Journal of Arthroplasty最新文献

{"title":"Letter Regarding “Thirty-Year Minimum Follow-up Outcome of a Straight Cementless Rectangular Stem”","authors":"Dario Smirnjak MD, Jure Serdar MD, Tomislav Smoljanović MD, PhD","doi":"10.1016/j.arth.2024.11.063","DOIUrl":"10.1016/j.arth.2024.11.063","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 4","pages":"Pages e29-e30"},"PeriodicalIF":3.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563226","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":"Timing of Knee Arthroplasty after Surgical Arthroscopy May Influence the Outcome","authors":"Giles R. Scuderi MD, Rajan Sharma DO, Michael A. Mont MD","doi":"10.1016/j.arth.2025.02.004","DOIUrl":"10.1016/j.arth.2025.02.004","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 4","pages":"Pages 819-820"},"PeriodicalIF":3.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563677","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":"Reply to Letter Regarding “Thirty-Year Minimum Follow-Up Outcome of a Straight Cementless Rectangular Stem”","authors":"Kevin Staats MD, PhD, Klemens Vertesich MD, Christoph Boehler MD, PhD","doi":"10.1016/j.arth.2024.12.024","DOIUrl":"10.1016/j.arth.2024.12.024","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 4","pages":"Page e31"},"PeriodicalIF":3.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563227","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":"Reply to Letter Regarding “Return to Cycling After Total Joint Arthroplasty”","authors":"Adam S. Driesman MD, Jason M. Jennings MD, DPT","doi":"10.1016/j.arth.2024.12.019","DOIUrl":"10.1016/j.arth.2024.12.019","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 4","pages":"Pages e33-e34"},"PeriodicalIF":3.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563229","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":"Robotic-Assisted Surgery Does Not Decrease Prosthetic Impingement in Total Hip Arthroplasty: A Retrieval Analysis.","authors":"Sara E Sacher, Jeffrey A O'Donnell, Timothy M Wright, Eytan M Debbi, Douglas E Padgett","doi":"10.1016/j.arth.2025.02.077","DOIUrl":"10.1016/j.arth.2025.02.077","url":null,"abstract":"<p><strong>Background: </strong>Prosthetic impingement after total hip arthroplasty (THA) has been associated with instability and may be a cause of accelerated polyethylene wear and pain. Previous retrieval studies report a high prevalence of impingement in acetabular liners. Robotic technology has the potential to reduce THA instability as it enables technical precision and optimizes implant positioning. However, whether robotics can improve impingement prevalence is unknown. Thus, the objectives of this study were to: (1) determine the prevalence and severity of acetabular liner impingement with robotic navigation; and (2) compare impingement prevalence with a control cohort of manually placed THA liners.</p><p><strong>Methods: </strong>There were 18 robotic-assisted liners and 11 non-robotic controls scored for the presence and severity of impingement. Radiographic measurements of acetabular inclination and anteversion were assessed using prerevision standing radiographs. Femoral head size (36 being the most common), length of implantation, revision indication, age, gender, and body mass index were recorded.</p><p><strong>Results: </strong>Of the robotic liners, 61% showed impingement, while 45% of the non-robotic liners showed impingement (P = 0.14). The robotic group demonstrated a lower variance of inclination (robotic: 41.7° ± 3.9, control: 42.8° ± 7.1, P = 0.64) and lower anteversion variance (robotic: 22.8° ± 2.8, control: 20.8° ± 7.9, P = 0.43), but mean values did not differ between the groups. Impingement presence and severity were not related to head size, length of implantation, or other demographic variables.</p><p><strong>Conclusions: </strong>This study suggests that the use of robotic-assisted technology employing modern-day implants with larger diameter heads does not reduce the prevalence or severity of prosthetic impingement in retrieved acetabular liners from revision THA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588045","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":"Cobalt-Chromium-Molybdenum Femoral Knee Implant Damage Correlates With Elevated Periprosthetic Metal Concentrations.","authors":"Peter W Kurtz, Shabnam Aslani, Michael A Kurtz, Lilliana M Taylor, Emma R Barnes, Daniel W MacDonald, Nicolas S Piuzzi, William M Mihalko, Steven M Kurtz, Jeremy L Gilbert","doi":"10.1016/j.arth.2025.02.075","DOIUrl":"10.1016/j.arth.2025.02.075","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) device systems frequently include cast cobalt chrome alloy (CoCrMo) femoral components. However, compared to total hip arthroplasty (THA), gaps persist in our understanding of the correlations between femoral component damage, local metal release, and potential biological effects. Additionally, it remains unclear how TKA metal release affects clinical success or patient satisfaction. In this study, we investigated the associations between implant damage and metal release in the periprosthetic tissues following TKA. We asked: (1) does damage severity correlate with increased metal concentrations within the periprosthetic tissue? and (2) does the magnitude of metal released from CoCrMo femoral components merit clinical concern?</p><p><strong>Methods: </strong>There were 51 CoCrMo femoral components and synovial samples that were prospectively collected by an institutional review board-exempt retrieval program. Devices received damage scores ranging from minimal (1) to severe (4). Tissue metal concentrations for cobalt (Co), chromium (Cr), molybdenum (Mo), and titanium (Ti) were quantified using inductively coupled plasma mass spectroscopy.</p><p><strong>Results: </strong>Visual damage correlated with increases in Co, Cr, and Mo concentrations in the periprosthetic tissue (P = 0.0008, 0.029, and 0.007, respectively). Within the tissue adjacent to severely damaged implants, we measured median Co, Cr, and Mo concentrations of 7.81, 5.26, and 0.713 μg/mL, respectively. For minimally damaged implants, we report median Co, Cr, and Mo concentrations of 0.111, 1.80, and 0.179 μg/mL, respectively. In several of the 51 (14%) tissue samples, we measured Co and Cr concentrations > 10 μg/mL. Additionally, within periprosthetic tissues of devices with Ti tibial trays, Ti concentrations increased (P = 0.0052) arising, in part, from tibial-femoral component contact during arthroplasty.</p><p><strong>Conclusions: </strong>We (1) showed elevated periprosthetic tissue metal concentrations in TKA patients and (2) established a positive correlation between damage severity and subsequent metal release. Measured tissue metal concentrations approached the magnitudes reported following metal-on-metal THA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587987","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 Influence of Obesity on Unicondylar Knee Arthroplasty.","authors":"Kevin B Fricka, Tobenna N Nwankwo, Robert A Sershon, Nancy L Parks, Alexander V Strait, William G Hamilton","doi":"10.1016/j.arth.2025.02.070","DOIUrl":"10.1016/j.arth.2025.02.070","url":null,"abstract":"<p><strong>Background: </strong>Some prior studies suggest obesity increases unicondylar knee arthroplasty (UKA) failure risk. This study evaluated obesity's impact on UKA outcomes at a single institution.</p><p><strong>Methods: </strong>We analyzed 4,973 primary cemented medial UKAs performed by eight surgeons from 2000 to 2022. The primary outcome was implant survivorship. Secondary outcomes included revision rates, reasons for revision, patient-reported outcomes, and clinical metrics. The mean age was 66 years (range, 33 to 96), 54.6% were women, body mass index (BMI) averaged 29.9 (range, 15.6 to 63.4), and follow-up averaged 5.1 years. Outcomes were stratified by BMI cutoffs (BMI: 30; 35; 40), yielding group sizes of ≤ 30 (N = 2,858), > 30 (N = 2,115), ≤ 35 (N = 4,137), > 35 (N = 836), ≤ 40 (N = 4,680), and > 40 (N = 293).</p><p><strong>Results: </strong>At 5 and 10 years, implant survivorship was 95.7 and 92.8%, respectively. At 5 years, survivorship remained high but declined slightly with increased BMI for the 30 and 35 cutoffs (≤ 30: 96.7%, > 30: 94.2%, P < 0.001; ≤ 35: 95.8%, > 35: 94.9%; P = 0.005), while a slight, nonsignificant increase occurred for BMI > 40 (≤ 40: 95.7%, > 40: 96.0%; P = 0.325). Arthritis progression was the most common revision reason, and it increased with BMI. Infection rates remained low across all BMIs. There was no difference in the percentage of patients achieving a minimal clinically important difference using the Knee Osteoarthritis Outcome Score, Joint Replacement with each BMI cutoff, but Knee Osteoarthritis Outcome Score, Joint Replacement score changes were significantly greater in the higher BMI patients using the BMI 30 cutoff (P = 0.034).</p><p><strong>Conclusions: </strong>While higher BMI patients had marginally higher rates of revision, we remain enthusiastic about UKA in these patients due to low infection rates across all BMI cohorts and improvements in patient-reported outcome measures.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574604","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":"An Analysis of Costs in the Year Before and After Total Knee Arthroplasty.","authors":"Elizabeth A Abe, Saad Tarabichi, Juan D Lizcano, Nihir Parikh, Matthew B Sherman, Chad A Krueger, P Maxwell Courtney","doi":"10.1016/j.arth.2025.02.071","DOIUrl":"10.1016/j.arth.2025.02.071","url":null,"abstract":"<p><strong>Background: </strong>While insurance claims database studies have reported on costs before total knee arthroplasty (TKA), the cost-efficacy of nonoperative treatment remains unclear in patients who eventually undergo TKA. Furthermore, we hypothesized that patients undergoing primary TKA would have lower costs in the year following surgery than if patients continued nonoperative treatment. The purpose of this study was to determine the costs of various nonoperative treatment modalities in the year before and following primary TKA.</p><p><strong>Methods: </strong>We reviewed a consecutive series of 13,117 patients undergoing primary TKA from 2020 to 2022 at a single institution with claims data from Medicare and a single commercial payer. We recorded all office visits, intra-articular injections, bracing, physical therapy, and imaging in the 12 months before and immediately following the patient's primary TKA, analyzing costs by the payer. Patient-reported outcome scores, readmissions, and reoperations were also noted, and costs were included in the 12-month postoperative analysis.</p><p><strong>Results: </strong>There were 5,516 (42.1%) patients who were insured by Medicare, 5,044 (38.5%) commercially insured and 2,557 (19.4%) insured by Medicare Advantage The mean total cost in the year before and after TKA declined from $760 to $598 (commercial), $583 to $351 (Medicare Advantage), and $580 to $370 (Medicare). Medicare patients had the greatest number of nonoperative treatments (6.5 versus 5.3 versus 5.1, P < 0.001) in the year before TKA. Patients in all three groups achieved the minimum clinically important difference for the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement at similar rates (74.8 versus 75.6 versus 72.7%, P = 0.35).</p><p><strong>Conclusions: </strong>Patients undergoing primary TKA had lower costs in the year following surgery than they did with trial nonoperative treatment in the year prior. Further studies are needed to evaluate the cost-efficacy of nonoperative treatment modalities.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574600","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 and Survival of a Single Model of Modular Neck Primary Total Hip Arthroplasty at a Mean of Eight Years.","authors":"Lee R Benaroch, James H Allen, Edward M Vasarhelyi, Douglas R Naudie, Brent A Lanting, James L Howard","doi":"10.1016/j.arth.2025.02.067","DOIUrl":"10.1016/j.arth.2025.02.067","url":null,"abstract":"<p><strong>Background: </strong>We report the outcomes and survival of a recalled modular neck primary total hip arthroplasty (THA). This study's purpose was to describe the survival, complications, patient-reported outcome measures, and serum metal ion levels at a mean of 8 years.</p><p><strong>Methods: </strong>We identified 89 hips that received a modular neck THA between May 2010 and March 2012. Failure was defined as the removal of the femoral component for any reason, excluding infection. The patient-reported outcome measures, including the Western Ontario and McMaster Universities Arthritis Index, Harris Hip Score (HHS), and Veterans RAND 12 Physical and Mental Score, and serum metal ion levels were recorded and compared between unrevised and revised patients.</p><p><strong>Results: </strong>The mean time to the most recent follow-up and revision surgery was 7.79 and 4.31 years, respectively. The mean survivorship was 10.0 years, with a survival of 51% at 13 years. There were 33 infection-free failures identified, with symptomatic adverse local tissue reaction or pseudotumor being the most common (62.5%). Of the patients who underwent revision surgery, six required repeat revisions. When comparing unrevised and revised cases, the unrevised group had significantly greater HHS function (P = 0.002), HHS total (P = 0.003), and Veterans RAND 12 Physical (P = 0.04) scores. Metal ion analysis showed that the mean serum Cobalt ion levels were significantly higher for the revised patients compared to the unrevised patients (P < 0.001).</p><p><strong>Conclusions: </strong>This study demonstrated that the taper corrosion-related failure continues to be an issue with this specific modular neck primary THA implant. Functional data demonstrated poorer outcomes in patients who required revision and a following revision surgery compared to patients who did not require a revision surgery. Patients who have received this implant should continue to be monitored on a routine basis, and care providers should have a low threshold to investigate symptoms.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574603","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":"Current Trends of Surgical Approach and Use of Enhancing Technology in Total Hip Arthroplasty: A Comparison of Early Career and More Experienced Surgeons Using the American Board of Orthopaedic Surgery Oral Examination and Recertification Data.","authors":"Charles L Nelson, John J Harrast, Joshua J Jacobs, David F Martin, Kevin L Garvin","doi":"10.1016/j.arth.2025.02.069","DOIUrl":"10.1016/j.arth.2025.02.069","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) has been among the most successful procedures in medicine, but the preferred approach and use of enhancing technologies are evolving. This study was conducted to define current THA practice (surgical approach and use of enhancing technologies) among early-career and more experienced surgeons. A secondary goal of this study was to identify differences in 6-month Patient-Reported Outcome Measurement Information System (PROMIS) pain interference or function scores and early complications.</p><p><strong>Methods: </strong>In 2022 and 2023, 35,068 THAs were submitted to the American Board of Orthopaedic Surgery by candidates for the part II oral certification examination (14,993) and by Diplomates as part of the recertification process (20,075). The average patient age was 66 years, and 54% of patients were women. Baseline and 6-month PROMIS pain interference and function surveys were obtained from 2,019 patients in the Part II group. Postoperative complications were reported by the candidates or diplomates for all patients.</p><p><strong>Results: </strong>Part II candidate surgical approach was direct anterior (DA) (69%), posterior (26%), direct lateral (2%), and other (2%). For recertification candidates, the surgical approach was DA (43%), posterior (43%), direct lateral (6%), and other (7%). Robotics or navigation was utilized in 18 and 15%, respectively. There were equivalent improvements in the PROMIS function in all groups. The surgeon-reported significant surgical complications were higher in part II candidates (8.4%) than in candidates undergoing recertification (2.7%, P < 0.001), with bone fracture the most common in each group (part II: 2.3%; recertification at 0.6%).</p><p><strong>Conclusions: </strong>The part II candidates are more likely to utilize the DA approach compared to recertification candidates. The Part II candidates report higher rates of postoperative complications. However, there was no difference in the rate of surgeon-reported surgical complications or fractures based on surgical approach. Robotics and navigation are utilized in less than 20% of THA cases. The PROMs improved equally in all THA groups.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574601","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}