Journal of Arthroplasty最新文献

{"title":"Trends in Payments for Ambulatory Surgery Center Facility Fees and Surgeon Professional Fees for Hip and Knee Arthroplasty.","authors":"Enrico M Forlenza, Alexander J Acuña, Vincent P Federico, Conor M Jones, Denis Nam, Craig J Della Valle","doi":"10.1016/j.arth.2024.12.028","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.028","url":null,"abstract":"<p><strong>Background: </strong>Ambulatory Surgery Centers (ASCs) have been shown to deliver high-quality care to patients at major cost savings to the healthcare system. The objective of this investigation was to examine trends in the Medicare facility and surgeon professional fee payments for hip and knee arthroplasty.</p><p><strong>Methods: </strong>Publicly available Medicare data was analyzed to determine professional and facility fee payments for unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), and total hip arthroplasty (THA) to ASCs and hospitals between 2018 and 2024. The Physician Fee Schedule Lookup Tool and the Medicare ASC Payment Rates files were used to determine professional fee payments and facility fee reimbursements, respectively. Descriptive statistics were used to calculate means and percent change over time. The compound annual growth rates (CAGR) were calculated.</p><p><strong>Results: </strong>After adjusting for inflation, Medicare professional fees declined significantly over the study period for UKA ($1,487.44 versus $1,147.50; P = 0.003), TKA ($1,738.99 versus $1,278.59; P = 0.003), and THA ($1,740.73 versus $1,280.52; P = 0.003). Medicare ASC facility fees also declined, albeit to a lesser degree for UKA ($9,007.62 versus $8,905.71; P = 0.764), TKA ($10,204.46 versus $9,048.76; P = 0.027), and THA ($9,982.66 versus $9,238.05; P = 0.308). Facility fee reimbursement decreased year over year, with annual percent change ranging from -0.19% for UKA to -2.49% for THA. Trends in Medicare hospital facility fees directly mirrored ASC facility fees over the study period. Professional fees also declined year over year, with annual percent changes ranging from -3.81% for UKA to -4.41% for TKA and THA.</p><p><strong>Conclusions: </strong>The ASC facility fees and professional fees both declined over the study period, with declines in professional fees far outpacing those of facility fees. Urgent reform of the Medicare payment structure is needed to ensure orthopaedic practice solvency and access to high-quality care for beneficiaries.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933369","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":"Differences in Microorganism Profile in Periprosthetic Joint Infections of the Knee in Patients Affected by Chronic Kidney Disease.","authors":"Rıfat Şahin, Maximilian Budin, Eduardo M Suero, Thorsten Gehrke, Mustafa Citak","doi":"10.1016/j.arth.2024.12.029","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.029","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infections (PJI) are one of the most devastating complications of total knee arthroplasty (TKA). Patients who have chronic kidney disease (CKD) are more vulnerable to PJI. We aimed to answer the following questions: 1) What are the commonly observed pathogens in PJI after TKA in CKD patients, and do they differ from those in non-CKD patients? and 2) What are the risk factors for PJI after TKA in CKD patients?</p><p><strong>Methods: </strong>Patients who underwent surgery due to a chronic PJI of the TKA were retrospectively enrolled. The patients were divided into two groups: patients who had and did not have CKD. Demographic data and comorbidities of the patients were recorded. The microorganisms responsible for PJI were identified based on the biopsy results, and comparisons were made between the two groups. There were 331 patients in the CKD group and 2,238 in the control group. Patients who had CKD were significantly older (P < 0.001) and had higher Charlson comorbidity index (CCI) scores (P < 0.001).</p><p><strong>Results: </strong>Binary logistic regression identified multiple microorganisms within the CKD group. The most common microorganisms in PJI were, respectively: Staphylococcus epidermidis (odds ratio [OR] 1.38; P = 0.030; 95% confidence intervals (CI) 1.03 to 1.86), Staphylococcus aureus (OR 1.88; P < 0.001; 95% CI 1.36 to 2.61), Enterococcus faecalis (OR 2.39; P < 0.001; 95% CI 1.44 to 3.94), Escherichia coli (OR 1.76; P = 0.028; 95% CI 1.06 to 2.94), Methicillin-resistant Stafilococcus aureus (MRSA) (OR 3.04; P = 0.024; 95% CI 1.15 to 8.02), polymicrobial infections (OR 1.52; P < 0.001; 95% CI 1.12 to 2.06).</p><p><strong>Conclusion: </strong>Patients who had PJI and CKD demonstrated a higher incidence of infections with specific microorganisms, including Staphylococci, enterococci, gram-negative bacteria, and MRSA. To mitigate the high PJI risk in CKD patients, a treatment plan based on this microbial profile and a multidisciplinary assessment of CKD comorbidities before TKA is recommended.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933398","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":"Orthopaedic Adult Reconstruction Fellowship Match Rates: How Do Degree and Sex Affect Match Success?","authors":"Kenneth B Choy, Maximilian Ganz, Lisa K Cannada, Peter White, Scott Steinmann, Randy M Cohn, Michael A Mont, Adam Bitterman","doi":"10.1016/j.arth.2024.12.030","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.030","url":null,"abstract":"<p><strong>Background: </strong>Discrepancies have previously been identified in terms of sex and medical degree throughout orthopaedic education. The purpose of this study was to evaluate trends in the degree type and sex of applicants to adult reconstruction fellowships.</p><p><strong>Methods: </strong>The San Francisco (SF) match data from 2012 to 2023 was analyzed. Data regarding the number of applicants and match rates based on applicant degree and sex were evaluated. Pearson's correlation test was used to evaluate trends for the number of applicants and match rates.</p><p><strong>Results: </strong>The number of applicants for both women (r = 0.64, P = 0.009) and men (r = 0.81, P = 0.0004) had a significant increase annually over the study period. Women applicants (r = 0.27, P = 0.19) did not have a significant change in match rate, while men candidates (r = 0.74, P = 0.002) experienced a significant increase over the study period. Although women applicants matched at a slightly higher rate than men applicants (87.6 versus 84.8%), this difference was not statistically significant (Odds Ratio (OR) = 1.14, Confidence Interval (CI) = 0.71 to 1.83, P = 0.64). Osteopathic applicants (r = 0.4, P = 0.09) did not experience a significant change in the number of applicants, while allopathic candidates (r = 0.8, P = 0.0006) did experience a significant increase. Both osteopathic candidates (r = 0.76, P = 0.001) and allopathic candidates (r = 0.62, P = 0.01) experienced a significant increase in match rate. From 2012 to 2023, allopathic applicants were more likely to match into an Adult Reconstruction fellowship than osteopathic applicants (OR = 2.47, CI = 1.86 to 3.26, P = 0.0001).</p><p><strong>Conclusions: </strong>Men and women applicants match at equal rates for the Adult Reconstruction Fellowship. Osteopathic graduates, regardless of sex, are consistently ranked lower by Adult Reconstruction fellowship programs in the fellowship match process and are less likely to match than allopathic graduates.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933367","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 Unicompartmental Knee Arthroplasty: Worse Than a Primary, But Better Than a Revision Total Knee Arthroplasty.","authors":"Enrico M Forlenza, Robert A Burnett, Alexander J Acuña, Brett R Levine, Jeremy M Gililland, Craig J Della Valle","doi":"10.1016/j.arth.2024.12.026","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.026","url":null,"abstract":"<p><strong>Background: </strong>Revision of a unicompartmental to a total knee arthroplasty (TKA) is often compared to primary TKA with regard to its technical difficulty and complication rates. We sought to compare medical and surgical complications following revision unicompartmental knee arthroplasty (UKA) to those following primary TKA and aseptic revision TKA.</p><p><strong>Methods: </strong>A national administrative claims database was queried for patients undergoing revision UKA between 2010 and 2019. Patients undergoing revision of a UKA were matched to patients undergoing primary TKA and aseptic revision TKA based on age, sex, Elixhauser Comorbidity Index (ECI), payor status, and a history of obesity, osteoporosis, tobacco use, and alcohol use disorder. Revision-free survivorship as well as 2-year and 90-day complication rates were compared. Multivariable logistic regression analysis was performed to determine the independent risk of medical and surgical complications.</p><p><strong>Results: </strong>A total of 3,924 matched primary TKA, revision of a failed UKA, and aseptic revision TKA patients were included. Overall survivorship was 96.9% (95% CI [confidence interval] 95.9 to 97.8%) for primary TKA, 93.4% (95% CI 92.1 to 94.8%) for revision UKA, and 89.8% (95% CI 88.2 to 91.5%) for aseptic revision TKA at 2-year follow-up (P < 0.001). At two years, revision UKA patients had higher rates of aseptic loosening (2.2 versus 0.8%, P = 0.004), instability (2.4 versus 0.8%, P = 0.002), and mechanical failures (3.0 versus 1.5%, P = 0.012) than primary TKA patients. The 90-day complication rates were comparable between primary TKA and revision UKA patients (all P > 0.05); the risk of reoperation, acute kidney injury, wound dehiscence, hematoma, and transfusion were all higher in the revision TKA than in the revision UKA cohort (all P < 0.05).</p><p><strong>Conclusion: </strong>Revision-free survivorship and arthroplasty-related complications at two years following revision UKA are lower than for primary TKA, but higher than for aseptic revision TKA, while medical complications are similar to those following primary TKA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928742","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":"Hormone Replacement Therapy in Post-Menopausal Women Undergoing Total Hip Arthroplasty is Associated with Reduced 10-Year Periprosthetic Femur Fracture Rate.","authors":"Amy Y Zhao, Adaugo Oguejiofor, Andrew B Harris, Kevin Wang, Alex Gu, J Stuart Melvin, Sandesh Rao, Savyasachi C Thakkar","doi":"10.1016/j.arth.2024.12.020","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.020","url":null,"abstract":"<p><strong>Introduction: </strong>In postmenopausal women who are estrogen deficient, hormone replacement therapy (HRT) has been shown to improve fragility fracture risk. However, few studies have examined the relationship between HRT and periprosthetic fracture (PPF) risk after total hip arthroplasty (THA). The purpose of this study was to determine the impact of HRT use on 10-year PPF risk following THA.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using a large national database. Women who underwent elective THA were identified and stratified based on preoperative (< six months) HRT use. Those taking HRT were propensity-score matched at a 1:2 ratio to those who do not have a history of HRT use based on age and Charlson Comorbidity Index score. Kaplan Meier and Cox proportional hazards analyses were conducted to determine rates of PPF, revision, and aseptic loosening within 10 years of surgery. Regression analyses were performed to determine 90-day rates of venous thromboemblism (VTE) after controlling for perioperative VTE prophylaxis. In total, 21,220 patients were included.</p><p><strong>Results: </strong>Patients who were taking HRT before THA demonstrated a lower risk of PPF (hazard ratio [HR]: 0.8; 95% confidence interval [CI]: 0.6 to 0.9) within 10 years of THA, but a similar risk of all-cause revision surgery and revision for aseptic loosening. The HRT cohort demonstrated lower odds of deep vein thrombosis (OR: 0.7; 95% CI: 0.6 to 1.0) and similar rates of pulmonary embolism.</p><p><strong>Conclusion: </strong>In postmenopausal women, HRT use prior to elective THA was associated with lower rates of PPF within 10 years of surgery and was not associated with increased VTE risk. Given these results, appropriate HRT usage in patients may have a role in reducing PPF after THA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883580","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 Altitude is an Independent Risk Factor for Postoperative Venous Thromboembolism Following Primary Total Knee Arthroplasty: A Large Database Study.","authors":"Kevin D Plancher, Elias Schwartz, Carlo Mannina, Karen K Briggs, Stephanie C Petterson","doi":"10.1016/j.arth.2024.12.022","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.022","url":null,"abstract":"<p><strong>Introduction: </strong>Venous thromboembolism (VTE) is a relatively uncommon but potentially fatal complication following total knee arthroplasty (TKA). High altitude may induce physiological changes that can predispose patients to VTE. The purpose of this study was to determine if high altitude is an independent risk factor for postoperative VTE following TKA.</p><p><strong>Methods: </strong>A large claims database was queried for patients who underwent TKA at high elevation (≥ 4,000 feet) and low elevation (≤ 100 feet) using Current Procedural Terminology (CPT) codes, International Classification of Disease (ICD) codes, and zip codes. High- and low-altitude cohorts were matched 1:3 by 5-year age range, sex, Charlson comorbidity index (CCI), and comorbidities including diabetes mellitus, obesity (BMI [body mass index] ≥ 30), hypertension, and tobacco use. There were 57,135 patients included in the high-altitude group and 171,322 in the low-altitude group. Outcome measures included 30- and 90-day incidence of VTE, deep venous thrombosis (DVT), and pulmonary embolism (PE). Chi-square tests were used to determine differences in demographics between cohorts. Binomial logistic regression analysis was used to determine postoperative rates of VTE, DVT, and PE.</p><p><strong>Results: </strong>The incidence of VTE was significantly higher for the high-altitude group than the low-altitude group at 30 days (OR [odds ratio] 1.15 [95% CI (confidence interval) 1.02 to 1.30], P = 0.022) and 90 days follow-up (OR 1.20 [95% CI 1.08 to 1.34], P = 0.0007). The incidence of DVT was significantly higher for the high-altitude cohort at both 30- (OR 1.30 [95% CI 1.10 to 1.54], P = 0.002) and 90-days postoperatively (OR 1.36 [95% CI 1.18 to 1.57], P < 0.0001). The incidence of PE within 30 and 90 days was not significantly different between groups.</p><p><strong>Conclusions: </strong>High altitude (> 4,000 feet) is an independent risk factor for VTE following TKA. Patients who undergo TKA at surgical centers greater than 4,000 feet in elevation are more likely to develop VTE and DVT within 30- and 90 days postoperatively. Surgeons may account for high altitude as a risk factor and determine the most suitable postoperative prophylaxis method for their patients.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883579","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":"Factors that Determine Pelvic Obliquity in Adults Who Suffered Legg-Calvé-Perthes Disease and the Role of Total Hip Arthroplasty in Its Restoration.","authors":"Alberto Losa Sánchez, Ricardo Fernández Fernández, Luis Moraleda Novo, Luis Palacios Diaz, Gaspar González Morán, Ana Cruz Pardos","doi":"10.1016/j.arth.2024.12.013","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.013","url":null,"abstract":"<p><strong>Background: </strong>The purpose of the study was to analyze the appearance of pelvic obliquity before total hip arthroplasty (THA) in adults who have Legg-Calvé-Perthes disease (LCPD) sequelae and its evolution in the first two postoperative years, identifying which factors influence its development.</p><p><strong>Methods: </strong>The THAs performed between 2012 and 2021 at a single institution in adults who had LCPD during childhood were retrospectively identified. Each case was matched 1:1, based on age at surgery, sex, and body mass index, with a primary THA performed for hip osteoarthritis (primary OA). A THA was implanted at a mean age of 47 years (range, 21 to 91), and 18 patients (64.3%) were men. We conducted a mean follow-up of 5.1 years (range, two to 10.1). Implant position, soft tissue balance, and pelvic obliquity were evaluated at six and 12 weeks and at one and two years. There were 28 THAs in 25 adults who suffered LCPD, and 28 THAs in patients who underwent surgery due to primary OA were included.</p><p><strong>Results: </strong>An increase in the initial pelvic obliquity at six weeks of THA was observed in both groups (from 3.6 ± 2.8 to 4 ± 3.2 and from 1.3 ± 1.2 to 1.8 ± 1.5, respectively), which progressively decreased at 12 weeks, one year, and two years after surgery, with final values of 2.2 ± 1.5 and 0.8 ± 0.7 for the LCPD and OA groups, respectively. Only in the LCPD group were the preoperative values associated with a greater limb length discrepancy (Rho = 0.41) and a lower femoral offset (Rho = -0.26) (P < 0.05).</p><p><strong>Conclusion: </strong>Patients who suffered LCPD in childhood have greater pelvic obliquity than those who have primary OA, and this is associated with greater limb length discrepancy and less femoral offset. In these patients, THA decreases pelvic obliquity two years after its implantation, although it increases in the first weeks, probably due to the shortening of the abductor muscles, so patients should be warned before surgery.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878517","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":"Aseptic Tibial Loosening is Associated with Thickness of the Cement: A Radiographic Case-Control Study.","authors":"Benjamin C Schaffler, Joseph X Robin, Jonathan Katzman, Armin Arshi, Joshua C Rozell, Ran Schwarzkopf","doi":"10.1016/j.arth.2024.12.023","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.023","url":null,"abstract":"<p><strong>Background: </strong>The cementation technique is crucial for achieving adequate fixation and optimal survivorship in total knee arthroplasty (TKA). The thickness of the cement at the tibial bone-implant surface may be related to aseptic tibial loosening. However, to date, no studies have demonstrated a direct association between cement thickness and rates of aseptic tibial loosening.</p><p><strong>Methods: </strong>We performed a retrospective review to identify 28,327 primary cemented TKAs with at least two years of follow-up at an academic health system from 2013 to 2021. A total of 115 cases underwent revision surgery for aseptic tibial loosening. Cases where the implant was recalled specifically for loosening (n = 23) were excluded. The remaining 92 aseptic tibial loosening cases were 2:1 propensity score matched and implant-matched to control patients who did not have tibial loosening. There were two independent reviewers who then measured the thickness of the cement interface in ten locations along the bone-implant interface from initial postoperative radiographs. The averages of the reviewers' measurements were calculated and then compared using independent t-tests.</p><p><strong>Results: </strong>Aseptic tibial loosening cases involving implant A tibial baseplate (n = 75) had significantly thinner cement interfaces than matched controls at all ten locations measured. Aseptic loosening cases involving implant B (n = 17) also displayed a thinner cement interface than matched controls in all locations, but this result was only statistically significant at the medial baseplate, medial keel, lateral keel, anterior keel, and posterior baseplate.</p><p><strong>Conclusion: </strong>In two widely used TKA systems, tibial aseptic loosening was associated with significantly thinner cement interfaces when compared to propensity-matched controls in two different implant types. Further prospective studies are needed to identify the optimal keel preparation and design as well as minimal cement interface thickness to avoid implant loosening.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878515","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":"How Should We Define Meaningful Improvement? A Commentary on MCID Assessment for HOOS-JR and KOOS-JR in Total Joint Arthroplasty.","authors":"Kareem Omran, Ran Schwarzkopf","doi":"10.1016/j.arth.2024.12.015","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.015","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878519","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 Debridement, Antibiotics, and Implant Retention in the Management of Infected Total Knee Arthroplasty: Analysis of 5,178 Cases from the National Australian Registry.","authors":"Nicolai K Kristensen, Stuart A Callary, Renjy Nelson, Dylan Harries, Michelle Lorimer, Paul Smith, David Campbell","doi":"10.1016/j.arth.2024.12.016","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.016","url":null,"abstract":"<p><strong>Introduction: </strong>Periprosthetic joint infection (PJI) is a devastating and severe complication of total knee arthroplasty (TKA). The Australian Joint Registry reports an increasing number of debridement, antibiotics, and implant retention (DAIR) procedures, underscoring the need to comprehend outcomes for informed treatment decisions. This study aimed to determine outcome of DAIR procedures, evaluate time since primary TKA, and identify patient-related factors associated with DAIR failure.</p><p><strong>Methods: </strong>We conducted a national registry-based cohort study using data from 1999 to 2021. We included 8,642 revisions for infection, of which 5,178 were DAIR procedures (60%) predominantly performed within four weeks of primary surgery. We assessed outcomes using Kaplan-Meier estimates and Cox proportional hazard models.</p><p><strong>Results: </strong>Post-DAIR, the cumulative percent second revision (CPR) in the DAIR cohort was 20% at year one, increasing to 36% at year 17. Early DAIR procedures had a lower post-DAIR revision rate until three months after primary TKA. A DAIR performed within two weeks after primary TKA compared to three months had a HR [hazard ratio]: 0.74 (95% CI [confidence interval]: 0.62 to 0.88). After four weeks, the post-DAIR revision rate did not deteriorate and was similar for further time periods from the primary. Men had an age-adjusted hazard ratio of 1.28 (95% CI: 1.14 to 1.43, P < 0.001) for DAIR failure compared to women. There was a significantly higher hazard ratio for post-DAIR revision in patients younger than 75 years of age, compared to patients aged ≥ 75 years.</p><p><strong>Conclusion: </strong>These findings underscore the critical influence of patient-related factors and the timing of DAIR treatment on the need for additional surgery. DAIR after four weeks had an increased risk of subsequent revision, and older women undergoing early DAIR interventions had more favorable outcomes. Understanding these nuances aids in optimizing PJI management strategies, offering insights for decision-making.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878521","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}