Journal of Arthroplasty最新文献

{"title":"Increased Body Mass Index is Associated with Increased Cost for Primary Total Hip Arthroplasty Irrespective of Complications or Readmissions.","authors":"Frances Akwuole, Kranti C Rumalla, Isaac Sontag-Milobsky, Austin R Chen, Giancarlo Riccobono, Adam I Edelstein","doi":"10.1016/j.arth.2025.03.081","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.081","url":null,"abstract":"<p><strong>Introduction: </strong>Surgeons participating in alternative payment models may encounter financial disincentives in caring for patients whose care requires higher costs for the treatment facility. While smaller studies have shown a positive relationship between body mass index (BMI) and cost in total hip arthroplasty (THA), this question has yet to be examined using data in a nationally representative dataset. We sought to leverage a national dataset to assess the relationship between BMI and cost in THA.</p><p><strong>Methods: </strong>We queried the healthcare dataset from 2016 to 2022 to identify primary THAs using Current Procedural Terminology (CPT) and International Classification of Disease-Procedure Coding System (ICD-PCS) codes (27130, 0SR90xx, 0SRB0xx) with a corresponding osteoarthritis diagnosis (ICD-10-CM: M16). Patient demographics, characteristics, and cost variables were extracted directly from the dataset. Cost was defined by supplies, labor, and equipment and assessed over a 90-day period starting with the index surgical encounter. A multivariate generalized linear model estimated costs across eight BMI categories (World Health Organization (WHO) BMI categories, with BMI > 40 patients grouped into BMI 40 to 45, BMI 45 to 50, and BMI > 50). A linear regression model assessed the effect of BMI on costs. Both models controlled for age, sex, payer, race, the Elixhauser comorbidity index (ECI), and ethnicity.</p><p><strong>Results: </strong>This study examined 10,366 primary THAs completed from 2016 to 2022. The mean BMI was 30.0 (SE ±0.1), the mean index cost was $14,632 (SE 52.9), and the mean 90-day cost was $16,527 (SE 145.4). Index and 90-day costs were lowest in the BMI 25 to 30 cohort ($14,344 and $15,865) and highest for the BMI > 50 cohort ($17,503 and $28,281), respectively. On multivariate analyses, index and 90-day cost increased by $23 and $69, respectively, for every one-point increase in BMI (P < 0.001).</p><p><strong>Conclusions: </strong>Results from this nationally representative dataset demonstrate that increasing BMI is associated with increased index and 90-day costs for total hip arthroplasty. This information may be useful to stakeholders in the development of alternative payment models.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789322","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":"Medicare Reimbursement Trends for Common Hip Arthroplasty Procedures: A Generational Perspective, 2006 to 2024.","authors":"Afshin Anoushiravani, Amir Human Hoveidaei, Gabrielle N Swartz, Reza Katanbaf, James E Feng, Casey M O'Connor, James Nace D O M P T F A O A O, Michael A Mont, Ronald E Delanois","doi":"10.1016/j.arth.2025.03.082","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.082","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess the trends in Medicare reimbursement for common hip arthroplasty procedures from 2006 to 2024.</p><p><strong>Methods: </strong>This study analyzed data from the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule (PFS) from 2006 to 2024 to identify payment trends for the most common orthopaedic procedures related to hip arthroplasty. The study calculated Medicare reimbursement by multiplying Relative Value Units (RVUs) by a CMS-determined conversion factor and adjusted reimbursement rates for inflation to 2024 United States (U.S.) dollars using the Consumer Price Index (CPI) inflation calculator from the U.S. Department of Labor. Projections for future trends were derived from mean values from 2020 to 2024, with data visualizations created in Microsoft Excel.</p><p><strong>Results: </strong>From 2006 to 2024, total reimbursements for medical procedures dropped by 0.1%, while the CPI increased by 55%. This caused the average reimbursement to fall by 35.5%. The biggest decrease was in primary total hip arthroplasty reimbursement, which fell by 40.7%. Additionally, the unadjusted work reimbursement rate for all procedures went down by 6.1%, resulting in a substantial inflation-adjusted decrease of 39.4%. If these trends continue, projections for 2029 suggest an additional projected decline in surgeon reimbursement of 33 to 42%, and work reimbursements could drop by 40 to 50%.</p><p><strong>Conclusion: </strong>From 2006 to 2024, inflation-adjusted Medicare reimbursement for hip arthroplasty has dropped markedly, challenging orthopaedic practices' sustainability. This may lead healthcare providers to see more patients, risking burnout and affecting patient outcomes. Compensation for orthopaedic surgeons should reflect the patient value added. However, this study demonstrates a progressive decrease in physician reimbursement, which could lead to an unneeded financial burden on orthopaedic practices. The focus should be on advocating for better reimbursement policies to maintain practice integrity rather than just increasing patient volume.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789326","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 Women in the Top 100 Most Influential Arthroplasty Publications: A Bibliometric Analysis.","authors":"Camryn Payne, Sayi P Boddu, Nathan Beckett, Alexandra Cancio-Bello, Joshua S Bingham","doi":"10.1016/j.arth.2025.03.073","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.073","url":null,"abstract":"<p><strong>Background: </strong>Women account for 2% of arthroplasty surgeons in the United States. It is important to understand how women contribute to the literature in the field of arthroplasty currently. We compared the proportion of first, middle, and senior authorship by women in the top 100 most-cited hip and knee arthroplasty studies published between 2010 and 2024 to the national proportion of women hip and knee arthroplasty surgeons and evaluated the H-indices of authors by sex.</p><p><strong>Methods: </strong>The literature search was performed on the Clarivate Analytics Web of Knowledge database. Once 100 studies met the inclusion criteria, those that did not originate from the US or whose author first names were not included were excluded. The author's sex was determined by first name. The Scopus author database was utilized to determine the H-index for first and senior authors.</p><p><strong>Results: </strong>There were 91 papers that met the criteria. These papers were produced by a total of 458 authors, of whom 13.7% were women. There were six (7.4%) of 81 unique first authors, 50 (15.8%) of 315 middle authors, and seven (11.3%) of 62 unique senior authors who were women. Women had lower average H-indices than men.</p><p><strong>Conclusion: </strong>Women's contributions to the most influential hip and knee arthroplasty articles are much higher than predicted given their underrepresentation in the field, indicating the substantial value they add to leading arthroplasty research. Despite this, disparities exist for women in authorship rank and H-index. These disparities may be mitigated by intentionally fostering greater support for women throughout all phases of orthopaedic surgery training to improve opportunities for impactful research and career advancement.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789330","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":"Primary Total Hip Arthroplasty in Patients Less Than 30 Years of Age: Durable, But Not Free of Complications.","authors":"Diego J Restrepo, Sergio F Guarin Perez, Breydan H Wright, Robert T Trousdale, Daniel J Berry, David G Lewallen, Rafael J Sierra","doi":"10.1016/j.arth.2025.03.056","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.056","url":null,"abstract":"<p><strong>Background: </strong>Primary total hip arthroplasty(THA) in young patients presents surgical challenges due to preoperative conditions and the likelihood of an active postoperative lifestyle. This study assesses mid-term (mean 7.5 years) survivorship and risk factors for revisions and reoperations in patients aged 30 years or younger undergoing primary THA.</p><p><strong>Methods: </strong>There were 353 patients (428 hips) aged ≤ 30 years who underwent primary THA between 2000- 2020 reviewed. The average follow-up was 7.5 years(range, two to 22),mean age at surgery was 23 years(range, 11 to 30),with 51% being women. The mean BMI was 27(range, 15 to 51). Common diagnoses included osteonecrosis(30%), hip dysplasia(25%), and osteoarthritis(14%). All acetabular components were cementless, with bearing surfaces comprising ceramic-on-highly-cross-linked polyethylene(C-XP) in 192 hips(45%), ceramic-on-ceramic(CoC) in 156 hips(37%), and metal-on-highly-cross-linked polyethylene(M-XP) in 78 hips(18%). Of the stems, 92% were cementless. Data on revision, reoperation, and the latest follow-up were utilized as endpoints in survivorship analyses, employing a Cox regression model to identify predictive variables.</p><p><strong>Results: </strong>Survivorship-free of revision was 97,94,and 88% at five,10, and15 years,respectively, while survivorship-free of any reoperation was 96,93,and 87% at the same time intervals. Complications occurred in 67 cases, with the most common being instability(28%), intraoperative fractures(18%), and periprosthetic joint infection(15%). Index THA secondary to infection increased the risk of reoperation(HR [hazard ratio]=11.48,P =0.0081). 28 mm femoral head sizes and M-XP bearings of increased risk for complications(HR = 1.88,P < 0.043 and HR=1.89,P < 0.031). Cemented femoral components, common in diverse unusual diagnoses, were associated with complications(HR=2.53,P<0.0036), revision(HR=7.79,P<0.0001),and reoperations(HR=8.02,P<0.0001). Atypical approaches, such as extended femoral osteotomy and lateral approaches,were associated with higher complication rates(HR=7.49,P<0.0008 and HR=9.70,P<0.0001,respectively).</p><p><strong>Conclusion: </strong>At 15 years, patients under 30 undergoing modern THA showed high survivorship. Factors associated with increased complexity, such as the use of cemented stems, preoperative infection, and extended approaches, were associated with higher failure rates.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781893","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 the Need for Manipulation Under Anesthesia Following Total Knee Arthroplasty: A Systematic Review and Meta-analysis.","authors":"Sumit Patel, Son Tran, Juliana Overbey, Richa Gupta, Andre Ksajikian, Keith Kenter, Karen Bovid, Yong Li","doi":"10.1016/j.arth.2025.03.064","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.064","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative knee stiffness following total knee arthroplasty (TKA) is a complication that can result in poor patient outcomes, reduced satisfaction, and even necessitate revision surgery. A common treatment for knee stiffness after TKA is manipulation under anesthesia (MUA). The purpose of this systematic review was to identify and evaluate risk factors for stiffness following primary TKA that resulted in MUA.</p><p><strong>Methods: </strong>There were six databases searched from inception to October 1, 2023, with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. There were 1,108 abstracts and 390 full-text articles that were screened for those that included risk factors predictive of MUA following TKA. The risk of biases was assessed using Quality in Prognostic Studies (QUIPS) criteria. Meta-analysis using odds ratio was calculated. The database search yielded 53 studies involving 2,931,517 patients.</p><p><strong>Results: </strong>There were five risk factors that were found to be significant: Younger age (mean differences: -4.23 years; 95% CI [confidence interval]: -8.17 to -0.29), Black race (OR [odds ratio]: 1.94; 95% CI: 1.56 to 2.40), smoking (OR: 1.43; 95% CI: 1.02 to 2.02), preoperative American Society of Anesthesiologists (ASA) score ≤ 2 (OR: 0.64; 95% CI: 0.55 to 0.76), and prior knee procedure (OR: 2.00; 95% CI: 1.49 to 2.69). There was no evidence for sex (OR; 1.30, 95% CI [0.74 to 2.30], P = 0.32), obesity (OR; 0.84, 95% CI [0.67 to 1.05], P = 0.12), and diabetes (OR; 0.85, 95% CI [0.69 to 1.05], P = 0.14) as potential risk factors for stiffness requiring MUA.</p><p><strong>Conclusion: </strong>The results of our meta-analysis indicate that the Black race, younger age, smoking, preoperative ASA scores ≤ 2, and prior knee surgery are strong evidence as risk factors for postoperative need for MUA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781895","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":"Retrospective Review of Outcomes of Total Hip Arthroplasty in Developmental Dysplasia of the Hip in Adults.","authors":"Faran Chaudhry, Adam Bridger, Anser Daud, Arieh Greenberg, Oleg A Safir, Allan E Gross, Paul R Kuzyk","doi":"10.1016/j.arth.2025.03.070","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.070","url":null,"abstract":"<p><strong>Introduction: </strong>Developmental dysplasia of the hip (DDH) is a major cause of hip arthritis in young adults. Total hip arthroplasty (THA) is an effective treatment for DDH, but few studies have examined mid- (5 to 10 years) to long-term (>10 years) outcomes. This study reports the long-term survivorship, clinical, and radiographic outcomes of THA in DDH patients.</p><p><strong>Methods: </strong>A total of 255 patients were included from our retrospective review of THAs from January 2004 to January 2022. Among these cases, 214 (83.9%) were women, the mean age at the time of surgery was 46 years (range, 18 to 87), and the mean follow-up was 8.3 (range, 0.05 to 21.08) years. Kaplan-Meier survivorship analysis was conducted with failure defined as revision surgery for any reason.</p><p><strong>Results: </strong>Kaplan-Meier survivorship for patients who underwent THA to treat DDH due to all-cause failure was 93.4% (95% CI [confidence interval]: 90.3 to 96.5) at five years, 92.5% (95% CI: 89.0 to 95.6) at 10 years, and 90.9% (95% CI: 86.2 to 94.0) at 15 years. The overall rate of revision of the index surgery was 18 of 255 (7.1%). These complications included pain (seven), dislocation (four), aseptic loosening of the cup (three), periprosthetic fracture (two), complete foot drop (one), and infection (one). Kaplan-Meier all-cause survivorship for Hartofilakidis A, B, and C was also conducted and showed no significant differences. The mean femoral offset improved from a preoperative value of 12.18 cm (SD 1.35) to a postoperative value of 11.65 cm (SD 1.05) (P < 0.001). The rate of femoral nerve palsy was 0.78%.</p><p><strong>Conclusion: </strong>Our study suggests THA for DDH is a viable treatment, providing excellent mid-term to long-term survivorship, clinical, and radiographic outcomes with a low complication rate. Future research should evaluate patient-reported outcomes and long-term follow-up in larger cohorts.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781894","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":"Impact of Robotic Assistance on Total Hip Arthroplasty: Granular Insights into Surgical Time.","authors":"Karlos Zepeda, Carmelo Burgio, Theofilos Karasavvidis, Tsion Yared, Cale Pagan, Edward Grabov, Seth A Jerabek, David J Mayman, Jonathan M Vigdorchik","doi":"10.1016/j.arth.2025.03.068","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.068","url":null,"abstract":"<p><strong>Background: </strong>Hospitals need efficiency and cost-effectiveness due to the shift to a value-based healthcare system. While robotic-assisted total hip arthroplasty (RA-THA) provides improved accuracy of component positioning, surgeons are concerned about increased surgical times. This study compared surgical time between RA-THA and manual THA (M-THA) through a granular analysis of individual procedural steps.</p><p><strong>Methods: </strong>This prospective study was conducted at a single institution from February to March 2024. A consecutive series of 50 primary posterior approach THA cases were included, excluding patients who had prior hardware or previous ipsilateral surgery. The study comprised 25 RA-THAs and 25 M-THAs. There were six clinical fellows, supervised by five attending orthopaedic surgeons, who performed the surgeries, representing a typical clinical training scenario. Of the attending surgeons, three conducted RA-THAs using a computed tomography (CT)-based robotic platform, while two performed manual procedures. Key intraoperative steps individually recorded included pin placement, registration, and robotic reaming in the RA-THA group and acetabular reaming in the M-THA group. Multivariate regression models evaluated the impact of robotic assistance on surgical times.</p><p><strong>Results: </strong>Total surgical times were similar for both groups (76 ± 10 versus 77 ± 13 minutes, P = 0.8). Robotic assistance did not significantly affect total surgical time (P = 0.5; 95% CI [confidence interval]: -8.7 to 19.7). The combined time for pin placement, registration, and reaming in RA-THA was comparable to acetabular reaming in M-THA (7 ± 1.1 versus 6.8 ± 1.8 minutes, P = 0.7). Acetabulum reaming in RA-THA was significantly shorter than in M-THA (2.3 ± 0.7 versus 6.8 ± 1.8 minutes, P < 0.001). Pin placement and registration times were 2.2 ±0.9 and 2.4 ± 0.7 minutes, respectively.</p><p><strong>Discussion: </strong>The use of RA-THA does not increase surgical time compared to M-THA, indicating that the use of robotic systems can maintain OR efficiency. The additional time required for robotics seems to be offset by the reduced time needed for acetabular reaming. These findings support the broader adoption of robotic assistance in THA, offering potential benefits without compromising time.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774854","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":"Dexamethasone is Associated with Lower Rates of Pulmonary Complications Following Cemented Femoral Fixation During Primary Total Hip Arthroplasty.","authors":"Andrew Vega, Kevin C Liu, Sagar Telang, Mary K Richardson, Jay R Lieberman, Nathanael D Heckmann","doi":"10.1016/j.arth.2025.03.069","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.069","url":null,"abstract":"<p><strong>Introduction: </strong>The utilization of cemented femoral fixation during total hip arthroplasty (THA) has increased in recent years. Perioperative corticosteroids have been shown to attenuate the inflammatory cascade associated with cement-induced cardiopulmonary complications. Therefore the purpose of this study was to determine if dexamethasone (DEX) utilization was associated with decreased perioperative pulmonary complications associated with cemented THA.</p><p><strong>Methods: </strong>Patients who underwent a cemented THA from January 1, 2015, to December 31, 2021, were identified using a nationwide medical database. There were two cohorts were identified: patients who received intravenous DEX [DEX(+)] and those who did not [DEX(-)] on the day of surgery. The 90-day risk of pulmonary complications was compared between the DEX(+) and DEX(-) cohorts. Multivariable analyses accounting for potentially confounding variables, including demographic, comorbidity, and venous thromboembolic chemoprophylactic agents, were performed. In total, 27,017 cemented THAs were identified, of which 14,743 (54.6%) received DEX and 12,274 (45.4%) did not.</p><p><strong>Results: </strong>The DEX(+) cohort had fewer aggregate pulmonary complications (5.0 versus 8.3%, P < 0.001), was less likely to experience acute respiratory failure (3.6% versus 5.7%, P < 0.001), re-intubation (0.6% versus 1.1%, p<0.001), pneumonia (2.1% versus 4.2%, p<0.001) or pulmonary edema (0.6% versus 1.1, P < 0.001) compared to the DEX(-) cohort. After accounting for potential confounders, the DEX(+) cohort was at decreased risk of aggregate pulmonary complications (adjusted odds ratio [aOR]: 0.83, 95% confidence interval [CI]: 0.74 to 0.92, P = 0.001), pneumonia (aOR: 0.73, 95% CI: 0.63 to 0.85, P < 0.001) and pulmonary edema (aOR: 0.72, 95% CI: 0.54 to 0.96, P = 0.026) compared to the DEX(-) cohort.</p><p><strong>Conclusion: </strong>Perioperative DEX administration was associated with a significantly decreased risk of aggregate pulmonary complications, including pneumonia and pulmonary edema, following cemented THA. Orthopaedic surgeons utilizing cement fixation in THA should consider the utilization of perioperative DEX.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774853","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 Limb Length During Stage One Revision Leads to Higher Rates of Instability Following Stage Two Revision Total Hip Arthroplasty.","authors":"Ian M Clapp, Dalton L Braathen, Brenna E Blackburn, Christopher E Pelt, Lucas A Anderson, Jeremy M Gililland, Michael J Archibeck","doi":"10.1016/j.arth.2025.03.071","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.071","url":null,"abstract":"<p><strong>Background: </strong>Currently, two-stage revision total hip arthroplasty (THA) is the gold standard in managing periprosthetic joint infection (PJI) of the hip, however, complications are common, including instability. The purpose of this study was to determine how alterations in limb length during a stage 1 articulating spacer affect dislocation rates of the stage 2 revision.</p><p><strong>Methods: </strong>A retrospective study of consecutive patients who underwent two-stage revision THA for PJI between December 2013 and December 2022 was performed. We measured limb length as the perpendicular distance from the trans-teardrop line to the apex of the lesser trochanter for all patients after stage 1 articulating spacer implantation. Independent t-tests and logistic regression were used to compare limb lengths following stage 1 spacers between patients who did and did not dislocate after stage 2 implantation.</p><p><strong>Results: </strong>There were 147 patients who underwent staged revisions for the treatment of PJI identified. The cohort was 59% women who have a mean age of 60 years (range, 25 to 84) and an average follow-up time of 2.7 years (range, 1.0 to 9.1). The dislocation rates after stage 1 and stage 2 were 3.0 and 11.7%, respectively. Limb length did not impact dislocation rates of the articulating stage 1 spacers (P = 0.71), but patients who sustained a dislocation following stage 2 were lengthened significantly more at stage 1 implantation than patients who did not dislocate (8.5 ± 15.9 versus 0.8 ± 11.8 mm, P = 0.033). Additionally, the odds of dislocation after stage 2 increased by 7% with each mm lengthened during stage 1 (OR [odds ratio] =1.07, 95% CI [confidence interval] 1.01 to 1.13).</p><p><strong>Conclusion: </strong>During a stage 1 articulating spacer of the hip, limb length restoration is often disregarded, which can result in overlengthening that may necessitate subsequent shortening during stage 2 reconstruction. This study demonstrates that overlengthening of an articulating stage 1 hip spacer can place the patient at increased risk of dislocation following stage 2 reconstruction and should be avoided when possible.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774855","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":"Medicare May Be Broken, But the Sky Is Not Falling.","authors":"Giles R Scuderi, Michael A Mont, Richard Iorio, Ronald E Delanois","doi":"10.1016/j.arth.2025.03.076","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.076","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755659","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}