Journal of Arthroplasty最新文献

{"title":"Circulating Bacteriophage DNA Distinguishes Staphylococcal Infection from Commensal Colonization.","authors":"Robert Manasherob, Daisuke Furukawa, Naomi L Haddock, Tony H W Chang, Aviv Hargil, Prerna Arora, Niaz Banaei, William J Maloney, Paul L Bollyky, Derek F Amanatullah","doi":"10.1016/j.arth.2025.09.051","DOIUrl":"https://doi.org/10.1016/j.arth.2025.09.051","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing periprosthetic joint infections (PJI) is challenging. We previously reported on using bacteriophage sequences in cell-free DNA (cfDNA) in plasma to diagnose bacterial pathogens in sepsis. Here, we hypothesized that plasma bacteriophage cfDNA can serve as a serological biomarker to monitor staphylococcal PJI.</p><p><strong>Methods: </strong>Using a previously described computational pipeline, bacteriophage sequences were identified in cfDNA from 35 plasma samples from three distinct patient cohorts: patients who had a current Staphylococcal PJI (n=10), patients with a prior PJI (n=12), and patients with no PJI (n=13). The overall phageome and the proportion of Staphylococcus bacteriophage was described and compared among the three cohorts. The presence of Staphylococcus bacteriophage as a binary variable was also analyzed for its diagnostic performance in identifying Staphylococcal PJI.</p><p><strong>Results: </strong>There were no differences in the distribution of bacterial cfDNA among the three cohorts (P = 0.597). The current PJI cohort had a significantly higher proportion of Staphylococcus bacteriophage compared to no PJI (median, 2.6 versus 0%, P = 0.013), and the prior PJI cohort had a significantly higher proportion of Staphylococcus bacteriophage compared to no PJI (median, 1.0 versus 0%, P = 0.049). Of note, there was no difference in the proportion of Staphylococcus bacteriophage between current PJI and prior PJI (median, 2.6 versus 1.0%, P = 0.554). Staphylococcus bacteriophage was present in six of 10 samples in the current PJI, seven of 12 samples in the prior PJI, and one of 13 samples in the no PJI groups. The presence of Staphylococcus bacteriophage had a sensitivity of 60% and specificity of 92% for a Staphylococcal PJI.</p><p><strong>Conclusions: </strong>These findings suggest that plasma bacteriophage cfDNA offers a promising approach to detect and monitor staphylococcal PJI. The persistence of these Staphylococcus bacteriophages in prior PJI may reflect subclinical infection or residual microbial DNA undetectable by standard culture-based diagnostics.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276554","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":"Mechanical Load-to-Shear Failure of Cemented Patellar Components in Well-Functioning Postmortem Total Knee Arthroplasties.","authors":"Drake G LeBrun, Sara Sacher, Breana Siljander, Elexis C Baral, Ryan Breighner, Hollis G Potter, Robert H Hopper, Timothy M Wright, Charles A Engh, Douglas E Padgett","doi":"10.1016/j.arth.2025.10.007","DOIUrl":"https://doi.org/10.1016/j.arth.2025.10.007","url":null,"abstract":"<p><strong>Background: </strong>Shear forces on the patella can lead to patellar loosening and failure in total knee arthroplasty (TKA). Our objectives were to: (1) evaluate the mechanical load-to-shear failure in a unique cohort of cemented patellar components in well-functioning postmortem TKAs and (2) determine the influence of clinical and radiographic factors on load-to-shear failure.</p><p><strong>Methods: </strong>There were 22 patellae that were harvested from well-functioning postmortem TKAs (mean implantation duration 9.1 years [range, 1.7 to 19.6]). There were three all-polyethylene 3-peg onlay patellar designs evaluated. The patellae were evaluated for polyethylene damage, implant-to-bone size ratios, microarchitectural parameters, and implant-cement-bone interface. Patellar specimens were loaded with isolated shear stress using a servo-hydraulic test frame until failure. Univariate and multivariable linear regression models were used to analyze the influence of clinical and radiographic factors on load-to-shear failure.</p><p><strong>Results: </strong>The mean load-to-shear failure was 1,881 +/- 621 N. There were nine patellae that failed at the bone-cement interface, seven that failed at the implant-cement interface, and six that involved both interfaces. There were no failures at the peg-implant junction. On multivariable analyses, load to failure was positively associated with bone volume fraction and negatively associated with body mass index, duration of implantation, and implant-to-bone surface area coverage. Load-to-shear failure was not associated with surface damage or radiographic parameters and did not differ across the three patellar implant designs.</p><p><strong>Conclusion: </strong>In this novel cohort of cemented patellar buttons from well-functioning postmortem TKAs, load-to-shear failure was higher than previously reported in buttons cemented in cadaver native patellae. The amount of bony coverage by the patellar button was inversely associated with shear strength after accounting for other pertinent factors. When choosing between two patellar button sizes, surgeons should consider opting for the smaller size, which may improve the maximum shear strength of the patellar construct.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes After Contemporary Cementless versus Cemented Primary Total Knee Arthroplasty at Five-Years: Some Subtle Differences.","authors":"Harold I Salmons, Michael W Seward, Caden J Messer, Nicholas A Bedard, Michael J Taunton, Kevin I Perry, Mark W Pagnano, Robert T Trousdale, Cody C Wyles","doi":"10.1016/j.arth.2025.10.006","DOIUrl":"https://doi.org/10.1016/j.arth.2025.10.006","url":null,"abstract":"<p><strong>Introduction: </strong>Cementless total knee arthroplasty (TKA) has regained interest due to the potential long-term survivorship and ease of use. However, data on contemporary cementless TKA remain limited. We investigated implant survivorship and outcomes following contemporary cementless versus cemented TKA.</p><p><strong>Methods: </strong>We identified 3,763 primary TKAs for osteoarthritis from January 1, 2016, to December 31, 2023, using our institutional total joint registry. There were 598 cementless and 3,165 cemented TKAs. Cementless tibial components included porous titanium (Ti) in 509 knees and beaded cobalt-chromium (CoCr) in 89. We excluded all-polyethylene tibias, stemmed tibias, and revision constructs. The mean age was 68 years (range, 28 to 96), the mean body mass index was 32 (range, 17 to 65), and 56% were women. The cementless group was younger and contained more men (P < 0.05). Kaplan-Meier and Cox regression analyses adjusted for age, sex, BMI, and surgical year were performed. The mean follow-up was three years (range, two to eight).</p><p><strong>Results: </strong>There were 61 revisions (1.6%): 11 (1.8%) in the cementless and 50 (1.6%) in the cemented group. Revisions were primarily for infection (N = 31) and aseptic loosening (N = nine). All four loosening cases after cementless TKA involved CoCr tibias within one year. All five cemented TKA loosening cases occurred between two and five years. The five-year revision-free survivorship was 92% in cementless and 97% in cemented TKAs (hazard ratio (HR) = 3; P < 0.05). Excluding CoCr tibias, Ti cementless survivorship was 97%. The five-year survivorships free from revision for infection were 98% in cementless and 99% in cemented TKAs (HR = 3; P < 0.05). There were no differences in periprosthetic fracture risk observed (P = 0.5).</p><p><strong>Conclusions: </strong>We identified subtle differences between contemporary cementless and cemented primary TKA mid-term outcomes. We found a slightly higher infection risk in the cementless group, excellent durability of Ti cementless and cemented tibias, and a higher loosening risk with CoCr cementless tibias.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276558","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 We Achieve Consensus on the Choice of Anesthetic Medication for Adductor Canal Block in Total Knee Arthroplasty?","authors":"Giles R Scuderi, Alparslan Turan","doi":"10.1016/j.arth.2025.10.001","DOIUrl":"https://doi.org/10.1016/j.arth.2025.10.001","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259785","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":"Bridging Disciplines: A Commentary on the Phase 3 Trial of Liposomal Bupivacaine via Adductor Canal Block for Total Knee Arthroplasty","authors":"Michael A. Mont MD ,&nbsp;Joseph Marino MD","doi":"10.1016/j.arth.2025.07.060","DOIUrl":"10.1016/j.arth.2025.07.060","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 11","pages":"Pages 2775-2776"},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236313","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":"A Call for Clinically Relevant Study Control Arms: A Commentary.","authors":"David J Conrad, R Michael Meneghini","doi":"10.1016/j.arth.2025.10.003","DOIUrl":"https://doi.org/10.1016/j.arth.2025.10.003","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259818","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 Knee Arthroplasty in Patients Who Have Neuromuscular Disorders and Genu Recurvatum Using a Rotating-Hinge Implant: A Case Series with a Mean Four-Year Follow-Up.","authors":"Andre Giardino Moreira da Silva, Pedro Nogueira Giglio, Daniel Araujo Fernandes, Daniel Teixeira de Oliveira, Idemar Monteiro da Palma, Helder Rocha da Silva Araújo, João Paulo Fernandes Guerreiro, Cristiano Grimm Menegazzo, Julio Cesar Gali, Gilberto Luis Camanho, Camilo Partezani Helito","doi":"10.1016/j.arth.2025.09.049","DOIUrl":"https://doi.org/10.1016/j.arth.2025.09.049","url":null,"abstract":"<p><strong>Background: </strong>Patients who have neuromuscular disorders and quadriceps weakness may develop knee osteoarthritis along with progressive recurvatum deformity. Due to challenges in ligament balancing and the risk of knee hyperextension recurrence, the use of constrained implants may be required. The objective of this study was to report mid-term (mean four-year) clinical outcomes of patients who had neurological conditions and knee hyperextension and who underwent primary total knee arthroplasty (TKA) with a rotating-hinge implant.</p><p><strong>Methods: </strong>Patients who had neuromuscular disorders and gonarthrosis with recurvatum deformity and who underwent primary TKA using a rotating-hinge implant between 2015 and 2021 at multiple centers were reviewed retrospectively. Inclusion criteria included neurological conditions, preoperative recurvatum > 5°, and a follow-up period of ≥ 24 months. Demographic, clinical, and radiographic data were collected, including age, Body Mass Index (BMI), underlying neurological disease, symptom duration, and previous surgeries. In total, patients (26 knees) were included. The mean age was 60 years (range, 42 to 82) and the mean preoperative hyperextension was 33.4 ± 12.6°. The most common neurological condition was poliomyelitis (40.9%), followed by idiopathic neuropathy (31.8%), Charcot neuroarthropathy (22.8%), and sequelae of childhood meningitis (4.5%). Clinical outcomes were assessed using functional scores (Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), Forgotten Joint Score (FJS), and Global Perceived Effect Scale (GPE)), postoperative complications, and radiographs to evaluate implant loosening and patella baja.</p><p><strong>Results: </strong>The mean functional scores were: KSS 72.4, KOOS 74.3, FJS 66.9, and GPE 3.8. The failure rate was 7.7%, with two patients needing revision surgery due to aseptic loosening. Regarding complications, one intraoperative tibial shaft fracture occurred. Postoperatively, one patient developed peroneal nerve neuropraxia, and one had bilateral arthrofibrosis requiring surgical release.</p><p><strong>Conclusion: </strong>Patients who have neuromuscular disorders and genu recurvatum can achieve favorable outcomes with rotating-hinge TKA, yielding good functional scores and acceptable complication and failure rates, considering the severity of the condition.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259834","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":"Superior Transverse Atraumatic Reconstruction Total Hip Arthroplasty Achieves Similar Satisfaction and Minimal Clinically Important Differences When Compared to the Direct Anterior Approach: A Propensity Score Matched Study with Two-Year Outcomes.","authors":"Hong Yu Jared Chua, Chen Jiawei, Seng-Jin Yeo, Hee Nee Pang, Darren Keng-Jin Tay, Ming Han Lincoln Liow","doi":"10.1016/j.arth.2025.09.043","DOIUrl":"https://doi.org/10.1016/j.arth.2025.09.043","url":null,"abstract":"<p><strong>Background: </strong>Numerous studies comparing the direct anterior (DAA) and postero-lateral approach (PLA) in total hip arthroplasty (THA) have been inconclusive, mostly demonstrating earlier recovery with DAA, with no differences in outcomes by one year. However, there are limited studies comparing the DAA with the superior transverse atraumatic reconstruction (STAR) THA, which is a type of PLA. This study aimed to compare the 2-year follow-up patient-reported outcome measures (PROMs), satisfaction, and complication rates between DAA and STAR THA.</p><p><strong>Methods: </strong>A retrospective analysis of all primary THAs performed (January 2018 to December 2022) at a high-volume tertiary hospital was conducted. The study included patients > 60 years at the time of THA with minimum 2-year outcomes of Oxford Hip Score (OHS), Western Ontario and McMaster University Arthritic Index (WOMAC), Short Form 36 Health Survey (SF-36) subscale and summative (physical component score [PCS]/mental component scores [MCS]), patient satisfaction, and expectation fulfillment scores. The DAA THA was performed with either fluoroscopic or robotic assistance, whereas the STAR THA was performed manually. Logistic regressions were performed to estimate propensity scores, followed by greedy matching in a 1:1 ratio to establish the DAA and STAR groups. Parametric and non-parametric statistical tests were used to compare postoperative scores and the proportion attaining a minimum clinically important difference (MCID). A total of 132 DAA THA were successfully matched with 132 STAR THA.</p><p><strong>Results: </strong>The DAA group demonstrated significantly higher scores in 2-year postoperative OHS (P = 0.0140), WOMAC stiffness (P = 0.0455), physical function (P = 0.0125), SF-36 physical function (P = 0.00537), general health (P = 0.0495), social function (P = 0.0266), PCS (P = 0.0478), and MCS (P = 0.0482). There was no difference in MCID attainment, patient satisfaction, or expectation fulfillment scores noted.</p><p><strong>Conclusion: </strong>While technology-assisted DAA THA demonstrated better functional outcomes at two years, its clinical relevance may be limited, as manually performed STAR THA also attained MCID thresholds and yielded high patient satisfaction rates without additional complications. This suggests that slightly lower functional scores do not compromise overall THA success.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259942","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":"Malnutrition and Clinical Factors as Predictors of Extended Hospital Stay After Total Hip Arthroplasty: Development of a Predictive Nomogram.","authors":"Zhen Wang, Zijian Chen, Jixi Liu, Chaoyi Zhang, Wenzheng Liu, Wei Lin, Guanglin Wang","doi":"10.1016/j.arth.2025.09.047","DOIUrl":"https://doi.org/10.1016/j.arth.2025.09.047","url":null,"abstract":"<p><strong>Background: </strong>Extended lengths of stay (eLOS) after total hip arthroplasty (THA) increase healthcare costs and adverse outcomes. Nutritional status is important in postoperative recovery, but its impact on eLOS remains underexplored.</p><p><strong>Methods: </strong>This study included 805 THA patients, and the prolonged hospitalization group (PHG) was defined as a LOS ≥ 10 days. Nutritional status was evaluated using the controlling nutritional status (CONUT), geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI) scores, and their predictive value for eLOS was assessed via receiver operating characteristic (ROC) analysis. Independent predictors of eLOS in THA patients were identified using logistic regression analyses, upon which a nomogram was developed for risk prediction.</p><p><strong>Results: </strong>The PHG had significantly lower GNRI and PNI scores than the non-prolonged hospitalization group (NPHG) (P < 0.001), while CONUT scores showed no difference (P = 0.153). After adjusting for age and sex, GNRI (r = -0.195, P = 0.008) and PNI (r = -0.08, P = 0.024) were negatively correlated with eLOS. The ROC analysis indicated that GNRI had superior predictive accuracy for eLOS [area under the curve (AUC) = 0.643] compared to PNI, and combining multiple nutritional scores did not enhance predictive performance. Multivariate regression identified GNRI, HuaXi fall risk score (HXFS), age-adjusted Charlson comorbidity index (ACCI), visual analog scale (VAS), and admission type as independent risk factors for eLOS (all P < 0.05). A nomogram incorporating these variables demonstrated the highest predictive value (AUC = 0.750) with a sensitivity of 71.4% and specificity of 72.1%.</p><p><strong>Conclusions: </strong>The GNRI score is an independent risk factor for eLOS in THA patients. A predictive model incorporating other variables demonstrated the highest diagnostic value, and the application of this model for the early identification of high-risk patients who have eLOS may facilitate targeted interventions, optimize preoperative management, and improve clinical outcomes.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259801","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":"Association of Metformin Use with Osteoarthritis Incidence, Progression, and Joint Arthroplasty Risk in the Knee and Hip: A Systematic Review and Meta-Analysis.","authors":"Kexin Yao, Feng Li, Qiuyuan Wang, Jiayi Guo, Chen Yue, Yapeng Li","doi":"10.1016/j.arth.2025.09.050","DOIUrl":"https://doi.org/10.1016/j.arth.2025.09.050","url":null,"abstract":"<p><strong>Background: </strong>Although hip and knee osteoarthritis (OA) constitutes a major cause of disability globally, disease-modifying therapies do not exist. Preclinical evidence suggests that metformin has disease-modifying potential, but clinical evidence is conflicting. This meta-analysis assessed the effect of metformin on 1) hip/knee OA incidence, 2) radiographic/symptomatic progression, and 3) joint arthroplasty (JA) risk.</p><p><strong>Methods: </strong>We systematically searched the PubMed, Web of Science, Embase, and Cochrane Library databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Random-effects meta-analyses and qualitative synthesis were performed for the prespecified outcomes.</p><p><strong>Results: </strong>Evidence from 13 studies enrolling 167,107 cases demonstrated that metformin users had a 33% lower hip/knee OA incidence (pooled risk ratios (RRs) 0.67, 95% confidence intervals (CI) 0.61 to 0.74). Qualitative synthesis indicated reduced magnetic resonance imaging-assessed medial cartilage loss and delayed symptomatic progression with respect to pain, joint function, and quality of life among metformin users. Crucially, metformin was associated with a 43% lower JA risk (pooled RR 0.57, 95% CI: 0.38 to 0.84), with enhanced protection in those who had pre-existing OA versus those who had diabetes/obesity alone (RR 0.37 versus 0.81) and those receiving more than two years versus two years or less of treatment (RR 0.38 versus 0.80).</p><p><strong>Conclusion: </strong>Metformin may reduce hip/knee OA incidence and slow radiographic/symptomatic progression. It significantly reduces the risk of JA, particularly in patients who have pre-existing OA and receive prolonged metformin therapy. These findings support considering metformin in this subgroup while highlighting the need for trials to confirm its efficacy among patients who have diabetes/obesity, but do not have established OA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259846","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}