Journal of Arthroplasty最新文献

{"title":"Robotic-Assisted Total Hip Arthroplasty Provides Greater Implant Placement Accuracy and Lower Complication Rates, But Not Superior Clinical Results Compared to the Conventional Manual Approach: A Systematic Review and Meta-Analysis.","authors":"Alessandro Bensa, Gherardo Pagliazzi, Antonio Miele, Guglielmo Schiavon, Marco Cuzzolin, Giuseppe Filardo","doi":"10.1016/j.arth.2024.12.014","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.014","url":null,"abstract":"<p><strong>Background: </strong>Accurate component placement plays a critical role in the outcome of total hip arthroplasty (THA). Robotic-assisted THA (R-THA) has emerged as an option to optimize this aspect compared to the conventional manual THA (C-THA). The aim of this meta-analysis was to analyze the studies comparing R-THA and C-THA. The hypothesis was that the use of robotic technology could improve component positioning, but this advantage may not translate into clinically relevant benefits.</p><p><strong>Methods: </strong>The literature search was conducted on three databases (PubMed, Cochrane Library, Web of Science) in January 2024. The screening process and analysis were conducted separately by two independent observers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria were comparative studies, English language, no time limitation, and focusing on the comparison of R-THA and C-THA. Among the 1,883 articles retrieved, 38 studies (10,055 patients) were included. The meta-analysis covered radiological outcomes, clinical outcomes, and perioperative parameters, complications, and revisions. The quality of each article was assessed using the \"Downs and Black's Checklist for Measuring Quality.\"</p><p><strong>Results: </strong>Robotic THA provided superior radiological results compared to C-THA in terms of acetabular cup placement within the Lewinnek safe zone (P < 0.01) and horizontal change of the rotation center (P = 0.03). No statistically significant difference was obtained in terms of clinical scores between the two approaches, including Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index, Forgotten Joint Score, and Merle d'Aubigné Hip Score. Robotic THA showed longer operative time (P < 0.01), but lower complication rates (P = 0.04). No difference was obtained in terms of intraoperative blood loss and revision rates.</p><p><strong>Conclusion: </strong>The results of this meta-analysis suggest that R-THA can provide more accurate cup placement and better restoration of the native hip anatomy while reducing complication rates compared to C-THA. However, these benefits did not translate into clinical differences in terms of patient-reported outcomes between the two approaches, and R-THA required longer operative time. While the overall results suggest some benefits with the robotic technology, future studies should investigate if further technical improvements will translate into clinically relevant benefits for patients undergoing THA.</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":"142878523","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":"Periprosthetic Joint Infection and Concomitant Sepsis: Unveiling Clinical Manifestations, Risk Factors, and Patient Outcomes.","authors":"Susanne Baertl, David Lovasz, Martin G Kees, Nike Walter, Melanie Schindler, Jing Li, Jan Reinhard, Volker Alt, Markus Rupp","doi":"10.1016/j.arth.2024.11.062","DOIUrl":"10.1016/j.arth.2024.11.062","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the epidemiology, risk factors, and outcomes of sepsis, a life-threatening complication, in the context of periprosthetic joint infections (PJIs) of the hip and knee.</p><p><strong>Methods: </strong>Sepsis was determined using the sepsis-1 criteria. The cohort with PJI and sepsis was compared to patients who had PJI without sepsis. Analyzed risk factors were patient characteristics, microbiological findings, and comorbidities. Outcome parameters were mortality, length of hospital stay, and intensive care unit stay. Among 108 PJIs (48 hips and 60 knees), 40.6% met the sepsis criteria.</p><p><strong>Results: </strong>In hip PJI, the sepsis group had a higher Charlson Comorbidity Index (4.0 versus 1.0; P ≤ 0.001) with Staphylococcus aureus infections more common in septic cases (9 of 17 versus 6 of 31; P = 0.04). Renal (odds ratio (OR) 16.9; P ≤ 0.001) and cardiac (OR 12.5; P = 0.02) disease increased sepsis risk. Sepsis correlated with prolonged hospital stays (54 versus 24 days; P = 0.002) and increased mortality (23.5 versus 3.2%; P = 0.047). In knee PJI cases, septic patients had more Staphylococcus aureus PJI (14 of 28 versus 8 of 32; P = 0.04). Atrial fibrillation (OR 3.3; P = 0.04) and renal disease (OR 4.0; P = 0.02) were associated with sepsis. Sepsis cases had longer hospital stays (48 versus 29.5 days; P = 0.01) and higher intensive care unit admissions (67.9 versus 34.4%; P = 0.02). In-hospital mortality was 10-fold higher in the sepsis cohort (25.0 versus 3.3%; OR 10.3, P = 0.02).</p><p><strong>Conclusions: </strong>In a considerable number of patients, PJI can lead to a septic course associated with increased mortality. This underscores the need for close monitoring to prevent overlooking these patients' deteriorating clinical conditions. Timely interventions, akin to the \"every hour counts\" approach in sepsis management, might help reduce morbidity and mortality in these patients.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873481","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":"Evaluating the Use of Dexamethasone in Diabetic Patients Undergoing Total Joint Arthroplasty: A Systematic Review and Meta-analysis.","authors":"Daniel Razick, Muzammil Akhtar, Ubaid Ansari, Nabeal Dean, Maaz Azim, Mustafa Jundi, Zachary C Lum","doi":"10.1016/j.arth.2024.12.018","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.018","url":null,"abstract":"<p><strong>Background: </strong>The American Association of Hip and Knee Surgeons (AAHKS) strongly recommends the use of dexamethasone in patients undergoing total joint arthroplasty (TJA) due to its therapeutic effects. However, use in diabetic patients is controversial due to safety. Therefore, the objective of this study was to determine safety: (1) calculating the post-operative glucose levels; (2) finding the ideal dexamethasone dosing regimen; and (3) reporting complications of dexamethasone administration in diabetic patients undergoing TJA.</p><p><strong>Methods: </strong>A search was performed utilizing the Boolean search phrase \"((dexamethasone) AND (diabetic)) AND (((total joint) OR (total knee)) OR (total hip)).\" Postoperative day (POD) one, two, and three glucose levels were compared between intervention and control groups with a random effects proportion meta-analysis weighted for individual study size. Weighted means and standard deviations were calculated for postoperative glucose levels. Across the 12 studies, 46,685 patients were included, of which 23,892 received at least one dose of dexamethasone.</p><p><strong>Results: </strong>Dexamethasone administration in diabetic patients resulted in significantly elevated mean glucose levels (mg/dL) on POD1 compared to patients in whom dexamethasone was withheld (170.1 ± 5.3 versus 158.1 ± 5.8, P = 0.0007). However, 95% confidence interval levels were below the 200 mg/dL threshold. Additionally, there were no significant differences on POD2 (P = 0.23) and POD3 (P = 0.16). The risk of infection was not significantly different between the intervention and control groups (risk ratio: 0.82, 95% CI [confidence interval]: 0.39 to 1.72, P = 0.61). Due to the heterogeneity of data, and only four studies reporting exact dosages as opposed to ranges, an ideal dosage of dexamethasone could not be found.</p><p><strong>Conclusion: </strong>Administration of perioperative dexamethasone in diabetic patients appears to be safe. Further investigation is warranted regarding dosage and timing of administration to optimize beneficial effects of dexamethasone while preventing excessive hyperglycemia in diabetic patients.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873521","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":"Analysis of Synovial Fluid Aspirations in Aseptic Loosening and Instability After Total Knee Arthroplasty.","authors":"Zachary K Christopher, Dalton Braathen, Brenna E Blackburn, Lucas A Anderson, Jeremy M Gililland, Christopher E Pelt, Michael J Archibeck","doi":"10.1016/j.arth.2024.12.017","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.017","url":null,"abstract":"<p><strong>Introduction: </strong>Aseptic total knee arthroplasty (TKA) complications can be challenging to diagnose. Many studies have defined periprosthetic joint infection (PJI) using synovial aspirations, but few studies have described aspiration characteristics in aseptic TKA problems. The aim of this study was to determine the synovial fluid characteristics of patients who had TKA failure caused by two common aseptic diagnoses: aseptic loosening and instability. We sought to compare the characteristics between these groups in addition to the failure caused by PJI.</p><p><strong>Methods: </strong>A retrospective study was performed in which consecutive patients who had a preoperative knee aspiration and underwent TKA revision for one of three diagnoses (PJI, aseptic loosening, or instability) were evaluated. Clinical notes were used to obtain demographics, comorbidity data, aspiration cell count, and differential to compare among the groups. There were 399 patients included: 240 PJI, 103 aseptic loosening, and 56 instability.</p><p><strong>Results: </strong>There were significant differences between mean white blood cell (WBC) count and polymorphonuclear, lymphocyte, and monocyte percentages between all groups. Findings consistent with a diagnosis of aseptic loosening included a mean WBC count of 1,021.9 cells/μL with 29.7% polymorphonuclear leukocyte (PMNs), 32.7% lymphocytes, and 44.6% monocytes, and relatively elevated PMN/lymphocyte (2.1) and PMN/monocyte (3.5) ratios. Findings consistent with a diagnosis of instability included a mean WBC count of 1,261.2 cells/μL with 23.5% PMNs, 35.6% lymphocytes, and 50.0% monocytes, and a relatively lower PMN/lymphocyte (1.1) and PMN/monocyte (1.5) ratios compared to aseptic loosening. In both aseptic loosening and instability, there were significantly more lymphocytes and monocytes than in PJI. In addition, instability cases had a higher mean red blood cell (RBC) count of 405,996.9 cells/μL (P = 0.012).</p><p><strong>Conclusions: </strong>Differentiating between instability and aseptic loosening in TKA remains a diagnostic challenge. This study provides insight into the cellular pathophysiology of aseptic TKA complications and can be used to aid in clarifying the diagnosis of aseptic loosening versus instability.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873514","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 Impact of Patient Resiliency on Successful Same-Day Discharge and Postoperative Outcomes in Primary Total Hip and Knee Arthroplasty.","authors":"J Weston Robison, Zachary Wuthrich, Carson L Keeter, Michael Dayton, Craig Hogan, Ryan Koonce","doi":"10.1016/j.arth.2024.12.012","DOIUrl":"10.1016/j.arth.2024.12.012","url":null,"abstract":"<p><strong>Background: </strong>Total hip (THA) and knee arthroplasty (TKA) rates in the outpatient setting continue to increase in the United States. Patient resiliency is one facet surgeons may consider when determining whether a patient would make a suitable candidate for same-day discharge (SDD). This study examined the relationship between resilience and success of SDD in patients undergoing primary THA and TKA.</p><p><strong>Methods: </strong>A retrospective review was conducted to examine the effects of preoperative resiliency scores (Pain Self-Efficacy Questionnaire Abbreviated Two-Item Form [PSEQ-2]) on SDD rates and patient-reported outcome measures (PROMs) at 3 months and 1 year postoperatively. Data analyses utilized logistic regressions to evaluate the odds of SDD success with preoperative PSEQ-2 resiliency scores. Mixed linear models were utilized to evaluate the relationship between preoperative PSEQ-2 resiliency scores and postoperative PROMs.</p><p><strong>Results: </strong>Of the cohort of 700 (TKA) patients, after controlling for confounding factors such as age and body mass index patients who were discharged home on the day of surgery had significantly higher preoperative PSEQ-2 scores (P = 0.022). Of the cohort of 530 THA patients, again after controlling for confounding factors such as age and body mass index, patients who were discharged home on the day of surgery trended toward significantly higher preoperative PSEQ-2 scores, although statistical significance was not reached (P = 0.058). There was a significant inverse relationship seen between preoperative PSEQ-2 scores and Global Mental Health scores at 3 months and 1 year postoperatively (P = 0.023). No other statistically significant relationships were seen between preoperative PSEQ-2 and the other PROMs.</p><p><strong>Conclusions: </strong>Preoperative resiliency scores were significantly higher in patients undergoing primary THA and TKA that were discharged home on the day of surgery. Preoperative resiliency scores did not predict higher postoperative PROMs.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856431","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 Direct Anterior Approach Total Hip Arthroplasty: A 6.5-Fold Reduction in Fluoroscopic Radiation Exposure.","authors":"Colin C Neitzke, Claude J Regis, Pravjit Bhatti, Shu-Han Wang, Eytan M Debbi, Elizabeth B Gausden, Alexander S McLawhorn, Brian P Chalmers","doi":"10.1016/j.arth.2024.12.011","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.011","url":null,"abstract":"<p><strong>Introduction: </strong>Direct anterior approach (DAA) for total hip arthroplasty (THA) is increasing in popularity. Fluoroscopy is commonly utilized during DAA THA to increase the accuracy of component placement. The objective of this study was to compare the mean fluoroscopy time and radiation dose for DAA THA when utilizing robotic-assistance (RA), computer-assisted navigation (CAN), or manual (M) technique.</p><p><strong>Methods: </strong>A retrospective review identified 6,541 patients who underwent primary, unilateral DAA THA between 2016 and 2023, including 4,333 M-THA, 1,158 RA-THA, and 1,050 CAN-THA. The mean age was 65 years (range, 20 to 96), the mean body mass index was 26 (range, 15 to 56), and 63% were women. The mean fluoroscopy time (seconds) and radiation dose in milliGray (mGy) were compared between cohorts. Regression analysis controlled for differences in baseline demographics.</p><p><strong>Results: </strong>The RA-THA cohort had a shorter mean fluoroscopy time (4.4 ± 5.6 seconds) than both the CAN-THA (17.6 ± 9.1 seconds, P < 0.001) and M-THA (21.8 ± 39.4 seconds, P < 0.001) cohorts. The CAN-THA cohort also had a shorter mean fluoroscopy time than M-THA cases (P < 0.001). The RA-THA cohort had a smaller mean fluoroscopic radiation dose (0.4 ± 0.6 mGy) than both CAN-THA (2.6 ± 2.2 mGy, P < 0.001) and M-THA (2.5 ± 2.5 mGy, P < 0.001). There was no difference in fluoroscopic radiation dose between the M-THA and CAN-THA cohorts (P = 0.822).</p><p><strong>Conclusion: </strong>In this series of DAA THA, RA-THA required a 4.0 to 5.0-fold shorter mean fluoroscopy time and a 6.5-fold smaller mean fluoroscopic radiation dose compared to CAN-THA and M-THA. As DAA THA volume increases, surgeons should consider the cumulative radiation exposure to themselves, patients, and operating room staff.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830299","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 do Patient-Reported Outcomes Correlate with Real-Time Objective Measures of Function after Total Knee Arthroplasty? A Prospective Study Using Daily Gait Metrics.","authors":"Kevin A Wu, David N Kugelman, Rahul K Goel, Eric S Dilbone, Sean P Ryan, Samuel S Wellman, Michael P Bolognesi, Thorsten M Seyler","doi":"10.1016/j.arth.2024.12.007","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.007","url":null,"abstract":"<p><strong>Introduction: </strong>Patient-reported outcome measures (PROs) are essential for evaluating patients undergoing total knee arthroplasty (TKA). While wearable technologies offer objective measures of physical function through Apple HealthKit, their relationship with PROs in TKA patients is not well understood. We investigated the association between commonly used PROs and objective measures of physical function in patients undergoing TKA.</p><p><strong>Methods: </strong>We conducted a prospective cohort study involving 152 patients undergoing unilateral TKA, assessing PROs (Knee Injury and Osteoarthritis Outcome Score, Joint Replacement [KOOS, JR] and EuroQol Five-Dimensional Questionnaire [EQ-5D]) and objective HealthKit metrics (gait speed, step count, standing duration, steadiness, estimated six-minute walk test) before and at one, six, and 12 months after surgery. Pearson correlation coefficients were used to analyze the relationship between PROs and HealthKit metrics at each time point, adjusting for multiple comparisons.</p><p><strong>Results: </strong>Significant improvements were observed in PROs post-TKA. The KOOS, JR scores improved from 52.1 ± 11.9 and rest preoperatively to 82.5 ± 13.2 at 12 months postoperatively (P < 0.001), and EQ5D scores improved from 73.9 ± 17.8 to 85.7 ± 11.6 over the same period (P < 0.001). However, correlations between PROs and HealthKit metrics were consistently low (mean r = 0.2 to 0.3) and not significant after adjusting for multiple comparisons at various operative time points. Notably, correlations among HealthKit metrics themselves remained high, indicating that objective measures were internally consistent but not strongly related to PROs.</p><p><strong>Conclusion: </strong>Despite their importance in patient-centered care, PROs may not fully reflect actual physical function. Clinicians should consider incorporating objective measures, such as those provided by HealthKit, into routine assessments to obtain a more comprehensive view of patient recovery post-TKA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820177","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":"Floating Knee Arthrodesis after Periprosthetic Knee Infection: A Multi-Center Study.","authors":"Amparo Ortega-Yago, Aranza Pedraza-Corbi, Laia Boadas-Gironès, Kushal Lakhani, Marta Sabater-Martos, Pablo S Corona, Ignacio Baixauli-García, Francisco Argüelles-Linares, Jose Baeza-Oliete","doi":"10.1016/j.arth.2024.12.009","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.009","url":null,"abstract":"<p><strong>Background: </strong>Knee arthrodesis is a means of avoiding above-knee amputation after a periprosthetic joint infection (PJI). The objective of this study was to analyze the results of floating knee arthrodesis in patients who had a history of a periprosthetic knee infection and to perform an external validation of the BAOR Scale (Baeza-Ortega scale). The analysis consisted of determining reinfection rates, functional results, and the survival of arthrodesis.</p><p><strong>Methods: </strong>There were 86 patients who had undergone floating knee arthrodesis in cases of PJI who were retrospectively included in the study. The operations were performed between 2012 and 2022 at three different referral centers for complex bone and joint infections in Spain. In addition to being evaluated clinically, analytically, and radiographically, the patients were assessed functionally with the BAOR scale, which had been previously validated. At a mean follow-up of four years (range, one to nine), 13 patients suffered reinfection (15%), and 29% of patients experienced complications with an average of 42 months until a complication appeared.</p><p><strong>Results: </strong>The recurrence of infection was not observed to be significantly affected by sex (P = 0.13), age (P = 0.1), or the type of surgery previously undergone (P = 0.17), nor was the McPherson Host Grade (P = 0.4) observed to have a significant effect. Patients who had a McPherson Limb Grade 3 were more likely to suffer reinfection than those with a McPherson Limb Grade 2 (P = 0.036). There were 45 patients (53%) who were fully evaluated and scored. For 16 patients (35%), the results were evaluated as excellent, for 22 (48%) acceptable, for six (14%) low, and for one (3%) poor. There was a significant correlation between patient satisfaction and functional outcomes (P = 0.0006).</p><p><strong>Conclusions: </strong>The arthrodesis nail without bone-bone fusion is an effective and safe procedure for patients who have a recurrent PJI, providing satisfactory functional results when a knee prosthesis revision cannot be performed.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820172","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":"Utilization of Glucagon-Like Peptide-1 Receptor Agonist at the Time of Total Hip Arthroplasty for Patients Who Have Morbid Obesity.","authors":"Billy I Kim, Tyler K Khilnani, Scott M LaValva, Susan M Goodman, Alejandro G Della Valle, Gwo-Chin Lee","doi":"10.1016/j.arth.2024.12.008","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.008","url":null,"abstract":"<p><strong>Background: </strong>Morbid obesity negatively affects outcomes after total hip arthroplasty (THA). The optimal strategy for weight loss before THA has not been identified. Recently, glucagon-like peptide-1 receptor agonists (GLP-1 RA) have become increasingly popular as an effective pharmacologic weight loss agent. The goal of this study was to evaluate the effect of perioperative GLP-1 RA use in patients who have morbid obesity undergoing primary THA on postoperative outcomes.</p><p><strong>Methods: </strong>Using an administrative claims database, patients who had morbid obesity (body mass index [BMI] ≥ 40.0) undergoing primary THA were identified. Patients who had morbid obesity and GLP-1 RA use for three months before and after surgery (treatment) were matched to patients who had morbid obesity without GLP-1 RA use (control) and to a comparison group of patients who had severe obesity (BMI = 35.0 to 39.9) in a 1:4:4 ratio, resulting in 771, 3,084, and 3,084 patients in the treatment, control, and severe obesity comparison group, respectively. Overall group differences in 90-day and 2-year postoperative outcomes were compared using univariable tests, followed by post hoc pairwise testing and P-value adjustment.</p><p><strong>Results: </strong>Patients who had morbid obesity on GLP-1 RA had a significantly lower rate of 90-day periprosthetic joint infection (PJI) (1.6 versus 3.2%; P = 0.03), readmission (6.9 versus 9.7%; P = 0.04), any medical complication (10.5 versus 14.1%; P = 0.03), and postoperative hematoma formation (0 versus 1.3%, P < 0.01) compared to controls. Patients who had morbid obesity on GLP-1 RA demonstrated lower rates of hematoma formation (0 versus 1.0%; P <0.01) compared to patients who had severe obesity (BMI = 35.0 to 39.9). There were no differences in 2-year surgical complications.</p><p><strong>Conclusion: </strong>Perioperative use of GLP-1 RA in patients who had morbid obesity is associated with reduced risk of acute PJI and 90-day hospital readmission. The risk is reduced to a level comparable to obese patients who have a BMI < 40.0. Randomized controlled trials are necessary to determine the true effect and mechanism of action.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814872","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 Early Hospital Discharge Following Revision Total Hip Arthroplasty: An Analysis of a Large National Database Using Machine Learning.","authors":"Teja Yeramosu, Jacob M Farrar, Avni Malik, Jibanananda Satpathy, Gregory J Golladay, Nirav K Patel","doi":"10.1016/j.arth.2024.12.006","DOIUrl":"10.1016/j.arth.2024.12.006","url":null,"abstract":"<p><strong>Background: </strong>Revision total hip arthroplasty (rTHA) was recently removed from the Medicare inpatient-only list. However, appropriate candidate selection for outpatient rTHA remains paramount. The purpose of this study was to evaluate the utility of a large national database using machine learning (ML) and traditional multivariable logistic regression (MLR) models in predicting early hospital discharge (EHD) (< 24 hours) following rTHA. Furthermore, this study aimed to use the trained ML models, cross-referenced with traditional MLR, to determine key perioperative variables predictive of EHD following rTHA.</p><p><strong>Methods: </strong>Data were obtained from a large national database from 2021. Patients who had unilateral rTHA procedures were included. Demographic, preoperative, and operative variables were analyzed as inputs for the models. An ML regression model and various ML techniques were used to predict EHD and were compared using the area under the curve, calibration, Brier score, and decision curve analysis. Feature importance was identified from the overall best-performing model. Of the 3,097 patients in this study, 866 (27.96%) underwent EHD.</p><p><strong>Results: </strong>The random forest model performed the best overall and identified aseptic surgical indication, operative time < three hours, absence of anemia (hematocrit < 40% in men and < 35% in women), neuraxial anesthesia type, White race, men, independent functional status, body mass index > 20, age < 75 years, and the presence of home support as factors predictive of EHD. Each of these variables was also significant in the MLR model.</p><p><strong>Conclusions: </strong>Each ML model and MLR displayed good performance and identified clinically important variables for determining candidates for EHD following rTHA. Machine learning (ML) techniques such as random forest may allow clinicians to accurately risk stratify their patients preoperatively to optimize resources and improve patient outcomes.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814869","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}