Journal of Arthroplasty最新文献

{"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 MD, PhD,&nbsp;Tamon Kabata MD, PhD,&nbsp;Yoshitomo Kajino MD, PhD,&nbsp;Yu Yanagi MD,&nbsp;Musashi Ima MD,&nbsp;Satoru Demura MD, PhD","doi":"10.1016/j.arth.2025.05.076","DOIUrl":"10.1016/j.arth.2025.05.076","url":null,"abstract":"<div><h3>Background</h3><div>This study investigated the long-term (mean 13.5 years) clinical results of resurfacing hip arthroplasty<span> (RHA) in Japanese patients who had osteonecrosis (ON) and compared the results with those of patients who had other diagnoses.</span></div></div><div><h3>Methods</h3><div>A consecutive series of 65 hips (50 men and 15 women), with 30 in the ON group and 35 hips in the nonosteonecrosis (non-ON) group, were included. The mean follow-up period was 13.5 years (range, 10 to 20). The Japanese Orthopaedic<span><span> Association 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. Data on </span>postoperative complications<span> were retrieved from the medical records. Kaplan‒Meier analysis was used to compare the survival rate between the two groups.</span></span></div></div><div><h3>Results</h3><div><span>Significant improvement was observed between the preoperative and final follow-up Japanese Orthopaedic Association 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<span> 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 (</span></span><em>P</em> = 0.53). In the ON group, the 15-year survival rate was 92% in Type C1 and 90% in Type C2 cases (<em>P</em> = 0.84).</div></div><div><h3>Conclusions</h3><div>This study showed satisfactory mean 13.5 years clinical results of RHA in Japanese patients who had ON.</div></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 10","pages":"Pages S92-S96"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","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":"Risk Factors, Pathogenesis, Diagnosis, and Treatment Options for COVID-Associated Osteonecrosis: A Systematic Review","authors":"Sean B. Sequeira MD ,&nbsp;Lynne P. Jones MD ,&nbsp;Stuart B. Goodman MD, PhD ,&nbsp;Michael A. Mont MD","doi":"10.1016/j.arth.2025.06.015","DOIUrl":"10.1016/j.arth.2025.06.015","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Osteonecrosis associated with COVID-19 is a relatively rare clinical entity, but with a high incidence during the pandemic. There is a paucity of data regarding the characterization of this group of osteonecrosis patients. The purpose of this investigation was to systematically review the literature to identify: (1) clinical presentation/epidemiology, (2) </span>pathophysiology, (3) </span>diagnostic modalities, and (4) treatment guidelines/algorithms of COVID-19 osteonecrosis.</div></div><div><h3>Methods</h3><div>Using the Preferred Reporting Items for Systematic Reviews<span> and Meta-Analyses guidelines, we conducted a systematic review across three databases, resulting in a total of 10 articles. Articles met the inclusion criteria if they provided data regarding: (1) clinical presentation/epidemiology, (2) pathophysiology, (3) diagnostic modalities, and/or (4) treatment guidelines/algorithms of COVID-19 osteonecrosis.</span></div></div><div><h3>Results</h3><div><span>There was considerable variability in duration between COVID-19 infection and osteonecrosis symptoms. The clinical presentation of COVID-associated osteonecrosis is similar to standard symptoms, including joint pain and pain with weight-bearing. Corticosteroids tended to be the most identifiable associated risk factor for COVID-associated osteonecrosis. Diagnosis included radiographs and </span>magnetic resonance imaging<span><span><span> for definitive diagnosis. Treatment varied depending on the rapidity of osteonecrosis progression, ranging from bisphosphonates and </span>analgesics to joint-preserving procedures and total joint </span>arthroplasty.</span></div></div><div><h3>Conclusions</h3><div>Although COVID-associated osteonecrosis is a rare clinical condition, it is one that orthopaedic surgeons should be aware of and meticulously screen for in their patients. For patients inoculated with the COVID-19 virus, it is important for surgeons to use information regarding clinical presentation, pathophysiology, diagnosis, and treatment of COVID-associated osteonecrosis to screen and manage patients appropriately.</div></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 10","pages":"Pages S13-S20"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259343","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":"Increasing Prevalence and Risk Factors for Multifocal Osteonecrosis in Patients Who Have Corticosteroid-Associated Osteonecrosis of the Femoral Head: A 15-Year Multicenter Study","authors":"Keiji Otaka MD ,&nbsp;Takashi Sakai MD, PhD ,&nbsp;Wakaba Fukushima MD, PhD ,&nbsp;Yasuhiko Takegami MD, PhD ,&nbsp;Wataru Ando MD, PhD ,&nbsp;Shiro Imagama MD, PhD ,&nbsp;Nobuhiko Sugano MD, PhD","doi":"10.1016/j.arth.2025.05.043","DOIUrl":"10.1016/j.arth.2025.05.043","url":null,"abstract":"<div><h3>Background</h3><div><span>Multifocal osteonecrosis (MFON) is a rare condition affecting multiple bone sites, with limited epidemiological data available. This study investigated the frequency, trends, and risk factors for MFON in patients aged &gt; 15 years who had corticosteroid-associated </span>osteonecrosis of the femoral head (ONFH) using data from a multicenter sentinel monitoring system in Japan.</div></div><div><h3>Methods</h3><div><span><span>Data from 658 patients between 2009 and 2023 were analyzed. The MFON was defined as osteonecrosis involving three or more separate anatomical sites. The frequency and trends of MFON were assessed across three 5-year periods. The risk factors for MFON were analyzed using data from 2014 onward, when smoking history data became available. The group with no necrosis other than that in the </span>femoral head was defined as the non-MFON group, and the demographics and comorbidities were compared between the MFON and non-MFON groups. The risk factors were analyzed using univariate and </span>logistic regression analyses.</div></div><div><h3>Results</h3><div>The frequency of MFON was 5.3% during the entire period and increased significantly over time (1.6, 7.4, and 8.0%; <em>P</em> &lt; 0.01). The knee joint was the most common site of osteonecrosis, and all patients had knee joint involvement. The MFON group was younger (<em>P</em> &lt; 0.001) and had more women (<em>P</em><span> &lt; 0.05) than the non-MFON group and had significantly more patients who had systemic lupus erythematosus (SLE) and hematological tumors (both </span><em>P</em> &lt; 0.01). The independent risk factors for MFON included age &lt; 40 years (<em>P</em> &lt; 0.05), SLE (<em>P</em> &lt; 0.05), and hematological tumors (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The frequency of MFON in patients who had corticosteroid-associated osteonecrosis of the femoral head was 5.3%. Young patients, those who have SLE, or those who have hematological tumors are at a higher risk of MFON and should be considered for MFON screening.</div></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 10","pages":"Pages S146-S151"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121455","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":"Predicting Progression of Traumatic Osteonecrosis of the Femoral Head Based on Magnetic Resonance Imaging Classification: A Retrospective Cohort Study","authors":"Shihua Gao MD ,&nbsp;Zhikun Zhuang MD ,&nbsp;Changyu Huang MSc ,&nbsp;Qiushi Wei MD ,&nbsp;Wei He MD ,&nbsp;Tiantian Xia MSc ,&nbsp;Ziqi Li MD","doi":"10.1016/j.arth.2025.06.030","DOIUrl":"10.1016/j.arth.2025.06.030","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of our study was to develop a novel magnetic resonance imaging classification system to predict the progression of traumatic osteonecrosis of the femoral head (TONFH) in young adults and assess its clinical implications.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted from January 2007 to December 2022, including 134 hips (134 patients, mean age 41 years (range, 21 to 43), 65.7% men) diagnosed with TONFH at Association Research Circulation Osseous Stage I. The bone repair band (BRB) classification system categorized lesions into Superficial (Type S), Uncertain (Type U), and Extensive (Type E) based on magnetic resonance imaging coronal views. Patients were followed with observational treatment and x-ray assessments. Radiographic signs and femoral head collapse were evaluated during follow-up. Survival analysis and Cox proportional hazards regression assessed the association between BRB classification and disease progression.</div></div><div><h3>Results</h3><div>The 134 hips were categorized into Type S (n = 54), Type U (n = 21), and Type E (n = 59). Over a mean follow-up of 39.6 months, radiographic signs were most prevalent in Type E (94.9%) and least in Type S (9.3%), with median times to radiographic signs of 18 months for Type U and 16 months for Type E. Femoral head collapse occurred in 50.8% of Type E, 23.8% of Type U, and none in Type S, with a median time to collapse of 34 months for Type E. Both univariate and multivariate analyses identified BRB classification as an independent predictor of disease progression, with Type E showing the highest risk for adverse outcomes.</div></div><div><h3>Conclusions</h3><div>The newly proposed BRB classification provides a systematic approach to assessing necrotic lesion severity in TONFH and demonstrates significant correlation with femoral head collapse risk. Future studies are needed to further validate its clinical significance and explore the anatomical basis underlying this classification.</div></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 10","pages":"Pages S152-S159"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295341","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 Role of Cell Therapies for the Treatment of Osteonecrosis of the Femoral Head","authors":"Simon K-H Chow PhD ,&nbsp;Joshua P. Rainey MD ,&nbsp;Michael A. Mont MD ,&nbsp;Lynne P. Jones PhD ,&nbsp;Stuart B. Goodman MD, PhD","doi":"10.1016/j.arth.2025.06.018","DOIUrl":"10.1016/j.arth.2025.06.018","url":null,"abstract":"<div><h3>Background</h3><div>Osteonecrosis of the femoral head<span> (ONFH) can cause pain, diminished function, and eventual articular collapse, disproportionately impacting younger patients. Core decompression (CD) is used to halt or at least delay postcollapse disease in patients who suffer from ONFH, but it can have variable outcomes. Orthobiologics are cellular therapies, growth factors, and biomaterial substances obtained from human cells and tissue that promote biological healing and have recently gained attention in the treatment of osteonecrosis. In this review, the role of orthobiologics in the treatment of osteonecrosis is discussed.</span></div></div><div><h3>Methods</h3><div>We reviewed the existing literature regarding orthobiologics in the treatment of precollapse ONFH. A total of 11 studies were included, consisting of six randomized controlled trials and five retrospective reviews. The included literature was obtained through a PubMed query of all studies from 1990 to 2024 that evaluated the role of ancillary cell-based therapies in the treatment of precollapse ONFH. Level IV and non-human studies were not included.</div></div><div><h3>Results</h3><div><span>There were seven studies that supported the use of orthobiologics as an augmentation strategy to CD in terms of radiographic outcomes (i.e., prevention of femoral head collapse), clinical symptoms, or conversion to </span>total hip arthroplasty. There were four studies (one retrospective review and three randomized controlled trials) that found no clinical or radiographic difference in collapse progression in patients who received CD versus CD along with an orthobiologic augmentation strategy.</div></div><div><h3>Conclusions</h3><div>In summary, further adequately powered, multicenter, blinded, randomized controlled trials are necessary. In addition, many of the studies had other limitations, including a large variability in mesenchymal cell content and standardization. Although the current literature regarding orthobiologic augmentation in the treatment of precollapse ONFH appears promising, further investigation is necessary to conclude its efficacy.</div></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 10","pages":"Pages S46-S50"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287060","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":"Changes in Hip Arthroplasty Practice Decreased Dislocation Risk After Primary Arthroplasties Performed for Nontraumatic Osteonecrosis of the Femoral Head","authors":"Seneki Kobayashi MD, PhD ,&nbsp;Nobuhiko Sugano MD, PhD ,&nbsp;Wataru Ando MD, PhD ,&nbsp;Wakaba Fukushima MD, PhD ,&nbsp;Kyoko Kondo PhD ,&nbsp;Takashi Sakai MD, PhD","doi":"10.1016/j.arth.2025.06.023","DOIUrl":"10.1016/j.arth.2025.06.023","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Hip arthroplasty<span> practices have evolved considerably over time. This nationwide multicenter follow-up cohort study of </span></span>primary hip arthroplasties performed for nontraumatic </span>osteonecrosis of the femoral head aimed to address the following question: Have demographic and operative variables, as well as follow-up outcomes (dislocation and need for reoperation), changed over time?</div></div><div><h3>Methods</h3><div>A total of 7,494 hip arthroplasties were analyzed, categorized into three 9-year periods based on the date of operation: the first (1996 to 2004, 1,403 hips), the second (2005 to 2013, 2,631 hips), and the third (2014 to 2022, 3,460 hips) periods.</div></div><div><h3>Results</h3><div><span>Demographic characteristics changed gradually over time, while operative variables shifted significantly. The use of the posterior approach declined, and larger prosthetic heads became more common. The overall dislocation rate was 4.1% (307 hips) and varied by surgery type: 4.7% in total hip arthroplasties<span>, 1.1% in bipolar hemiarthroplasties, and 0% in resurfacings (</span></span><em>C</em><em>hi</em>-square test; <em>P</em><span> &lt; 0.001). Factors associated with dislocation were analyzed in 6,207 total arthroplasties (6,026 total hip arthroplasties and 181 total resurfacings) with a mean follow-up of 7.1 years (range, 0.5 to 27). The dislocation rate was 4.7%, with rates of 10.5, 5.4, and 2.3% in the first, second, and third periods, respectively (</span><em>C</em><em>hi</em>-square test; <em>P</em><span> &lt; 0.001). Multivariate logistic regression confirmed the reduction in dislocation risk over time; compared with the second period, odds ratios for the first and third periods were 1.48 (</span><em>P</em> = 0.015) and 0.58 (<em>P</em><span> = 0.001), respectively. No significant temporal changes in the risk of reoperation were observed.</span></div></div><div><h3>Conclusions</h3><div>With temporal transition, demographic characteristics evolved gradually, while operative techniques changed markedly. The decline in the use of the posterior approach and the increased adoption of larger prosthetic heads likely contributed to the observed reduction in dislocation risk. However, the risk of reoperation remained unchanged across periods.</div></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 10","pages":"Pages S129-S135"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295333","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":"Can Preoperative Patient-Reported Outcome Measures Predict Clinical Outcomes Following Total Knee Arthroplasty?","authors":"Jonathan L Katzman, Casey Cardillo, Benjamin C Schaffler, Ran Schwarzkopf, Joshua C Rozell","doi":"10.1016/j.arth.2025.08.075","DOIUrl":"10.1016/j.arth.2025.08.075","url":null,"abstract":"<p><strong>Background: </strong>The Centers for Medicare and Medicaid Services now mandates the collection of patient-reported outcome measures (PROMs) before and after total knee arthroplasty (TKA), though their utility in predicting clinical outcomes remains unclear. This study compared the power of preoperative PROMs to predict clinical outcomes after TKA to established indices, including the Charlson Comorbidity Index and the Risk Assessment and Prediction Tool (RAPT).</p><p><strong>Methods: </strong>We retrospectively reviewed 2,923 patients undergoing elective, primary, unilateral TKA who completed the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and four Patient-Reported Outcomes Measurement Information System (PROMIS) domains within 90 days preoperatively. Outcomes included same-day discharge (SDD) rate, prolonged length of stay (LOS ≥ 48 hours), nonhome discharge, 90-day readmission, and revision surgery. Predictive utility was assessed using receiver operating characteristic curves (area under the curve [AUC]) and multivariable logistic regressions.</p><p><strong>Results: </strong>The RAPT was the strongest predictor of SDD (AUC = 0.697), extended LOS (AUC = 0.703), and nonhome discharge (AUC = 0.877). The PROMIS Physical Health (AUC = 0.609 for SDD; 0.607 for LOS; 0.696 for discharge) and PROMIS Mental Health (AUC = 0.613; 0.610; 0.655) demonstrated modest predictive value. In adjusted models, higher PROMIS Mental Health was associated with greater odds of SDD (odds ratio (OR) = 1.027, P = 0.003) and lower odds of extended LOS (OR = 0.975, P < 0.001). Higher PROMIS Physical Health was associated with decreased odds of nonhome discharge (OR = 0.935, P = 0.017). The Charlson Comorbidity Index was the strongest predictor of 90-day readmission (AUC = 0.604) and the only significant variable in adjusted models. There were no PROMs that were significant predictors of readmission or revision.</p><p><strong>Conclusions: </strong>Preoperative PROMs are associated with some clinical outcomes following TKA, but demonstrate limited predictive power compared to established tools like the RAPT score. These findings underscore the need for more robust, outcome-aligned PROMs to improve surgical planning in a value-based care model.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994325","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":"Risk Factors for Periprosthetic Fractures Following Total Hip Arthroplasty in Patients Younger Than 50 Years.","authors":"Eric Cui, Jackson W Durbin, Amy Zhao, Andrew Fealy, Philip M Parel, Rachel Ranson, Theodore Quan, Sabrina Gill, Amil Agarwal, Bella Gomez, Sandesh Rao, Savyasachi C Thakkar","doi":"10.1016/j.arth.2025.08.069","DOIUrl":"https://doi.org/10.1016/j.arth.2025.08.069","url":null,"abstract":"<p><strong>Introduction: </strong>With the expansion of total hip arthroplasty (THA) into younger populations, the number of periprosthetic fractures (PPF) seen amongst young patients is expected to increase. Therefore, the aim of this study was to identify risk factors for PPF following THA in patients under 50 years.</p><p><strong>Methods: </strong>In total, 270,986 patients were included in this study. Patients who underwent primary THA with subsequent PPF within two years of surgery were stratified into five age cohorts: under 20, 21 to 30, 31 to 40, 41 to 50, and 51 to 60 years of age. Risk factors were identified using multivariate regression with the age 51-60 years cohort as reference. After applying the Bonferroni correction, a P-value of less than 0.03 was used as the cutoff for significance. All statistical analysis was conducted using R software (Vienna, Austria).</p><p><strong>Results: </strong>In patients under the age of 50 years, risk factors for PPF included undergoing THA for osteonecrosis (OR (odds ratio): 1.5; P < 0.001). Other risk factors included a history of arrhythmia (OR: 1.4; P < 0.001), peripheral vascular disease (OR: 1.2; P = 0.002), paralysis (OR: 1.3; P = 0.03), neurologic disease (OR: 1.8; P < 0.001), pulmonary disease (OR: 1.3; P < 0.001), chronic kidney disease (OR: 1.3; P < 0.001), anemia with blood loss (OR: 1.6; P = 0.01), and alcohol abuse (OR: 1.9; P = 0.001). Protective factors included hip osteoarthritis (OR: 0.8; P < 0.001), men (OR: 0.7; P < 0.001), and age of 40 to 50 years (OR: 0.8; P < 0.001).</p><p><strong>Conclusion: </strong>Several risk factors for PPFs following THA in patients under age 50 years were identified. Of note, hip osteoarthritis, men, and age 41 to 50 years were protective factors against PPFs. As the proportion of younger patients undergoing THA continues to increase, our results can be used to guide surgeons in identifying patients at increased risk for PPF and improve patient outcomes.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994321","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":"Which Radiographic View Visualizes the Initial Collapse in Osteonecrosis of the Femoral Head? A Computed Tomography Scan Study","authors":"Hidetoshi Hamada MD, PhD ,&nbsp;Kazuma Takashima MD, PhD ,&nbsp;Ryo Higuchi MD ,&nbsp;Wataru Ando MD, PhD ,&nbsp;Nobuhiko Sugano MD, PhD ,&nbsp;Keisuke Uemura MD, PhD","doi":"10.1016/j.arth.2025.05.068","DOIUrl":"10.1016/j.arth.2025.05.068","url":null,"abstract":"<div><h3>Background</h3><div>An accurate diagnosis for staging osteonecrosis of the femoral head (ONFH), particularly in early-stage collapse, is essential for determining therapeutic strategies. Various radiographic views in different femoral positions have been used to detect femoral head collapse. However, previous studies have not established the optimal femoral position that can sensitively detect initial collapse on plain radiography. This study aimed to identify the most sensitive radiographic view for visualizing collapse in early-stage ONFH by analyzing reconstructed frontal images of the femoral head at multiple femoral positions on computed tomography (CT).</div></div><div><h3>Methods</h3><div>This study included 30 hips with early-stage ONFH (10 hips without collapse and 20 hips with collapse [&lt; three mm] based on the anteroposterior and lateral radiographic images). The presence or absence of collapse in 10 reconstructed frontal images of the femoral head on CT scans, corresponding to 10 different femoral positions, was classified. Furthermore, the ability to detect collapse in each image was compared.</div></div><div><h3>Results</h3><div>The reconstructed frontal image of the femoral head on CT scans at 45° flexion and 20° abduction had the highest sensitivity for detecting collapse among the analyzed positions. Hence, it had a significantly greater sensitivity than the neutral position (86 versus 53%, <em>P</em> &lt; 0.01). Of 70% who did not present with collapse on plain radiography had collapse on the reconstructed frontal image at 45° flexion and 20° abduction.</div></div><div><h3>Conclusions</h3><div>The plain radiographic image taken at 45° flexion and 20° abduction, referred to as the 45° Dunn view, had a greater diagnostic potential for early collapse in ONFH compared with the anteroposterior radiographic image. Nevertheless, further research should be performed to comprehensively investigate the areas where collapse occurs in ONFH and to identify the most effective femoral position for detecting collapse on plain radiography.</div></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 10","pages":"Pages S27-S33"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144220","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":"Characteristics of Osteonecrosis of the Femoral Head After COVID-19 Compared to Corticosteroid-Associated Osteonecrosis of the Femoral Head: A Multicenter, Large Database Study in Japan","authors":"Takashi Imagama MD, PhD ,&nbsp;Wakaba Fukushima MD, PhD ,&nbsp;Wataru Ando MD, PhD ,&nbsp;Yuta Matsuki MD, PhD ,&nbsp;Nobuhiko Sugano MD, PhD ,&nbsp;Takashi Sakai MD, PhD","doi":"10.1016/j.arth.2025.06.052","DOIUrl":"10.1016/j.arth.2025.06.052","url":null,"abstract":"<div><h3>Background</h3><div>Coronavirus disease 2019<span><span> (COVID-19) has been associated with systemic complications in addition to respiratory symptoms, including potential musculoskeletal disorders, such as </span>osteonecrosis of the femoral head (ONFH). The aim of this study was to determine the difference between ONFH after COVID-19 and corticosteroid-associated ONFH using a large-scale ONFH database.</span></div></div><div><h3>Methods</h3><div>We analyzed 5,371 registered ONFH patients from a large multicenter Japanese database, identifying 20 patients (32 hips) who developed ONFH after COVID-19 (COVID-19 group). These were compared with 693 corticosteroid-associated ONFH patients (1,197 hips) from 2020 to 2024 who were unrelated to COVID-19 (corticosteroid group). Patient demographics, Japanese Investigation Committee (JIC) type and stage classification, duration of corticosteroid administration, maximum daily dose, and corticosteroid-pulse therapy were assessed.</div></div><div><h3>Results</h3><div>Patients in the COVID-19 group had significantly shorter corticosteroid administration (2.3 ± 2.9 versus 44.9 ± 65.1 months, <em>P</em> &lt; 0.0001) and lower maximum daily dosages (28.1 ± 19.8 versus 53.2 ± 117.3 mg, <em>P</em> = 0.011). Fewer patients received pulse therapy (15.0% versus 49.4%, <em>P</em> = 0.0025). The COVID-19 group showed a notable men predominance (<em>P</em> = 0.008), and the proportion of JIC type C2 was high (<em>P</em> = 0.027).</div></div><div><h3>Conclusions</h3><div>Osteonecrosis of the femoral head after COVID-19 showed the features of lower corticosteroid use, higher prevalence in men, and higher rate of JIC type C2 compared to corticosteroid-associated ONFH, underscoring the potential impact of COVID-19-related thrombotic pathways. Physicians should be aware of these features and perform appropriate tests as early as possible in COVID-19 patients who have musculoskeletal symptoms, even if corticosteroid use is low.</div></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 10","pages":"Pages S2-S6"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369517","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}