Journal of Arthroplasty最新文献

{"title":"Revision Total Knee Arthroplasty for Juvenile Idiopathic Arthritis: Implant Survivorship and Clinical Outcomes the Second Time Around.","authors":"Ryan Cheng, Francesca R Coxe, Yu-Fen Chiu, Hannah Szapary, Katherine Hwang, Antonia F Chen, Stuart Goodman, Vivek M Shah, Mark P Figgie, Jason L Blevins","doi":"10.1016/j.arth.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.019","url":null,"abstract":"<p><strong>Background: </strong>Juvenile idiopathic arthritis (JIA) is a rare disease that oftentimes requires treatment with total knee arthroplasty (TKA). While studies have examined the outcomes of primary TKA for this cohort, the literature on 10- and 20-year revision TKA implant survivorship and clinical outcomes is limited.</p><p><strong>Methods: </strong>A multi-center retrospective review identified 63 patients who underwent 70 revision TKAs between June 1, 1987, and September 30, 2020. The primary and secondary outcomes of interest were long-term implant survivorship and clinical outcomes, respectively. Patient-reported outcomes were assessed between April 1, 2020, and December 31, 2022. The average age was 47 years (range, 21 to 75). The mean follow-up was 12 years (range, 1.2 to 32.8) for both implant survivorship and patient-reported outcomes.</p><p><strong>Results: </strong>Implant survivorship for revision TKA in JIA patients was 86% (95% Confidence Interval (CI): 77 to 94) at five years, 75% (95% CI: 65 to 86) at 10 years, and 70% (95% CI: 59 to 81) at 20 years. The mean Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) score was 72.8 ± 16.1 points, with 53% (18 of 34 patients, 21 of 38 TKAs) reaching the KOOS JR patient acceptable symptom state (PASS) threshold. Risk factors for re-revision included the use of constrained prostheses (Hazards Ratio (HR): 6.0, 95% CI [1.3 to 28.6], P = 0.025). The most common reasons for re-revision were implant loosening/instability (eight TKAs, 40%), pain/synovitis (eight TKAs, 40%), and infection (four TKAs, 20%).</p><p><strong>Conclusion: </strong>Revision TKA implant survivorship for JIA patients is modest at 10 years and 20 years after surgery. Patient-reported outcomes were similar to those previously reported for revision TKA. Re-revision risk increased with higher levels of constraint. Surgeons should be aware of these outcomes and risk factors when counseling and treating these patients the second time around.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665301","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":"Vancouver B Fractures After Using Cementless Femoral Fixation: A Single Center Experience.","authors":"Zachary A Mosher, Alexander V Strait, Nicholas R Olson, Jared A Wolfe, Henry Ho, Robert H Hopper, William G Hamilton","doi":"10.1016/j.arth.2025.03.024","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.024","url":null,"abstract":"<p><strong>Background: </strong>Cementless stems have been the predominant type of femoral component used for total hip arthroplasty (THA) in the United States for several decades. However, recent literature has reported an increased periprosthetic fracture (PPFx) rate and complications associated with these components, particularly among older patients. This study evaluated the incidence and outcome of Vancouver B PPFx after primary THA using cementless stems.</p><p><strong>Methods: </strong>A single institution's database was used to identify 12,400 primary THAs performed from 2009 through 2023. The mean age at surgery was 64 years, and 57% of THAs were performed among women. All postoperative PPFx were identified, and those classified as Vancouver B were evaluated for treatment method and secondary reoperations.</p><p><strong>Results: </strong>Among 72 postoperative PPFx, 34 were classified as Vancouver B for an overall rate of 0.27% (34 of 12,400). The median time from THA to Vancouver B PPFx was 33 days. Patients over 75 years of age at surgery had a higher rate of Vancouver B PPFx (0.6%, 13 of 2,094) compared to patients 18 to 75 years of age at surgery (0.2%, 21 of 10,306, P < 0.001). Type C3 triple-taper collared titanium stems had a lower fracture rate (0.1%, four of 4,748) compared to Type A flat taper stems (0.7%, 23 of 3,105, P < 0.001). In patients over 75 at surgery, Type C3 stems had a lower fracture rate (0.3%, three of 923) compared to Type A stems (1.5%, seven of 472, P = 0.04). There were 28 patients who had Vancouver B fractures (82%) who underwent reoperation. Secondary reoperations were performed among 25% (seven of 28) of THAs, and three of these involved periprosthetic joint infection.</p><p><strong>Conclusion: </strong>Consistent with other reports, the Vancouver B PPFx rate was higher in patients over the age of 75 at surgery. At our institution, Type C3 triple-taper collared titanium stems lowered the PPFx fracture rate in all age groups, including those over age 75 at surgery. Secondary reoperations remain highly morbid to patients.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665360","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":"Increased Lengths of Stay and Denial Rates Seen with Managed Care Organizations Following Total Hip Arthroplasty.","authors":"Reza Katanbaf, Gabrielle N Swartz, Jeremy A Dubin, Sandeep S Bains, Michael A Mont, James Nace, Ronald E Delanois","doi":"10.1016/j.arth.2025.03.028","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.028","url":null,"abstract":"<p><strong>Introduction: </strong>As Medicaid has expanded in response to the Affordable Care Act, managed care organizations (MCOs) have become the main healthcare delivery service for beneficiaries. These plans have prior authorization denial rates of over 12%. This finding warrants an ongoing evaluation of potentially modifiable barriers to access to care, such as denial rates, and how this restriction ultimately impacts patient care. This study compared patient characteristics, including age and the Charlson Comorbidity Index (CCI), lengths of stay, discharge dispositions, and denial rates following primary and revision total hip arthroplasty (THA) between patients who had MCOs and commercial insurance from 2020 to 2023.</p><p><strong>Methods: </strong>We reviewed our institutional database to identify patients who underwent primary or revision THA from 2020 to 2023. After excluding patients who had other insurance payer types, a history of hip fracture, and a history of malignancy, we identified 543 patients who underwent primary THA (MCO (n = 211); Commercial (n = 332)) and 96 patients who underwent revision THA (MCO (n = 26); Commercial (n = 72)). We analyzed patient demographics (age and the CCI), LOS, and denial rates between the two cohorts for primary and revision THA.</p><p><strong>Results: </strong>For patients who underwent primary THA, those who had MCO plans had similar CCIs (1.7 versus 1.7, P = 0.86) but were younger (54 versus 58 years, P < 0.0001) than those who had commercial plans, respectively. For patients who underwent revision THA, those who had MCO plans had a similar average age (53 versus 57 years, P = 0.25) and CCI (1.6 versus 1.7, P = 0.71) as those who had commercial plans, respectively. The average length of stay was significantly higher in the MCO cohort compared to the commercial cohort for primary THA (2.5 versus 1.2, P < 0.0001) and revision THA (6.6 versus 2.9 days, P = 0.0001), respectively. The denial rate was significantly higher in the MCO cohort compared to the commercial cohort for primary THA (2.8 versus 0.7%, P < 0.0001) and revision THA (2.4 versus 0.6%, P < 0.0001), respectively.</p><p><strong>Conclusion: </strong>Lengths of stay and denial rates were higher in the MCO cohort than in the commercial cohort. This could lead to decreased provider participation and potentially serve as a barrier to care for patients who have MCO plans.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665253","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 Preoperative Colonoscopy on Revision Surgery Risk in Primary Total Knee Arthroplasty: A Comprehensive Population-Based Analysis.","authors":"Talal Al-Jabri, Matthew J Wood, Lauren L Nowak, Emil Schemitsch","doi":"10.1016/j.arth.2025.03.022","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.022","url":null,"abstract":"<p><strong>Background: </strong>In the same age group of patients undergoing TKA, colonoscopies are performed commonly as part of national colorectal cancer screening pathways. Several authors have reported PJI cases after colonoscopy, suggesting transient bacteremia as a potential mechanism for hematogenous seeding. However, the effect of preoperative colonoscopy on the risk of PJI in prospective TKA patients has been minimally studied. This study aimed to investigate the relationship between preoperative colonoscopy and reoperation and revision rates in TKAs performed for osteoarthritis, using data from Ontario's healthcare databases.</p><p><strong>Methods: </strong>This retrospective cohort study identified adults undergoing TKA for osteoarthritis in Ontario, Canada, between 2003 and 2022 through linked databases (CIHI, DAD, and OHIP). Propensity-score matching, Cox-Proportional-Hazards regression analysis, Nelson-Aalen curves, and log-log-survival curves were used to evaluate the effect of preoperative colonoscopy on the risk of reoperation and revision arthroplasty due to PJI.</p><p><strong>Results: </strong>Having a colonoscopy in the three months before TKA was associated with a significantly increased risk of TKA-related reoperation and revision TKA (rTKA) (HR [hazard ratio] 2.20; 95% CI [confidence interval] 1.05 to 4.63 and HR 2.59; 95% CI 1.16 to 5.80, respectively). In addition, patients who underwent colonoscopy in the 12 months before TKA had a 1-year rTKA rate of 1.0% compared to 0.5% of patients who did not undergo a colonoscopy in the same time period (P = 0.020). However, having a colonoscopy in the 12 months before TKA was not associated with a significantly increased risk of TKA-related reoperation (HR 1.43; CI 0.88 to 2.32) or rTKA (HR 1.62; CI 0.94 to 2.78) on multivariate logistic regression analyses.</p><p><strong>Conclusion: </strong>This study demonstrated a statistically significant association between having a colonoscopy in the three months preceding TKA and increased rates of both TKA-related reoperation and rTKA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665250","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":"Broach Only Total Hip Arthroplasty Using a Short, Uncemented, Collarless, Fit-and-Fill Stem: Average 5-year Follow-up.","authors":"John B Meding, Meding Lindsey K, Evan R Deckard, Leonard T Buller, R Michael Meneghini","doi":"10.1016/j.arth.2025.03.032","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.032","url":null,"abstract":"<p><strong>Introduction: </strong>Short femoral stem use in total hip arthroplasty (THA) can preserve bone stock and may diminish may thigh pain. Tapered-wedge short stems are appealing because reaming is not typically required as it is with classic \"fit-and-fill\" designed stems. This study aimed to evaluate the minimum 2-year clinical, radiographic, and clinical results of a short, uncemented, collarless, fit-and-fill stem implanted using a broach-only technique.</p><p><strong>Methods: </strong>The clinical and radiographic results of a consecutive series of 505 cementless THAs were reviewed two to nine years postoperatively. The average age was 62 years (range, 32 to 91), and 54% of the patients were men. Dorr's class was 31% A, 64% B, and 5%C. All patients were followed for a minimum of two years. The average follow-up was 5.6 years (range, two to nine).</p><p><strong>Results: </strong>At the final follow-up, the average Harris hip and pain scores were 90 and 42, respectively. There were 82% of hips were rated as pain-free. A single patient reported activity-related thigh pain. There were no cases of femoral aseptic loosening. At operation, 14% of stems were placed in more than five degrees of varus. An intraoperative femur fracture occurred in 13 hips (2.5%). There were two stems were revised (one infection and one late femur fracture).</p><p><strong>Conclusion: </strong>The theoretical advantages of using this collarless fit-and-fill stem may be offset by the tendency for varus placement and proximal femur fracture when using a broach-only technique. Nevertheless, the varus stems in this series remain well-ingrown and radiographically stable at average five-year follow-up.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665276","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":"Pediatric Patients Undergoing Total Hip Arthroplasty: A Single Center Experience at Average 5.3 Year Follow-Up.","authors":"Jennifer X Hong, Avi Dravid, Wudbhav N Sankar, Neil P Sheth","doi":"10.1016/j.arth.2025.03.017","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.017","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) is an increasingly popular option for pediatric end-stage hip disease. However, data regarding implant longevity and functional outcomes remain limited. This case series evaluated complication and revision rates, patient-reported outcome measures (PROMs), and implant survivorship in consecutive pediatric THA patients from a single surgeon. We hypothesized that pediatric patients would have low revision rates and excellent functional outcomes at five-year follow-up.</p><p><strong>Methods: </strong>Following institutional review board approval, 74 patients under age 21 who underwent 92 THAs between 2013 and 2023 were identified. Age, etiology, follow-up interval, complications, revisions, and pre- and postoperative PROMs were recorded. The mean follow-up was 5.3 years (range, one to 11.2) and mean age at surgery was 16 years (range, 11 to 21). All patients underwent THA by the senior surgeon through a posterior (92.4%) or anterior (7.6%) approach; 90.2% received a ceramic on a highly cross-linked polyethylene bearing, with the remaining 9.8% receiving a metal femoral head. All patients received a cementless stem based on femoral morphology. No patients were lost to follow-up.</p><p><strong>Results: </strong>The most common etiologies were Perthes disease and corticosteroid-induced osteonecrosis (15.2% each). A patient (1.1%) with Mucopolysaccharidosis type IV required a femoral revision for aseptic loosening; no other patients were revised. All average postoperative PROMs improved significantly (P < 0.00001): Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS-JR) 53.4 (interquartile range [IQR], 46.7 to 70.4) to 89.9 (IQR, 85.3 to 100), EQ-5D 0.5 (IQR, 0.2 to 0.7) to 0.8 (IQR, 0.7 to 1), and EQ visual analog scale (EQ-VAS) 81 (IQR, 70 to 95) to 85 (IQR, 80 to 100). Revision-free Kaplan-Meier survivorship at five and 10 years was 98.9%.</p><p><strong>Conclusion: </strong>Total hip arthroplasty in patients under age 21 yields substantial improvements in five-year functional outcomes, regardless of etiology, with extremely low revision rates and excellent implant survivorship.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665298","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":"Simulated Partial and Complete Resection of the Posterior Cruciate Ligament in Medially Conforming Total Knee Arthroplasty Causes a Graded Reduction in Femoral Rollback and Increase in Posterior Tibial Sag: A Computational Study.","authors":"Reza Pourmodheji, Cynthia A Kahlenberg, Brian P Chalmers, Eytan M Debbi, William J Long, Timothy M Wright, Geoffrey H Westrich, David J Mayman, Carl W Imhauser, Peter K Sculco","doi":"10.1016/j.arth.2025.03.030","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.030","url":null,"abstract":"<p><strong>Background: </strong>Medially conforming (MC) total knee arthroplasty (TKA) has seen increased clinical utilization. This design allows for either retention or resection of the posterior cruciate ligament (PCL); however, the impact of the PCL on femoral rollback and posterior tibial sag is unknown. Therefore, we developed a computational model to quantify how the PCL affects femoral rollback and posterior sag in MC-TKA.</p><p><strong>Methods: </strong>Computational models of ten cadaver knees were virtually implanted with MC-TKAs. Clinical tests of passive flexion and posterior sag were simulated, and femoral rollback and posterior tibial translation (PTT) were quantified. These tests were simulated in MC-TKA with the PCL retained, partially resected, and completely resected. We then assessed how increasing the tibial insert thickness in PCL-resected MC-TKA and switching to posterior-stabilized (PS)-TKA impacted posterior sag.</p><p><strong>Results: </strong>Femoral rollback decreased medially by a median of 2.4 mm (P ≤ 0.001) and laterally by a median of 3.3 mm (P < 0.001) with simulated PCL resection. For the simulated sag test, PTT increased by a median of 4.2 mm (P < 0.05) and 7.4 mm (P ≤ 0.001) with partial and complete PCL resection, respectively. Moreover, PTT was reduced by a median of 7.1 mm (P ≤ 0.01) when converting a PCL-resected MC-TKA to a (PS)-TKA.</p><p><strong>Conclusion: </strong>In a computational model, MC-TKA does not fully compensate for the function of the PCL, which facilitates femoral rollback in passive flexion and resists PTT during a posterior sag test. Resecting the antero-lateral (AL) bundle, with preservation of the postero-medial (PM) bundle of the PCL, yields more femoral rollback and less PTT than complete PCL resection in MC-TKA. Increasing tibial insert thickness in MC-TKA also does not account for the role of the PCL in reducing PTT during a sag test, while a PS-TKA does.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651897","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":"Special Considerations Before Total Hip Arthroplasty for Rapidly Progressive Osteoarthritis with a Recent Corticosteroid Injection.","authors":"Joshua Rainey, Adam Taylor, Logan Radtke, Amanda Crawford, Brenna Blackburn, Lucas Anderson, Christopher Peters, Jeremy Gililland, Christopher Pelt","doi":"10.1016/j.arth.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.023","url":null,"abstract":"<p><strong>Background: </strong>Rapidly progressive osteoarthritis (RPOA) has been associated with hip corticosteroid injections (CSIs), but may also mimic septic arthritis, which demonstrates similar erosive findings. This retrospective review evaluated a consecutive series of patients who had RPOA of the hip following CSI who underwent total hip arthroplasty (THA) and assessed outcomes and potential infection screening implications.</p><p><strong>Methods: </strong>All radiographic reports concerning RPOA were retrospectively identified at a single academic referral center from January 2014 to January 2023. A total of 4,279 reports were identified, and after removing duplicates, 2,175 patients were individually chart-reviewed. Occurrence of RPOA was defined as chondrolysis of at least two millimeters per year or 50% of joint space loss within one year of a CSI of the hip. Patients who had prior malignancy, septic arthritis, oral corticosteroid use, or prior femoral head avascular necrosis were excluded.</p><p><strong>Results: </strong>Ultimately, 81 patients, who had a mean follow-up time of two years, were identified who had undergone THA for RPOA following CSI. The average time between CSI and THA was 183.6 days (SD = 140.2). Preoperative infectious workup was performed in 31 patients who have inflammatory markers and eight patients who have a hip aspiration based on surgeon discretion. The mean aspiration cell counts and polymorphonuclear percentages were 1,410.8 (SD = 1,574.2) and 52.3% (SD = 23.3), respectively. Cultures were negative in all aspirations. All eight patients had negative aspirations and negative intraoperative cultures, and none developed periprosthetic joint infection (PJI). Of interest, two patients developed PJI within one month following THA, and neither underwent a preoperative infectious workup with labs or aspirations. Aside from these two PJIs, no other patients underwent repeat surgery.</p><p><strong>Conclusion: </strong>The occurrence of RPOA of the hip following CSI was associated with an estimated 2.5% risk of PJI. Preoperative screening with inflammatory markers and possible joint aspiration should be considered prior to THA for patients who have CSI-related RPOA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651900","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":"Complete and Selective Resection of the Posterior Cruciate Ligament Reduces Contact Forces Asymmetrically in Cruciate-Retaining Total Knee Arthroplasty: A Computational Study.","authors":"Reza Pourmodheji, Brian P Chalmers, Eytan M Debbi, William J Long, Timothy M Wright, Geoffrey H Westrich, David J Mayman, Carl W Imhauser, Peter K Sculco, Cynthia A Kahlenberg","doi":"10.1016/j.arth.2025.03.031","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.031","url":null,"abstract":"<p><strong>Background: </strong>Assessing intraoperative ligament balance in the posterior cruciate ligament (PCL)-retaining total knee arthroplasty (CR-TKA) can be achieved by quantifying tibio-femoral contact forces. Ligament balancing may involve selectively releasing PCL fibers; however, the effects of the extent and location of PCL release on compartmental contact forces are not well understood. To investigate these effects, we developed a computational model to quantify changes in medial and lateral contact forces resulting from targeted PCL fiber release.</p><p><strong>Methods: </strong>Computational models of ten cadaveric knees (five men, five women; mean age of 63 years) were virtually implanted with a CR-TKA. Passive knee flexion was simulated under three PCL conditions: all PCL fibers retained, all PCL fibers resected, and only the central PCL fibers released. Tibio-femoral contact forces in the medial and lateral compartments at 90° of flexion were measured for each PCL condition.</p><p><strong>Results: </strong>Resecting the PCL resulted in a reduction of contact forces by a median of 24.2 N (P ≤ 0.01) medially and a median of 11.1 N (P ≤ 0.01) laterally. Selective release of only the central PCL fibers reduced medial and lateral contact forces by medians of 11.5 N (P ≤ 0.05) and 4.5 N (P ≤ 0.05), representing 47 and 50% of the reduction observed with complete PCL resection, respectively.</p><p><strong>Conclusion: </strong>Resecting the PCL asymmetrically impacts compartmental contact forces, with a greater reduction observed in the medial compartment. Given the contribution of the releasing PCL's central portion to the reduction in compartmental contact forces, surgeons may consider first focusing on this region when conducting intraoperative releases to achieve ligament balance via PCL resection in CR-TKA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651843","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 Quadriceps Vector in the Lower Extremity of Indian Patients is Similar in Caucasian and Japanese Patients.","authors":"Fangzhou Chi, Shigeru Takagi, Tomoharu Mochizuki, Hiroyuki Kawashima, Rajesh Malhotra, J David Blaha","doi":"10.1016/j.arth.2025.03.020","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.020","url":null,"abstract":"<p><strong>Introduction: </strong>Correct alignment of knee components contributes to the longevity and function of total knee arthroplasty. The accuracy and reliability of calculating the three-dimensional quadriceps vector (QV) using computed tomography (CT) scans in Caucasian and Japanese study participants have been established in previous studies. In all cases, the QV was directed from the top of the patella to the middle of the femoral neck. The literature describes considerable differences in the morphology of bone in the lower extremities of Indian people compared with that of Caucasian and Japanese people.</p><p><strong>Methods: </strong>An imaging study was conducted using CT scans to determine the QV in a cohort of 36 patients from India [18 women (mean age 59 years), 18 men (mean age 61 years)]. The same measurement methods were used for this cohort as in previous studies. The QV and all measured axes were compared within the cohort.</p><p><strong>Results: </strong>The QV for the Indian cohort was found to be directed from the top of the patella toward the femoral neck, as in Caucasian and Japanese CT scans. In the Indian knees, the passing point of the vector was found to be lateral 30.8 mm (range, 25.2 to 36.4) and anterior 31.2 mm (range, 28.4 to 33.9) to the femoral head. When projected to the coronal plane, the QV was closest to that of the spherical axis, 1.2 ± 0.8° (P < 0.05).</p><p><strong>Conclusion: </strong>As in previous studies, the QV crosses the femoral neck lateral to the femoral head and is most parallel to the spherical axis (center femoral head to center spherical medial condyle) projected onto the coronal plane in the native Indian knee. These data suggest that using the QV for alignment may be applied to most human knees regardless of morphology.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651920","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}