Journal of Arthroplasty最新文献

{"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}

{"title":"Treatment Approaches for Managing Periprosthetic Joint Infection Following Total Knee Arthroplasty: A Population Based Analysis.","authors":"Matthew J Wood, Talal Al-Jabri, David Pincus, Bheeshma Ravi, Lauren L Nowak, Emil Schemitsch","doi":"10.1016/j.arth.2025.05.077","DOIUrl":"https://doi.org/10.1016/j.arth.2025.05.077","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is expected to become an increasing burden on healthcare systems worldwide. We sought to examine approaches to managing PJI following TKA in Ontario, Canada, from 2012 to 2019.</p><p><strong>Methods: </strong>We identified patients who underwent TKA for osteoarthritis from 2012 to 2019 using administrative databases in Ontario, Canada, and those who underwent surgery for PJI up to five years following initial TKA. We grouped patients by type of revision: Tibial Insert Exchange (TIE), single-stage revision TKA (ssrTKA), and two-stage revision (tsrTKA), and identified repeat revisions within two years. We used Chi-square and Fisher exact tests to examine unadjusted differences in patient characteristics and outcomes between groups, and multivariable logistic regression to identify predictors of revision and repeat revision.</p><p><strong>Results: </strong>From 2012 to 2019, 98,384 patients received primary TKA in Ontario, Canada, 660 (0.7%) of whom underwent revision for PJI. Revisions were primarily tsrTKA (n = 269, 40.8%), followed by TIE (n = 255, 38.6%), and ssrTKA (n = 136, 20.6%). A total of 131 patients (19.8%) underwent a repeat revision within two-years. Repeat-revisions were higher following ssrTKA (n = 38, 27.9%) versus TIE (n = 49, 19.2%) and tsrTKA (n = 44, 16.4%), and were completed primarily for infection. Both TIE (OR [odds ratio] 1.77; 95% CI [confidence interval] 1.12 to 2.81) and ssrTKA (OR 2.42; 95% CI 1.42 to 4.12) were associated with a higher risk of all-cause repeat-revision, and ssrTKA was associated with a higher rate of repeat-revision for persistent infection (OR 1.93; 95% CI 1.16 to 3.21).</p><p><strong>Conclusion: </strong>These data show a relatively low risk of revision for PJI following TKA in Ontario, Canada. However, patients who undergo surgical treatment for PJI show a 19.8% risk of repeat revision, typically for persistent infection. TIE and ssrTKA were associated with a higher risk of repeat revision than tsRTKA, and ssrTKA was associated with worse rates of infection eradication compared to tsrTKA.</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":"144175754","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":"Osteonecrosis: A More Appropriate Term Than Avascular Necrosis - Pathophysiologic Rationale.","authors":"Edward Y Cheng, Alireza Mirzaei, Nobuhiko Sugano, Philippe Hernigou, Lynne C Jones, Kyung-Hoi Koo, Wolf Robert Drescher, Quanjun Cui, Rafael J Sierra, Stuart B Goodman, Dewei Zhao, Michael Mont","doi":"10.1016/j.arth.2025.05.064","DOIUrl":"https://doi.org/10.1016/j.arth.2025.05.064","url":null,"abstract":"<p><p>Non-traumatic osteonecrosis has traditionally been attributed to vascular insufficiency, causing deprivation of oxygen and nutrients to the bone and subsequent bone death. The terminology used to describe this condition has varied widely, reflecting a lack of consensus regarding its underlying mechanisms. A thorough review of the literature reveals that the ultimate pathophysiologic event in the development of non-traumatic osteonecrosis is disrupted bone homeostasis, which may be induced by vascular insufficiency or caused by vascular-independent mechanisms. The continued use of the term \"avascular necrosis\" or \"ischemic necrosis\" presents major drawbacks, as it disproportionately emphasizes vascular insufficiency, directing diagnostic and therapeutic strategies primarily toward restoring blood flow. This narrow focus risks overlooking other equally or more relevant underlying mechanisms. In this manuscript, we critically evaluate the use of various terms for osteonecrosis, particularly \"avascular necrosis\" and \"ischemic necrosis,\" and reinforce a previous shift towards adopting \"osteonecrosis\" as the preferred term. By advocating for the adoption of the term \"osteonecrosis,\" we promote a more inclusive understanding of the multifactorial nature of the condition. This linguistic shift could also drive the development of innovative therapies that address not only vascular insufficiency but also the other underlying mechanisms contributing to bone necrosis.</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":"144175719","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":"Rate and Patient Specific Risk Factors for Periprosthetic Acetabular Fractures during Primary Total Hip Arthroplasty using a Pressfit Cup.","authors":"Sebastian Simon, Heldemar Gobi, Jennyfer A Mitterer, Bernhard Jh Frank, Stephanie Huber, Alexander Aichmair, Martin Dominkus, Jochen G Hofstaetter","doi":"10.1016/j.arth.2025.05.075","DOIUrl":"https://doi.org/10.1016/j.arth.2025.05.075","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic acetabular fractures following primary total hip arthroplasty (THA) using a cementless acetabular component range from occult to severe fractures. The aims of this study were to evaluate the perioperative periprosthetic acetabular fracture rate and patient-specific risks of a modular cementless acetabular component.</p><p><strong>Methods: </strong>In this study, we included 7,016 primary THAs (61.4% women, 38.6% men; age, 67 years; interquartile-range, 58 to 74) that received a cementless-hydroxyapatite-coated modular-titanium press-fit acetabular component from a single manufacturer between January 2013 and September 2022. All perioperative radiographs and CT (computer tomography) scans were analyzed for all causes. Patient-specific data and the revision rate were retrieved, and radiographic measurements were performed using artificial intelligence-based software. Following matching based on patients' demographics, a comparison was made between patients who had and did not have periacetabular fractures in order to identify patient-specific and radiographic risk factors for periacetabular fractures.</p><p><strong>Results: </strong>The fracture rate was 0.8% (56 of 7,016). Overall, 33.9% (19 of 56) were small occult fractures solely visible on CT. Additionally, there were 21 of 56 (37.5%) with a stable small fracture. Both groups (40 of 56 (71.4%)) were treated nonoperatively. Revision THA was necessary in 16 of 56, resulting in an overall revision rate of 0.2% (16 of 7,016). Patient-specific risk factors were small acetabular-component size (≤ 50), a low body mass index (BMI) (< 24.5), a higher age (> 68 years), women, a low lateral-central-age-angle (< 24°), a high Extrusion-index (> 20%), a high sharp-angle (> 38°), and a high Tönnis-angle (> 10°).</p><p><strong>Conclusions: </strong>A wide range of periprosthetic acetabular fractures were observed following primary cementless THA. In total, 71.4% of acetabular fractures were small cracks that did not necessitate revision surgery. By identifying patient-specific risk factors, such as advanced age, women, low BMI, and dysplastic hips, future complications may be reduced.</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":"144175721","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}