at a single elective center between January 1, 2006, and November 30, 2022. Our aim was to examine whether obesity and morbid obesity have an effect on long-term clinical outcomes and revision rates.</p><p><strong>Methods: </strong>The patients were divided into three groups: non-obese (body mass index (BMI) < 30), obese (BMI 30 to < 40), and morbidly obese (BMI ≥ 40). Our primary outcomes were the mean change in Oxford Hip Score (OHS) and Western Ontario and McMaster's Universities Osteoarthritis Index (WOMAC) up to 10 years to assess the long-term clinical benefit of surgery. The secondary outcomes measured were the rate of revisions up to 10 years, rate/100 component years, time between primary THA and revision, reasons for revision (aseptic loosening, deep infection, dislocation, fractured femur), mean skin-to-skin time, American Society of Anesthesiologist Classification, and the 90-day mortality rate. The BMI data were not available for 1,130 patients (13.97%).</p><p><strong>Results: </strong>There was no difference in the absolute at 10 years and mean change in OHS and WOMAC up to 10 years between the groups. There was no difference in the absolute revision rate between the groups, although the obese and morbidly obese groups did have a higher rate of revision/100 component years and can expect a shorter time interval between THA and revision surgery compared to the non-obese groups. We did not find any significant association between obesity and the reasons for revision surgery, with the exception of fractured femur in the non-obese group.</p><p><strong>Conclusion: </strong>The long-term functional outcomes and revision rates of THA do not justify restricting access to surgery on the basis of BMI.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719090","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":"Reliable Outcomes Provided by a Rotating Hinge Knee Arthroplasty for Patients Who Have Moderate-to-Severe Arthrofibrosis.","authors":"Johnathan R Lex, Bahar Entezari, David J Backstein, Jesse I Wolfstadt","doi":"10.1016/j.arth.2025.07.041","DOIUrl":"https://doi.org/10.1016/j.arth.2025.07.041","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic arthrofibrosis after total knee arthroplasty (TKA) is a challenging complication resulting in stiffness and pain. Modern rotating-hinge (RH) prostheses have gained popularity for managing arthrofibrosis during revision TKA. The primary aim of this study was to evaluate the effectiveness of revision TKA using an RH prosthesis on improving range of motion (ROM) for patients who have moderate and severe arthrofibrosis. The secondary aim was to evaluate the survivorship of these prostheses.</p><p><strong>Methods: </strong>This was a retrospective study of all patients who underwent revision TKA for a diagnosis of arthrofibrosis with an RH prosthesis at a single arthroplasty center between 2014 and 2023. There were 41 patients with a mean follow-up of 3.6 years (standard deviation (SD): 2.5) included. Knee ROM measurements were collected preoperatively, at six weeks, 12 weeks, and one year postoperatively. Postoperative complications were recorded. Differences in arc of ROM for each patient between time points were assessed using analysis of variance. Kaplan-Meier survival analysis with log-rank test was performed for complications requiring reoperation.</p><p><strong>Results: </strong>Mean preoperative ROM, maximum flexion, and maximum extension were 52.7 degrees (SD: 20.1, range, 10 to 90), 68.5 degrees (SD: 21.3, range, 30 to 120), and 15.7 degrees (SD: 14.5, range, 0 to 90), respectively. There was a significantly greater ROM, maximum extension, and maximum flexion at six weeks, 12 weeks, and one year (P < 0.05 for all). At one year, mean improvement in ROM was 34.7 degrees (SD: 26.8, range, -34 to 85), and mean ROM was 89.5 degrees (SD: 20.6, range, 46 to 130). Implant survivorship at final follow-up was 90.2%.</p><p><strong>Conclusions: </strong>Revision TKA with RH prosthesis is effective for the management of idiopathic arthrofibrosis after TKA, resulting in significant improvements in ROM with acceptable short-to-mid-term survivorship. Multicenter, prospective studies with long-term follow-up are warranted to validate these findings.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719105","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":"Restless Legs Syndrome Is Associated with Higher Rates of Dislocation After Total Hip Arthroplasty.","authors":"Adam Nguyen, Patrick J Tansey, Alexis B Sandler, Allen S Wang, Joseph C Wenke","doi":"10.1016/j.arth.2025.07.040","DOIUrl":"https://doi.org/10.1016/j.arth.2025.07.040","url":null,"abstract":"<p><strong>Background: </strong>Restless Legs Syndrome (RLS) is a neurological disorder that induces involuntary leg movements that may hinder compliance with postoperative hip precautions; however, its impact on total hip arthroplasty (THA) outcomes has yet to be investigated. This study seeks to evaluate the influence of RLS on THA by comparing complication rates between patients who have RLS and a propensity-matched control cohort.</p><p><strong>Methods: </strong>A retrospective analysis using a national database was conducted to identify patients who had a history of RLS who underwent THA between 2009 and 2022. This RLS cohort was propensity matched with a control cohort who did not have a history of RLS, and the rates of postoperative complications were identified. After propensity score matching, 3,204 RLS patients were identified per cohort. Absolute risks and odds ratios (ORs) were calculated for both study groups.</p><p><strong>Results: </strong>Our analysis demonstrated a higher risk of dislocation (OR: 1.64, P = 0.043), emergency department utilization (OR: 1.19, P = 0.027), and a decreased risk of readmission (OR: 0.63, P = 0.001) in patients who had RLS within 90 days postoperatively than in those who did not have RLS. At two years, the incidence of aseptic loosening was 3.3% in the RLS cohort and 2.4% in the non-RLS cohort (OR: 1.37, P = 0.036). Similarly, the incidence of periprosthetic joint infection was 2.5% in the RLS cohort and 1.8% in the non-RLS cohort (OR: 1.42, P = 0.045).</p><p><strong>Conclusion: </strong>Restless legs syndrome was associated with a greater risk of periprosthetic dislocation and emergency department utilization, but a decreased readmission rate within 90 days of surgery, whereas aseptic loosening and periprosthetic joint infection were at greater risk at two-year follow-ups compared to the propensity-matched control cohort. These findings suggest a clinically relevant association that offers the opportunity to mitigate these complications through targeted interventions.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719106","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's on call? Trends in Hemiarthroplasty versus Total Hip Arthroplasty for Femoral Neck Fractures Based on Subspecialty Training.","authors":"Jackson P Tate, Nolan M Reinhart, Neehar Desai, Lacee K Collins, William F Sherman","doi":"10.1016/j.arth.2025.07.027","DOIUrl":"https://doi.org/10.1016/j.arth.2025.07.027","url":null,"abstract":"<p><strong>Background: </strong>As annual femoral neck fracture (FNF) incidence rises in an aging United States population, the choice between hemiarthroplasty and total hip arthroplasty (THA) has become increasingly relevant, influenced not only by patient factors such as age and activity level, but also by the surgeon's subspecialty training. Traditionally, hemiarthroplasty is favored for older, less active patients, while THA is associated with better outcomes in younger, active patients. Recent trends suggest that some specialists may prefer THA even for older patients. This study examined trends in FNF treatment, focusing on the impact of surgeon subspecialty on the use of THA versus hemiarthroplasty.</p><p><strong>Methods: </strong>This study analyzed trends in FNF management from 2010 to 2022 using data from an administrative claims database. The FNF cases treated with either hemiarthroplasty or THA were identified and stratified by patient age (under and over 70 years) and surgeon subspecialty.</p><p><strong>Results: </strong>Of 89,454 FNFs included, 71,521 received hemiarthroplasty and 17,933 underwent THA. While hemiarthroplasty rates remained steady, THA cases more than doubled, especially among patients under 70 years, where the use of THA by adult reconstruction surgeons rose from 50 to 72%. Among patients over 70 years, trauma and sports surgeons increasingly adopted THA over hemiarthroplasty as well.</p><p><strong>Conclusion: </strong>The THA utilization has markedly increased for FNFs, particularly among adult reconstruction specialists and even in older patient groups. This shift reflects a growing emphasis on functional outcomes and mobility, with surgeon training appearing to influence treatment choice beyond traditional age-based guidelines. These findings underscore an evolving approach to FNF management that may create demand pressures on reconstruction and trauma specialists who are managing an expanding caseload of complex arthroplasties.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719107","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 One-Stage Total Hip Arthroplasty with Postoperative Intra-Articular Antibiotic Infusion for Chronic Infection after Periarticular Internal Fixation Failure.","authors":"Haiyao Zhang, Baochao Ji, Askhaliang Maimaitieyiming, Xiaogang Zhang, Guoqing Li, Boyong Xu, Yang Wang, Li Cao","doi":"10.1016/j.arth.2025.07.033","DOIUrl":"https://doi.org/10.1016/j.arth.2025.07.033","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic infection following periarticular internal fixation is challenging, with no standard treatment protocol. This study evaluated the results of one-stage total hip arthroplasty (THA) using intra-articular (IA) antibiotic infusions to treat this condition.</p><p><strong>Methods: </strong>A retrospective analysis (2013 to 2023) included 26 patients who had chronic infection following periarticular internal fixation undergoing one-stage THA with IA antibiotic infusions. Initial internal fixation involved six cases of plates and screws, 11 cannulated compression screws, and nine intramedullary nails. In the microbiological cultures, 13 cases (50%) were positive, consisting of five cases of methicillin-resistant Staphylococcus epidermidis (MRSE), one case of methicillin-resistant Staphylococcus hominis (MRSH), two cases of Staphylococcus aureus, one case of Corynebacterium striatum, two cases of Escherichia coli, one case of Enterobacter cloacae, and one case of a mixed infection of Enterococcus faecalis and MRSE; and 13 cases (50%) were negative cultures. After removal of all index internal fixation and thorough debridement and irrigation, IA antibiotic infusions were administered for an average of 10 days (range, four to 19), guided by culture results. Infection recurrence and clinical outcomes were evaluated.</p><p><strong>Results: </strong>Of the 26 patients, 25 (96.2%) remained free of periprosthetic joint infection (PJI) at a mean follow-up duration of 65.0 ± 30.2 months (range, 12 to 136). The five-year PJI-free survival cumulative rate was 96.2% (95% confidence interval [CI]: 88.8 to 100), while the five-year prosthesis survival cumulative rate was 88.5% (95% CI: 74.6 to 100). Complications included two cases of hip dislocation and one case of periprosthetic femur fracture, with two of these cases requiring further surgical revision. Additionally, two cases of deep venous thrombosis and two cases of delayed wound healing were reported. The mean Harris hip score (HHS) at the most recent follow-up was 91.0 points (range, 80.2 to 97).</p><p><strong>Conclusion: </strong>A one-stage THA with IA antibiotic infusions demonstrated high infection control rates and favorable clinical outcomes for chronic infection following periarticular fixation. This approach offers valuable insights and therapeutic strategies for treating this complex condition.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709772","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":"Patient, Hospital, and Outcome Factors Associated with Attaining Substantial Clinical Benefit Following Primary Total Hip Arthroplasty.","authors":"Catherine M Call, Aliyah A Olaniyan, Zoë A Walsh, George Babikian, Adam J Rana, Brian J McGrory","doi":"10.1016/j.arth.2025.07.036","DOIUrl":"https://doi.org/10.1016/j.arth.2025.07.036","url":null,"abstract":"<p><strong>Background: </strong>Centers for Medicare and Medicaid Services (CMS) began mandating at least 50% institutional compliance of patient-reported outcome-based performance measures (PRO-PMs) for Medicare fee-for-service patients undergoing inpatient, elective total hip arthroplasty (THA). The PRO-PM is calculated to represent the proportion of patients meeting or exceeding the substantial clinic benefit (SCB) threshold between pre- and postoperative patient-reported outcome measures (PROMs). The purpose of this study was to evaluate demographics, operative variables, hospital outcomes, and PROMs among two groups of patients following primary THA: those achieving SCB and those who did not reach this threshold.</p><p><strong>Methods: </strong>A retrospective review was performed of patients undergoing primary THA at a single large academic center between January 2015 and November 2024. Demographic, operative, and outcome variables were compared between patients meeting and not meeting SCB. Multivariable analysis was performed to identify risk factors for failure to achieve SCB.</p><p><strong>Results: </strong>A total of 1,257 patients were included; 54% were women, and 88% met SCB. Few differences between groups in demographics and complications were observed. Patients not meeting SCB more often had a contralateral hip arthroplasty (P < 0.001), government insurance (P = 0.011), and a higher preoperative HOOS JR interval score (q < 0.001); these associations remained significant on multivariable analysis. At postoperative time points, functional PROMs were lower and pain scores were higher among patients not achieving SCB.</p><p><strong>Conclusions: </strong>The institution of this new CMS mandate puts renewed attention on the SCB metric. Our results indicate the difficulty in collecting PROMs in accordance with this mandate. Patients not meeting SCB following THA demonstrated few differences in demographics or hospital course, yet exhibited a significant difference in PROMs profile. Future studies are needed to elucidate the underlying causes of observed differences, and essential for equitable arthroplasty care.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709773","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}