Journal of Arthroplasty最新文献

{"title":"Medicare (Dis)Advantage: The Patients and Physicians.","authors":"James A Browne, Matthew P Abdel, Robert M Meneghini, Bryan D Springer","doi":"10.1016/j.arth.2025.02.017","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.017","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Accuracy of a Computed Tomography-Based Mixed-Reality Navigation Tool for Acetabular Component Positioning in Total Hip Arthroplasty.","authors":"Eric S Dilbone, Alexander F Heimann, Justin Leal, Sean P Ryan, Samuel S Wellman","doi":"10.1016/j.arth.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.003","url":null,"abstract":"<p><strong>Background: </strong>Robotics and navigation systems have improved the accuracy and precision of acetabular component placement in total hip arthroplasty (THA). The purpose of this study was to determine if the intraoperative use of a novel mixed-reality (MR) navigation system resulted in accurate acetabular component placement with minimal outliers.</p><p><strong>Methods: </strong>A series of 79 patients who underwent THA performed by a single surgeon using a novel MR navigation system were retrospectively reviewed. The preoperative planned acetabular component operative inclination (OI) and tilt-adjusted operative anteversion (OA) were collected for each case. At the six-week follow-up, each patient underwent three-dimensional (3D) EOS imaging, which was used to measure the acetabular component placement via validated measuring software. Patients who had bilateral THAs or 3D images that did not have critical bony landmarks visible for measurement were excluded from the study. Absolute error was calculated for both inclination and anteversion. Outliers were defined as any cup position that was outside a range of ± 10 degrees from the preoperatively planned target.</p><p><strong>Results: </strong>A total of 39 patients met the inclusion criteria. The mean planned OI for each patient was 40.8 (range, 40 to 41) degrees, and the mean measured postoperative OI was 40.4 (range, 37 to 46) degrees (P = 0.40), resulting in a mean absolute error of 1.8 (range, zero to five) degrees. The mean planned OA was 30.2 (range, 25 to 35) degrees, and the mean measured postoperative OA was 31.1 (range, 27 to 42) degrees (P = 0.11), resulting in a mean absolute error of 2.0 (range, zero to six) degrees. There were no outliers in either OI or OA.</p><p><strong>Conclusion: </strong>The results of this study suggest that the use of MR navigation during THA results in accurate postoperative acetabular component inclination and anteversion relative to the preoperative plan without outliers.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426726","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":"Demographics of the American Association of Hip and Knee Surgeons and Fellowship Match Data.","authors":"Zachary C Lum, Nana O Sarpong, Molly A Hartzler, Rolanda Willacy, Obinna O Adigweme, Rinelda M Horton, Ugo N Ihehweazu, Mary I OConnor, Muyibat A Adelani","doi":"10.1016/j.arth.2025.02.016","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.016","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426721","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":"Patient Frailty in Total Knee Arthroplasty: The Implementation of a Frailty Score Using an Electronic Medical Record.","authors":"Casey M O'Connor, Ameer Tabbaa, Luba Ayzenshtat, James E Feng, Afshin A Anoushiravani, Steven T Lyons, Thomas Bernasek","doi":"10.1016/j.arth.2025.01.051","DOIUrl":"https://doi.org/10.1016/j.arth.2025.01.051","url":null,"abstract":"<p><strong>Introduction: </strong>Frailty has been associated with poor outcomes and higher costs after primary total knee arthroplasty. However, the implementation of a frailty score at a level one tertiary care facility to evaluate patient outcomes has not been well described. This study examined the retrospective implementation of the Hospital Frailty Risk Score (HFRS) and the relationship of the HFRS score with 90-day readmission, revision at any time point, and length of initial hospitalization.</p><p><strong>Methods: </strong>Using our relational database from our hospitals' electronic medical record system, we identified patients who were discharged following primary TKA from 2015 to 2023. The HFRS was calculated for each patient to determine frailty. Frail patients were defined as those who had an HFRS ≥ 5 and non-frail patients had an HFRS < 5. We used regression analyses to adjust for demographic confounders to evaluate the association of patient frailty (as defined by an HFRS ≥ 5) following primary TKA and patient outcomes, including 90-day readmissions, revision TKA, and length of hospital stay.</p><p><strong>Results: </strong>Frail patients had significantly higher rates of 90-day readmission (79 versus 14), revision (30 versus 11), and length of initial hospitalization (3.5 ± 3.5 versus 2.8 ± 2.3 days) (P < 0.0001). Frail patients were at increased risk of revision TKA for mechanical loosening (0.35 versus 0.045%, P < 0.05). Also, frail patients were at significantly higher risk for readmission and revision for infection compared to the non-frail cohort (1.4 versus 0.17%, P < 0.0001; 0.81 versus 0.25%, P < 0.05).</p><p><strong>Conclusions: </strong>Frailty, measured using HFRS, is associated with increased 90-day readmission, revision, and inpatient length of stay following primary TKA. Frail patients are at significantly increased risk of infectious complications following primary TKA. This study demonstrates that the HFRS can be implemented using a common electronic medical record (EMR) and may help multidisciplinary care teams better focus preoperative optimization interventions on this high-risk cohort.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426686","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":"Gut-Joint Axis: History of Clostridium Difficile Infection Increases the Risk of Periprosthetic Joint Infection After Total Knee Arthroplasty.","authors":"Jens T Verhey, Sayi P Boddu, Saad Tarabichi, David G Deckey, Zachary K Christopher, Mark J Spangehl, Henry D Clarke, Joshua S Bingham","doi":"10.1016/j.arth.2025.02.014","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.014","url":null,"abstract":"<p><strong>Introduction: </strong>Increasing evidence suggests that the gut microbiome is important in immune system function and influences the risk of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). A C. difficile infection (CDI) is an indicator of poor gut microbiome health. However, no prior studies have evaluated the independent risk of CDI on the rates of PJI after TKA.</p><p><strong>Methods: </strong>Patients undergoing TKA from 2010 to 2021 were identified in a patient claims database (n = 1,416,362). Patients who had a history of CDI within two years prior to TKA (n = 5,170) were propensity-matched on a 1:4 basis to those who did not have a diagnosis of CDI. The exposed CDI cohort was also stratified into four groups by time of CDI before TKA (zero to three months, three to six months, six to 12 months, and one to two years). The risk of PJI within two years following TKA was compared between the exposed and control cohorts. Logistic regression was used to evaluate the association of CDI occurring in each time interval prior to TKA and PJI after TKA.</p><p><strong>Results: </strong>A CDI within two years prior to TKA was independently associated with higher odds of PJI (OR [odds ratio], 2.1; 95% CI [confidence interval], 1.91 to 2.36). In addition, we observed a stepwise increase in the risk of PJI by the timing of preoperative CDI infection, with patients who had a diagnosis of CDI within three months of their primary TKA exhibiting the highest odds of developing PJI (OR, 4.19; 95% CI, 3.51 to 5.02). Additionally, patients who had a diagnosis of CDI within two years of undergoing primary TKA were significantly more likely to experience a subsequent episode of CDI at the latest follow-up (OR, 25.9; 95% CI, 22.3 to 30.1).</p><p><strong>Conclusion: </strong>A CDI prior to TKA is an independent risk factor for PJI. Closer proximity of CDI to surgery is associated with a \"dose-dependent\" increased PJI risk. Surgeons should consider delaying TKA until a minimum of one year after a diagnosis of CDI.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426728","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":"Clinical Predictors of the Forgotten Joint Score 12 in Total Knee Arthroplasty.","authors":"Weston Carpenter, Sara Strecker, Matthew Solomito, Robert James Carangelo, Daniel Witmer","doi":"10.1016/j.arth.2025.02.013","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.013","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcomes (PRO) have become a key criterion for determining patient satisfaction following orthopaedic procedures like total knee arthroplasty (TKA). The Forgotten Joint Score 12 (FJS-12) is designed to evaluate if a patient is aware of their replaced joint. Little literature exists surrounding the predictive power of other metrics on the FJS-12. In this paper, differences in these clinical metrics were assessed between groups of patients who scored above the FJS-12 cutoff and those who did not after TKA.</p><p><strong>Methods: </strong>Patients who underwent primary elective TKA and answered all required PROs during the designated study period were included. Using an established cutoff of 33.3, patients were put in a \"Forgotten Joint Group\" or a \"Remembered Joint Group.\" This study included 672 patients who fit the criteria. Of these, 508 (76%) forgot their joints and 164 (24%) remembered their joints at twelve months. Differences in clinical metrics between the two groups were assessed for significance using univariate analyses (t-test, Chi-square, Fisher's Exact). Receiver operating characteristic (ROC) curve analysis was then used to determine the predictive value of metrics that showed these significant differences.</p><p><strong>Results: </strong>Early results from the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and Numeric Pain Scale (NPS) were strongly correlative of the twelve-month FJS-12 score, rather than patient demographics. Patients who scored above 65.1 or 72.1 on the KOOS-JR three and six months after surgery, respectively, or below a 3 on the NPS three and/or six months after surgery were also favored to forget their replaced joint at twelve months.</p><p><strong>Conclusion: </strong>Identifying predictors of the FJS-12 allows for the recognition of at-risk patients before the twelve-month time point, facilitating earlier intervention and improving care after surgery. The scope of this analysis may be broadened in the future to include other arthroplasty procedures, such as for the hip and shoulder.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426719","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":"Albumin as a Predictor of Periprosthetic Joint Infection Following Total Joint Arthroplasty: Identifying a New Data-Driven Threshold Utilizing a Continuous Variable Analysis.","authors":"Sagar Telang, Ryan Palmer, Wesley S Cooperman, Andrew Dobitsch, Jay R Lieberman, Nathanael D Heckmann","doi":"10.1016/j.arth.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.002","url":null,"abstract":"<p><strong>Introduction: </strong>Albumin is a preoperative risk-stratification tool for patients undergoing primary total knee arthroplasty (TKA) and total hip arthroplasty (THA). However, existing literature predominantly evaluates serum albumin levels as a categorical variable using predetermined cut-off values, limiting our ability to identify a data-driven risk threshold. Our study addresses this gap by analyzing albumin as a continuous variable, aiming to establish a more clinically relevant preoperative threshold for identifying patients at increased risk of postoperative complications.</p><p><strong>Methods: </strong>A healthcare database was used to retrospectively identify all primary TKA and THA patients between 2016 and 2021 with available preoperative albumin values within a 28-day window. The primary outcome of interest was the 90-day periprosthetic joint infection (PJI) risk. Utilizing logistic regression, restricted cubic splines (RCSs) were employed to model the relationship between preoperative albumin as a continuous variable and PJI risk. Bootstrap simulation was used to determine a cutpoint indicative of an albumin level below which a significant increase in PJI risk was observed. Similar analyses were performed for aggregate medical and surgical complications. In total, 32,952 total patients (THA: 37.9%; TKA: 62.1%) who had preoperative albumin were identified. Of these, 184 (0.56%) individuals developed PJI.</p><p><strong>Results: </strong>For both TKA and THA bootstrap analysis identified a preoperative albumin cutpoint of 3.1 g/dL, below which the risk of PJI and medical complications significantly increased. While hypoalbuminemia was not associated with a higher risk of surgical complications following TKA, the risk of surgical complications significantly increased for THA patients with albumin levels below 3.1 g/dL.</p><p><strong>Conclusion: </strong>Patients undergoing TKA or THA who had a preoperative albumin <3.1 g/dL are at increased risk of PJI, medical complications, and surgical complications. Patients who have hypoalbuminemia should be counseled regarding the increased risk of infection, and attempts should be made to enhance these patients' nutritional status.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416238","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":"Letter regarding “The Use of Tranexamic Acid for Primary Prophylaxis of Heterotopic Ossification Following Total Hip Arthroplasty”","authors":"Shihong Ren MD,&nbsp;Zhan Wang PhD","doi":"10.1016/j.arth.2024.10.125","DOIUrl":"10.1016/j.arth.2024.10.125","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 3","pages":"Page e23"},"PeriodicalIF":3.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350386","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":"Conflict of Interest Statement","authors":"","doi":"10.1016/S0883-5403(25)00076-2","DOIUrl":"10.1016/S0883-5403(25)00076-2","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 3","pages":"Page IBC"},"PeriodicalIF":3.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143336784","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":"Reply to letter regarding “Routine Prescription of Proton Pump Inhibitors in the Perioperative Period is Associated with Decreased Rates of 2-Year Revision Surgery after Total Hip and Knee Arthroplasty”","authors":"Andrew B. Harris MD,&nbsp;Amil Agarwal MD,&nbsp;Vishal Hegde MD,&nbsp;Julius K. Oni MD,&nbsp;Harpal S. Khanuja MD","doi":"10.1016/j.arth.2024.10.114","DOIUrl":"10.1016/j.arth.2024.10.114","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 3","pages":"Pages e17-e18"},"PeriodicalIF":3.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348432","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}