Journal of Arthroplasty最新文献

{"title":"Socioeconomic Indices Are Associated With Increased Resource Utilization, But Not 90-Day Complications Following Total Hip and Knee Arthroplasty.","authors":"Anoop S Chandrashekar, Alicia Hymel, Courtney E Baker, J Ryan Martin, Jacob M Wilson","doi":"10.1016/j.arth.2024.08.044","DOIUrl":"https://doi.org/10.1016/j.arth.2024.08.044","url":null,"abstract":"<p><strong>Introduction: </strong>Socioeconomic disadvantage has been associated with negative outcomes following total hip (THA) and knee arthroplasty (TKA). The Area Deprivation Index (ADI) and Distressed Community Index (DCI) are composite rankings that score socioeconomic status (SES) using patients' home addresses. The purpose of this study was to examine the association of ADI and DCI with outcomes following THA and TKA while controlling for potential confounding covariates.</p><p><strong>Methods: </strong>A series of 4,146 consecutive patients undergoing primary THA and TKA between January 2018 and May 2023 were queried from our institutional total joint registry. The 90-day medical and surgical complications and resource utilization were collected. The ADI and DCI scores were obtained for each patient, and the association between these scores and postoperative outcomes was analyzed.</p><p><strong>Results: </strong>The ADI and DCI were both associated with patient age, sex, race, comorbidity burden, and smoking status. After controlling for these variables, higher ADI and DCI scores were associated with increased length of stay (P = 0.003 and P = 0.008, respectively), but were not associated with the occurrence of any 90-day complication, reoperation, or revision.</p><p><strong>Conclusion: </strong>The SES, as quantified by ADI and DCI, was associated with multiple known risk factors for complications following THA and TKA, but was not independently associated with complications, reoperations, or revision surgeries at 90 days postoperatively. While convenient metrics for the quantification of SES, in some populations, ADI and DCI may not be independently associated with detrimental outcomes following THA and TKA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134383","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":"Body Mass Index Improvement Reduces Total Knee Arthroplasty Complications Among Patients Who Have Extreme, But Not Severe, Obesity.","authors":"Marie C Spezia, Andrea Stitgen, Jacob W Walz, Emily V Leary, Arpan Patel, James A Keeney","doi":"10.1016/j.arth.2024.08.054","DOIUrl":"https://doi.org/10.1016/j.arth.2024.08.054","url":null,"abstract":"<p><strong>Background: </strong>While morbid obesity has been associated with increased complication risk in primary total knee arthroplasty (TKA), limited evidence is available to attribute decreased surgical complication rates with body mass index (BMI) reduction.</p><p><strong>Methods: </strong>We retrospectively assessed 464 unilateral TKAs performed in morbidly obese patients, including 158 extremely obese (BMI > 45) and 306 severely obese patients (BMI 40 to 44.9). A detailed medical record review identified concurrent modifiable risk factors and successful preoperative BMI reduction, reaching either a contemporary risk target (BMI < 40) or an institutionally accepted threshold (BMI < 45). Postoperative blood glucose levels and one-year adverse outcomes (periprosthetic joint infection (PJI), wound dehiscence, knee manipulation, periprosthetic fracture) were compared to 557 contemporary control subjects with expected slightly lower (moderate obesity, BMI 35 to 39.9) or sufficiently lower complication risk (overweight, BMI 25 to 29.9).</p><p><strong>Results: </strong>PJI and postoperative hyperglycemia were identified more frequently among morbidly obese patients in comparison with a moderately obese control group. Extremely obese patients (BMI > 45) whose BMI improved below 45 had no measurable difference in infection risk from the control group (OR [odds ratio] 0.84, 95% CI [confidence interval] 0.04 to 16.88), while those with a non-improved BMI had a significantly higher risk (OR 7.70, 95% CI 1.89 to 31.41). No significant differences in the risk for infection were observed between severely obese patients (BMI 40 to 44.9) with preoperative BMI improvement (1.5% rate, OR 1.70, 95% CI 0.17 to 16.57) or non-improvement (1.7% rate, OR 1.87, 95% CI 0.41 to 8.43).</p><p><strong>Conclusions: </strong>Preoperative medical optimization may decrease postoperative TKA complications. The findings of this study support BMI improvement for extremely obese patients (BMI > 45). The assignment of 40 BMI as a threshold for otherwise healthy patients may exclude patients from potential surgical benefits without realizing risk reduction.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134378","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 Relationship Between Age and 30-day Outcomes Following Unicompartmental versus Total Knee Arthroplasty.","authors":"Graham E Sullivan, Krista B Highland, Gregory J Booth, Alexander P Dunnum, Ashton H Goldman","doi":"10.1016/j.arth.2024.08.053","DOIUrl":"https://doi.org/10.1016/j.arth.2024.08.053","url":null,"abstract":"<p><strong>Background: </strong>An enhanced understanding of the short-term complication profile following unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA) can improve surgical decision-making and subsequent patient outcomes. This study aimed to determine if the difference in risk of 30-day morbidity and mortality between UKA and TKA varied as a function of patient age.</p><p><strong>Methods: </strong>This retrospective study of a national quality improvement database using data from 2014 to 2020 included 403,342 patients undergoing UKA (n = 12,324) or TKA (n = 391,018). A generalized additive model (GAM) evaluated non-linear relationships between primary outcome and predictors (age, procedure type, and procedure type x age interaction) using a 1:5 UKA to TKA matched sample. Probabilities and odds ratios (95% CI [confidence interval]) estimated the relative risk of complications across the age spectrum.</p><p><strong>Results: </strong>In the GAM, TKA patients relative to UKA had 1.30 higher odds (95% CI 1.19 to 1.43, P < 0.001) of 30-day morbidity and mortality. There was a significant, non-linear relationship between age and the primary outcome (P = 0.02), such that the odds were lowest at younger ages. They increased slowly until about age 65 years, at which point the slope became steeper. The interaction terms for age and procedure type were not significant (P = 0.30). The 30-day probability for short-term complications of a 65-, 75-, and 85-year-old undergoing UKA was 2.1% (95% CI, 1.8 to 2.3), 2.4% (95% CI, 2.0 to 2.8), and 3.2% (95% CI, 2.3 to 4.1), respectively. Conversely, the probability of a 65-, 75-, and 85-year-old undergoing TKA was 2.9% (95% CI, 2.7 to 3.0), 3.6% (95% CI, 3.3 to 3.8), and 5.5% (95% CI, 4.7 to 6.3).</p><p><strong>Conclusions: </strong>Patients undergoing UKA had a quantifiable lower likelihood of morbidity or mortality than TKA at all ages. These data can provide individualized risk for UKA and TKA across the age spectrum and could be helpful in counseling patients regarding their risk for perioperative complications.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134384","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":"What Factors Influence In-Hospital Mortality Following Aseptic Revision Total Hip Arthroplasty? : A Single-Center Analysis of 13,203 Patients.","authors":"Taner Karlidag, Maximilian Budin, T David Luo, M Fatih Dasci, Thorsten Gehrke, Mustafa Citak","doi":"10.1016/j.arth.2024.08.052","DOIUrl":"https://doi.org/10.1016/j.arth.2024.08.052","url":null,"abstract":"<p><strong>Background: </strong>Revision total hip arthroplasty (rTHA) is associated with an extended surgical period, an increased hospitalization period, expanded blood loss, and high mortality rates. The purpose of the current study was to assess the risk factors that contribute to in-hospital mortality following aseptic rTHA.</p><p><strong>Methods: </strong>We performed a retrospective examination of the medical records of all patients who underwent elective rTHA surgery at our tertiary referral arthroplasty center between March 1996 and March 2019. The study involved a group of 13,203 patients, including 70 who expired during hospitalization and 13,133 in the control group. Baseline characteristics, medical history, comorbidities, and surgery-related parameters of the patients were recorded. Logistic regression analyses were performed to examine the association between independent variables and in-hospital mortalities, which were presented as odds ratios (OR) and confidence intervals (CI).</p><p><strong>Results: </strong>Patient factors associated with in-hospital mortality included hepatitis C (OR 75.5, 95% CI 3.5 to 1,625.2), chronic obstructive pulmonary disease (OR 30.7, 95% CI 6.5 to 145.7), rheumatoid arthritis (OR 28.9, 95% CI 3.8 to 218.5), history of myocardial infarction (OR 24.9, 95% CI 4.4 to 140.8), history of cerebrovascular disease (OR 23.1, 95% CI 3.8 to 142), congestive heart failure (OR 18.9, 95% CI 3.8 to 94.2), and diabetes mellitus (OR 10.2, 95% CI 2.4 to 42.6). Surgical factors included the history of multiple prior revisions (OR 1.75, 95% CI 1.1 to 2.7), postoperative blood transfusion (OR 2.8, 95% CI 1.1 to 7.3), and decreased preoperative hemoglobin (OR 2.3, 95% CI 1.7 to 3.1).</p><p><strong>Conclusion: </strong>Several patient-related and intraoperative factors significantly increased the risk of in-hospital mortality following aseptic revision THA. Vigilance and close perioperative monitoring are essential for patients undergoing this complex surgery.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134386","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":"Does Preoperative Bisphosphonate Use Impact the Risk of Periprosthetic Fracture Following Total Hip Arthroplasty?","authors":"Rodnell Busigó Torres, James Hong, Hanish Kodali, Jashvant Poeran, Brocha Z Stern, Brett L Hayden, Darwin D Chen, Calin S Moucha","doi":"10.1016/j.arth.2024.08.043","DOIUrl":"https://doi.org/10.1016/j.arth.2024.08.043","url":null,"abstract":"<p><strong>Introduction: </strong>Bisphosphonate (BP) use is not uncommon among total hip arthroplasty (THA) candidates. While the impact of BP therapy post-THA has been investigated, there is a paucity of literature discussing the impact of BP therapy pre-THA. Using a national dataset, we aimed to study the association between preoperative BP use and surgical outcomes in primary THA recipients.</p><p><strong>Methods: </strong>This retrospective cohort study utilized a commercial claims and Medicare Supplemental Databases to identify adults aged ≥ 18 who had an index non-fracture-related primary THA from 2016 to 2020. The use of BP was defined as ≥ 6 months of BP therapy in the year prior to THA. Outcomes were 90-day all-cause readmission, 90-day readmission related to periprosthetic fracture (PPF), 90-day and 1-year all-cause revision, 1-year PPF-related revision, and 1-year diagnosis of PPF. In a 1:5 propensity-score matched analysis, each THA patient who had preoperative BP use was matched to five THA patients who did not have preoperative BP use. Logistic regression models were fitted; we report odds ratios (OR) and 95% confidence intervals (CI).</p><p><strong>Results: </strong>Of 91,907 THA patients, 1,018 (1.1%) used BP preoperatively. In the propensity-score-matched cohort (1,018 preoperative BP users, 5,090 controls), preoperative BP use was significantly associated with increased odds of 90-day all-cause revision surgery (OR 1.67; 95% CI 1.10 to 2.53; P = 0.02), 1-year PPF-related revision (OR 2.23; 95% CI 1.21 to 4.10; P = 0.01), and 1-year PPF diagnosis (OR 1.88; 95% CI 1.10 to 3.20; P = 0.02). There was no significant association between preoperative BP use and the other outcomes in the matched cohort.</p><p><strong>Conclusion: </strong>These findings suggest that preoperative BP use is associated with an increased risk of revision surgery and PPF in both the short and long term. This information can help in preoperative planning and patient counseling, potentially leading to improved surgical outcomes and reduced complication rates.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134380","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 Use of Tranexamic Acid for Primary Prophylaxis of Heterotopic Ossification Following Total Hip Arthroplasty.","authors":"Andrea H Johnson, Jane C Brennan, Parimal Rana, Justin J Turcotte, Paul J King","doi":"10.1016/j.arth.2024.08.055","DOIUrl":"https://doi.org/10.1016/j.arth.2024.08.055","url":null,"abstract":"<p><strong>Introduction: </strong>Heterotopic ossification (HO) is a relatively common complication after total hip arthroplasty (THA) and can range from a radiographic observation only to severely disabling and requiring revision surgery. Prophylaxis is recommended for high-risk patients, though the ideal method and targeted population are open to debate. Tranexamic acid (TXA) is a medication increasingly being used to reduce blood loss associated with orthopaedic surgeries, including THA.</p><p><strong>Methods: </strong>A retrospective review of 357 patients undergoing THA from November 2020 through December 2023 was conducted. The patients were grouped based on whether they received intravenous TXA perioperatively or not, and their propensity score matched 2:1 TXA to no TXA on age, body mass index, sex, the Charlson Comorbidity Index, and perioperative celecoxib use. Univariate and multivariate analyses were performed.</p><p><strong>Results: </strong>After propensity score matching, the only significant differences between groups were American Society of Anesthesiologists scores and preoperative celecoxib use between groups, as the TXA group had fewer patients who had an ASA of 3 or more (38.9 versus 58.5%, P < 0.001) and more patients who had taken celecoxib preoperatively (16.3 versus 5.9%, P = 0.010). Perioperatively, patients were more likely to undergo THA using the anterior approach (74.5 versus 57.6%, P = 0.002) and were more likely to receive postoperative celecoxib prescriptions (44.8 versus 31.4%, P = 0.021), but there was no difference in other nonsteroidal anti-inflammatory drug usage postoperatively. Postoperatively, patients who received TXA had a lower rate of heterotopic ossification on the last postoperative x-ray (20.1 versus 33.9%, P = 0.007). Multivariable logistic regression, to assess predictors of HO, found that patients who had TXA were 42% less likely to have visible HO (OR [odds ratio] = 0.58, P = 0.047) while holding surgical approach, ASA score, preoperative and postoperative celecoxib use, and postoperative other NSAID use constant.</p><p><strong>Conclusion: </strong>The use of tranexamic acid in patients undergoing primary total hip arthroplasty results in a decreased likelihood of heterotopic ossification formation on postoperative x-rays.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134385","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":"Evaluation of Two Clinical Stem Fit Philosophies within the Femoral Canal Using a Preoperative Planning Tool: Could a Hybrid Approach Be Best?","authors":"Thang D Nguyen, Jarrod Nachtrab, Michael LaCour, Andrew Jacobs, Manh Ta, Richard Komistek","doi":"10.1016/j.arth.2024.08.047","DOIUrl":"https://doi.org/10.1016/j.arth.2024.08.047","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) has transformed patient lives, yet evolving expectations and the number of postoperative foot angle changes have underscored the need for precise component positioning. The objective of this study was to use three-dimensional (3D) preoperative planning to evaluate stem alignment and orientation for three THA systems using two different stem fit algorithms. It was hypothesized that the different stem alignments would yield similar changes in stem orientation and placement within the canal for all three systems.</p><p><strong>Method: </strong>This study introduced a novel 3D preoperative planning tool, comparing two different surgical stem fit philosophies within the canal: \"canal fit\" (CF) and \"anatomical fit\" (AF). We virtually implanted ten subjects with three different THA implant systems using both philosophies, evaluating 60 total fits within the canals. The \"canal fit\" philosophy aimed to minimize cortical bone removal. In contrast, the \"anatomical fit\" philosophy prioritized aligning the implanted head with the anatomical head center.</p><p><strong>Results: </strong>Detailed analyses revealed that AF led to fixation occurring mainly on the medial aspect of the stem, while CF exhibited a more even distribution between medial and lateral sides. The AF philosophy achieved significantly closer placement of the implanted head to the anatomical center (2.0 to 2.1 mm) compared to the CF philosophy (3.0 to 6.0 mm) (P < 0.01). The AF resulted in neutral stem orientation (0°) across all stems, whereas the CF exhibited greater malrotation (2.0 to 7.0°) (P < 0.02). The AF required more bone removal (0.13 to 0.46 cm³) than the CF (0.02 to 0.06 cm³) (P < 0.01).</p><p><strong>Conclusion: </strong>The findings underscore the importance of 3D planning, emphasizing its potential to improve stem version alignment in THA. The results from this study may advocate 3D preoperative planning with robotic surgery to plan stem placement within the canal while maintaining anatomical femoral head restoration.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134381","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":"Effect of Vitamin D Deficiency on Periprosthetic Joint Infection and Complications After Primary Total Joint Arthroplasty","authors":"","doi":"10.1016/j.arth.2024.05.012","DOIUrl":"10.1016/j.arth.2024.05.012","url":null,"abstract":"<div><h3>Background</h3><p>Vitamin D deficiency is a global problem, and 13 to 75% of patients undergoing total joint arthroplasty (TJA) have vitamin D deficiency. Several studies have shown that low preoperative vitamin D levels may increase the risk of postoperative complications, including periprosthetic joint infection (PJI), in patients undergoing primary TJA. Most of the studies are underpowered. This study aimed to investigate the relationship between vitamin D deficiency and surgical and medical complications after primary TJA, with a specific focus on PJI.</p></div><div><h3>Methods</h3><p>Prospectively collected institutional multicenter arthroplasty databases were reviewed to identify patients who underwent primary total knee and hip arthroplasty. The study group was defined as patients whose vitamin D level is &lt; 30 ng/dL and who received a single oral dose of 7.5 mg (300,000 IU) D3 within two weeks before index surgery (n = 488; mean age 63 years). Patients in the control group were those whose preoperative vitamin D levels were unknown and who did not receive vitamin D supplementation (n = 592, mean age 66). The groups were compared regarding 90-day medical and surgical complications, including PJI, mortality, and readmission rates.</p></div><div><h3>Results</h3><p>The total number of complications (8.6 and 4.3%; respectively; <em>P</em> = .005), superficial wound infection (2.5 and 0.2%, respectively; <em>P</em> &lt; .001), and postoperative cellulitis (2.2 and 0% respectively; <em>P</em> &lt; .001) were statistically significantly higher in the patient group who did not receive vitamin D supplementation. However, 90-day mortality (<em>P</em> = .524), PJI (<em>P</em> = .23), and readmission rate (<em>P</em> = .683) were similar between the groups.</p></div><div><h3>Conclusions</h3><p>This study demonstrated that preoperative optimization of vitamin D levels may be beneficial in reducing postoperative complications, including superficial wound infection and postoperative cellulitis. Administering an oral 300,000 U single-dose vitamin D regimen to correct vitamin D deficiency can positively impact outcomes following primary TJA.</p></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0883540324004455/pdfft?md5=4f19de3a2cf49a9c9850db283cb97ce9&pid=1-s2.0-S0883540324004455-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nearly 14-Fold Increased Risk of Manipulation Under Anesthesia After Total Knee Arthroplasty When Previous Contralateral Total Knee Arthroplasty Required Manipulation Under Anesthesia","authors":"","doi":"10.1016/j.arth.2024.05.073","DOIUrl":"10.1016/j.arth.2024.05.073","url":null,"abstract":"<div><h3>Background</h3><p>Stiffness remains a common complication after primary total knee arthroplasty (TKA). Manipulation under anesthesia (MUA) is the gold standard treatment for early postoperative stiffness; however, there remains a paucity of data on the risk of MUA after primary TKA if a prior contralateral TKA required MUA.</p></div><div><h3>Methods</h3><p>We performed a retrospective review of 3,102 patients who had staged primary TKAs between 2016 and 2021. The mean body mass index was 33 (range, 18 to 59) and the mean age was 67 years (range, 24 to 91). The mean preoperative range of motion for the first TKA was 2 to 104°, and for the contralateral TKA was 1 to 107°. The primary outcomes were MUA following first and second primary TKAs. Multivariable Poisson regressions were used to evaluate associations between risk factors and outcomes.</p></div><div><h3>Results</h3><p>The rate of MUA after the first TKA was 2.6% (n = 83 of 3,102) and 1.3% (n = 40 of 3,102) after the contralateral TKA. After adjustment, there was a nearly 14-fold higher rate of MUA after the second TKA if the patient had an MUA after the first TKA (relative risk, 13.80; 95% CI [confidence interval], 7.14 to 26.66). For the first TKA, increasing age (adjusted risk ratio [ARR], 0.65; 95% CI, 0.50 to 0.83) and increasing body mass index (ARR, 0.65; 95% CI, 0.47 to 0.90) were associated with lower risk for MUA. For the second TKA, increasing age was associated with a lower risk of MUA (ARR, 0.60; 95% CI, 0.45 to 0.80).</p></div><div><h3>Conclusions</h3><p>For patients undergoing staged bilateral TKA, patients who undergo MUA following the first primary TKA are nearly 14-fold more likely to undergo an MUA following the contralateral primary TKA than those who did not have an MUA after their first TKA.</p></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S088354032400545X/pdfft?md5=c67746a76ce18addf9c242cb61ae1a8d&pid=1-s2.0-S088354032400545X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141186043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Hip Arthroplasty in Patients Who Have Marfan Syndrome: Adverse Events and 5-Year Revision Rates","authors":"","doi":"10.1016/j.arth.2023.10.052","DOIUrl":"10.1016/j.arth.2023.10.052","url":null,"abstract":"<div><h3>Background</h3><p>Marfan syndrome is a rare inherited connective tissue disease, which may be present in patients who have advanced hip pathologies that may require total hip arthroplasty (THA). The postoperative course of patients who have Marfan syndrome following THA has not yet been defined.</p></div><div><h3>Methods</h3><p>Adult patients who have and do not have Marfan syndrome and underwent THA were identified in a national database. Patients diagnosed who had infection, trauma, or neoplasms within the 90 days prior to surgery were excluded. Those who have versus those who did not have Marfan syndrome were matched 1:10 based on age, sex, and a comorbidity index. After matching, 144 patients who have Marfan syndrome and 1,440 who do not have Marfan syndrome were identified. The 90-day postoperative adverse events and 5-year revisions were assessed and compared with multivariable analyses and log rank tests, respectively.</p></div><div><h3>Results</h3><p>Multivariable analyses demonstrated that Marfan syndrome was independently associated with greater odds of 90-day adverse events: venous thromboembolic events (odds ratio [OR]: 2.9, <em>P</em> = .001), cardiac events (OR: 4.5, <em>P</em> = .034), pneumonia (OR: 3.5, <em>P</em> &lt; .001), and urinary tract infections (OR: 5.2, <em>P</em> &lt; .001). There was no significant difference in 5-year rates of revision.</p></div><div><h3>Conclusions</h3><p>Following THA, Marfan syndrome was independently associated with greater rates of several 90-day adverse events, but not higher 5-year rates of revision. The identified at-risk adverse events may help guide surgeons to improve perioperative care pathways, while having confidence regarding joint survival of THA in this rare disease population.</p></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0883540323010987/pdfft?md5=543612f67577ca9c895c61157eda24b6&pid=1-s2.0-S0883540323010987-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89720491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}