Journal of Arthroplasty最新文献

{"title":"Discharge Destination of Patients in Fast-Track Primary Hip and Knee Arthroplasty: Results From a Prospective Danish Cohort.","authors":"Oliver Lyndrup, Henrik Kehlet, Christoffer C Jørgensen, Martin Lindberg-Larsen, Thomas Jakobsen, Kirill Gromov, Mikkel R Andersen, Manuel Bieder, Søren Overgaard, Claus Varnum","doi":"10.1016/j.arth.2024.12.005","DOIUrl":"10.1016/j.arth.2024.12.005","url":null,"abstract":"<p><strong>Background: </strong>Following the implementation of the fast-track protocol in total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA), the median length of stay (LOS) has been significantly reduced without an increase in readmissions. However, it is unclear if the reduction in LOS is at the expense of an increase in nonhome discharge. The aim of this study was to investigate the discharge destination among THA, TKA, and UKA patients.</p><p><strong>Methods: </strong>The prospective multicenter study included 6,856 patients undergoing primary THA, TKA, and UKA in a fast-track setting with an overall median LOS of one day. Outcomes were discharge destination, median LOS in each discharge destination category, and cause of rehabilitation center discharge. Data were gathered using preoperative questionnaires and a review of medical records. Discharge destination and LOS were registered at discharge.</p><p><strong>Results: </strong>We found that 99% of patients had been discharged to their own homes, of which 21% had been discharged to their own homes with home care. There were 1% who were discharged to a rehabilitation facility and 0.1% who were discharged to a nursing home. The THA (1%, 95% confidence interval [CI] 0.7 to 1) and TKA (1%, 95% CI 0.9 to 2) had a significantly higher rate of discharge to a rehabilitation facility compared to UKA (0.1%, 95% CI 0.0 to 0.5).</p><p><strong>Conclusions: </strong>Despite a short LOS, 99% of patients were discharged to their own homes. Rehabilitation facility discharge was only 1% and was mostly caused by inadequate postoperative mobilization.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803281","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":"Early Patient-Reported Outcome Measures Following Computer Navigated Total Hip Arthroplasty: A Study from the Australian Orthopaedic Association National Joint Replacement Registry.","authors":"Ernest C Lourens, Yuze Zhai, Dylan Harries, Peter L Lewis, Andrew P Kurmis","doi":"10.1016/j.arth.2024.12.002","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.002","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) is a well-established treatment for symptomatic hip osteoarthritis (OA). The use of computer navigation in THA aims to achieve the reconstruction of the joint more consistently and precisely. The aim of this study was to contrast patient-reported outcome measures (PROMs) for THA procedures with and without commercially available navigation technologies.</p><p><strong>Methods: </strong>Post-operative PROMs for primary THA procedures performed for OA between August 2018 and December 2022 and recorded in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were analyzed. Procedures using computer navigation were compared to those using conventional instrumentation. Baseline patient characteristics and surgeon volume were sub-analyzed. Multivariable regressions were used to compare postoperative PROMs.</p><p><strong>Results: </strong>There were 13,400 THA procedures for OA with PROMs recorded and 749 with navigation. The mean (standard deviation) EuroQol-visual analog scales (EQ-VAS) scores for navigated cases were 67.3 (19.3) pre-operatively and 81.7 (15.0) post-operatively, compared with 66.0 (20.3) and 80.5 (15.8) for the non-navigated group. Oxford Hip scores (OHS) and patient-reported change were similar between groups. The change from pre- to postoperative EQ-VAS and OHS did not significantly differ between computer-navigated and non-navigated cases. After adjusting for patient and procedure factors, the use of computer navigation was associated with a higher rate of procedure satisfaction (rate ratio 1.03, 95% CI [confidence interval] 1.01 to 1.06, P = 0.02).</p><p><strong>Conclusions: </strong>While procedural satisfaction was marginally higher following navigated THA (P = 0.02), there were no statistically significant differences in the change in EQ-VAS or when comparing navigated with 'non-navigated' approaches for primary THAs. Based on the reviewed national registry data for PROMS, we were unable to demonstrate clinically relevant evidence to support claims of superiority of non-navigated or navigated primary THAs. Further work, including similar comparisons with longer-term follow-up, will be of value in elucidating if a true clinically relevant difference exists.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796563","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 Impact of Traveling Fellowships: Perspectives from Rothman-Ranawat Travel Fellows.","authors":"Aditya Joshi, Julius K Oni, Ran Schwarzkopf, Nirav K Patel","doi":"10.1016/j.arth.2024.12.003","DOIUrl":"https://doi.org/10.1016/j.arth.2024.12.003","url":null,"abstract":"<p><strong>Background: </strong>Traveling fellowships, such as the Hip Society Rothman-Ranawat fellowship, offer orthopaedic surgeons the opportunity to enhance their skills, conduct research, and gain mentorship at top orthopaedic centers. This study aimed to assess the impact of the Hip Society Rothman-Ranawat traveling fellowship on an adult reconstruction surgeon's career.</p><p><strong>Methods: </strong>A non-incentivized online survey was distributed to the 40 past recipients of the Hip Society Rothman-Ranawat traveling fellowship spanning from 2013 to 2023. The survey comprised short-answer questions and multiple-choice questions to evaluate the impact of the traveling fellowship. Surgeon publication counts and h-indexes were extracted from the Scopus database before the fellowship and at intervals of three years, five years, and the present post fellowship. Quantitative metrics were adjusted based on the time elapsed since the surgeon completed the fellowship and compared using paired-sample t-tests.</p><p><strong>Results: </strong>This study had a 95% response rate (n = 38). Following the completion of the fellowship, we observed an increase in publication count and h-index at various intervals compared to the time before the fellowship. The mean annual percentage increase in publication count was 25.6% at the 3-year mark, 37.6% at the 5-year mark, and 29.4% at the present time, all relative to the publication count before the fellowship. Similarly, the mean annual percentage increase in the h-index was 9.7% at the 3-year mark, 9.6% at the 5-year mark, and 4.1% at the present time, all compared to the h-index before the fellowship. Qualitative measures showed previous fellows endorsed that the fellowship positively changed their clinical practice (84% agreement), expanded their network (97% agreement), increased research productivity (82% agreement), and improved surgical technique (74% agreement).</p><p><strong>Conclusion: </strong>Responses from past Hip Society Rothman-Ranawat traveling fellows suggest that participating in the fellowship positively influenced their career trajectories.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796565","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":"Do Intact Collateral Ligaments Play a Role in the Overall Clinical and Radiological Results of Rotating Hinge Knee Arthroplasties?","authors":"Şahan Güven, Enejd Veizi, Nurdan Çay, Yasin Erdoğan, Tolga Tolunay, Kasım Kılıçarslan, Ahmet Fırat","doi":"10.1016/j.arth.2024.12.004","DOIUrl":"10.1016/j.arth.2024.12.004","url":null,"abstract":"<p><strong>Background: </strong>Rotating hinge knee arthroplasty (RHKA) implants are often utilized as a salvage procedure in cases where bone stock is compromised. The aim of this retrospective study was to investigate whether residual collateral ligament integrity affects functional and radiographic outcomes in patients undergoing revision surgery with RHKA.</p><p><strong>Methods: </strong>Patients treated with RHKA between 2011 and 2021 were eligible. Inclusion criteria were patients who had undergone an RHKA as a revision or a primary procedure, had complete radiological and clinical data, and had a minimum follow-up of 2 years. There were 79 knees that were included. Patients were evaluated with standing radiographs and two-dimensional multi-acquisition variable-resonance imaging combination selective (MAVRIC) magnetic resonance imaging (MRI) sequences to assess ligament integrity. Range of motion (ROM), Visual Analog Scale (VAS), Knee Society Scores (KSS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded. The mean age was 66 years (range, 39 to 79), and the mean follow-up was 54.6 months (approximately 4.5 years). The integrity of the collateral was successfully determined by the magnetic resonance imaging scans and patients were divided into three groups: those who had both collateral ligaments (n = 53), isolated medial collateral ligament damage (n = 14), and those who had both collateral ligaments damaged (n = 12).</p><p><strong>Results: </strong>No significant difference was observed between the groups with regard to both radiological data and clinical scores (P > 0.05). KSS, KSS-F, and Western Ontario and McMaster Universities Osteoarthritis Index function scores at the last follow-up were significantly higher in patients treated for secondary osteoarthritis (complex primaries).</p><p><strong>Conclusions: </strong>No significant difference in functional outcomes was detected in patients treated with RHKA, independent of collateral ligament integrity, at an average of 54 months postoperatively. When an RHKA is indicated as the first treatment option, results are more satisfactory in comparison to revision cases.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792475","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 Estimated Lifetime Risk of Revision After Primary Knee Arthroplasty Is Influenced by Implant Design and Patient Age: Data From the National Joint Registries.","authors":"Nick D Clement, Liam Z Yapp, Chloe E H Scott","doi":"10.1016/j.arth.2024.11.054","DOIUrl":"10.1016/j.arth.2024.11.054","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to determine the lifetime risk of revision surgery after primary knee arthroplasty (KA) according to implant choice and patient age.</p><p><strong>Methods: </strong>The risk of revision according to the implant type (unicondylar, unconstrained, semiconstrained, and fully constrained) was obtained from the National Joint Registry of England and Wales. Mortality risk according to age was estimated from the Scottish Arthroplasty Project (1998 to 2019). The cumulative incidence of revision and death was calculated up to 20 years. The lifetime risk was calculated as a percentage using a multiple decrement life-table methodology.</p><p><strong>Results: </strong>The lifetime risk of revision varied according to the implant, with unconstrained having the lowest risk and fully constrained and unicondylar having the highest risks, which increased with younger age. For an \"average\" patient aged between 65 and 69 years, the revision risks for an unconstrained (3.6%, 95% confidence interval [CI] 3.4 to 3.9), semiconstrained (7.2%, 95% CI 3.9 to 13.6), unicondylar (13.7%, 95% CI 12.4 to 15.2), and fully constrained (15.4%, 95% CI 9.2 to 25.7) total KA gradually increased. Relative to an unconstrained KA, the risk of revision for a semiconstrained implant was similar in patients aged < 65 years (relative risk < 2), whereas when this was employed in those ≥ 65 years, the relative risk was more than double (relative risk ≥ 2). Relative to an unconstrained KA, the risk of revision for a fully constrained or a unicondylar KA was more than double in patients aged < 55 years (relative risk > 2) and more than triple (relative risk ≥ 3) in patients ≥ 55 years CONCLUSION: The estimated lifetime risk of revision following KA was dependent on patient age and implant type, with fully constrained and unicondylar KA being associated with a higher lifetime revision risk. There are limitations in the data, and the indication for surgery and the reasons for revision were not assessed.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781872","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":"High-Dose Intravenous Iron Supplementation During Hospitalization Improves Hemoglobin Level and Transfusion Rate Following Total Knee or Hip Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Yong-Beom Park, Kang-Il Kim, Han-Jun Lee, Je-Hyun Yoo, Jun-Ho Kim","doi":"10.1016/j.arth.2024.11.058","DOIUrl":"10.1016/j.arth.2024.11.058","url":null,"abstract":"<p><strong>Background: </strong>Intravenous (IV) iron supplementation is a potential strategy to address anemia and reduce the need for blood transfusion following total knee or hip arthroplasty (TKA or THA). We aimed to investigate the effect and safety of IV iron supplementation as optimal blood management in patients after TKA or THA.</p><p><strong>Methods: </strong>The MEDLINE, Embase, Cochrane Library, CINAHL, and Scopus databases were systematically searched for studies comparing patients undergoing total knee arthroplasty or total hip arthroplasty with and without IV iron supplementation. Blood transfusion rate and postoperative hemoglobin drop were assessed for effectiveness, while adverse events and surgical site infection were evaluated for the safety of IV iron supplementation. Additionally, subgroup analyses were performed to investigate the effect of IV iron supplementation based on the iron dose or patient's indication. There were 14 studies included.</p><p><strong>Results: </strong>The use of IV iron supplementation significantly decreased the blood transfusion rate compared to no supplementation after TKA or THA (odds ratio [OR] 0.43; 95% confidence interval [CI], 0.27 to 0.68; P < 0.001) as clinical manifestations were considered for the transfusion, although no significant difference was found between postoperative days one and seven. Furthermore, IV iron supplementation significantly reduced postoperative Hb drop compared to no supplementation at postoperative two to six weeks (postoperative weeks two to three: mean difference [MD], -0.61; 95% CI, -1.01 to -0.20; P = 0.003 and postoperative weeks four to six: MD, -0.50; 95% CI, -0.70 to -0.31; P < 0.001). The safety profile did not significantly differ between the two groups. Adverse events occurred in 0.5% of the treatment group. Subgroup analysis showed that high-dose iron in high-risk patients led to a faster recovery of Hb drop than low-dose iron in routine patients following TKA or THA.</p><p><strong>Conclusions: </strong>Perioperative IV iron supplementation was effective and safe in blood management for reducing blood transfusion and Hb drop in patients following TKA or THA. High-dose iron supplementation provided faster recovery of Hb than low-dose iron, which was more effective in high-risk patients.</p><p><strong>Level of evidence: </strong>Meta-analysis of level 3 studies.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781869","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 Financial Burden of Patient Comorbidities on Total Knee Arthroplasty Procedures: A Matched Cohort Analysis of Patients Who Have a High and Non-High Comorbidity Burden.","authors":"Jonathan L Katzman, Jeremiah Thomas, Itay Ashkenazi, Claudette M Lajam, Joshua C Rozell, Ran Schwarzkopf","doi":"10.1016/j.arth.2024.11.059","DOIUrl":"10.1016/j.arth.2024.11.059","url":null,"abstract":"<p><strong>Background: </strong>Recent literature suggests a trend toward a higher comorbidity burden in patients undergoing total knee arthroplasty (TKA). However, the impact of increased comorbidities on the cost-effectiveness of TKA is underexplored. This study aimed to compare the financial implications and perioperative outcomes of patients with and without a high comorbidity burden (HCB).</p><p><strong>Methods: </strong>We retrospectively reviewed 10,647 patients who underwent elective, unilateral TKA between 2012 and 2021 at a single academic health center with available financial data. Patients were stratified into HCB (Charlson Comorbidity Index ≥ 5 and American Society of Anesthesiology scores of 3 or 4) and non-HCB groups. A 1:1 propensity match was performed based on baseline characteristics, resulting in 1,536 matched patients (768 per group). Revenue, costs, and contribution margins (CM) of the inpatient episode were compared between groups. Ninety-day readmissions and revisions were also analyzed.</p><p><strong>Results: </strong>The HCB patients had significantly higher total (P < 0.001) and direct (P < 0.001) costs, while hospital revenue did not differ between cohorts (P = 0.638). This disparity resulted in a significantly decreased CM for the HCB group (P = 0.009). Additionally, HCB patients had a longer length of stay (P < 0.001) and a higher rate of 90-day readmissions (P = 0.005).</p><p><strong>Conclusions: </strong>Increased inpatient costs for HCB patients undergoing TKA were not offset by proportional revenue, leading to a decreased CM. Furthermore, higher 90-day readmissions exacerbate the financial burden. These findings highlight potential challenges for hospitals in covering indirect expenses, which could jeopardize accessibility to care for HCB patients. Reimbursement models should be revised to better account for the increased financial burden associated with managing HCB patients.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774362","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 Geographic Social Vulnerability With Race-Based Differences in the Utilization of Total Hip Arthroplasty Surgeries for Medicare Beneficiaries.","authors":"Jordan J Cruse, Derek T Schloemann, Elizabeth C Danielson, Benjamin F Ricciardi, Patricia D Franklin, Rishi Balkissoon, Caroline P Thirukumaran","doi":"10.1016/j.arth.2024.11.053","DOIUrl":"10.1016/j.arth.2024.11.053","url":null,"abstract":"<p><strong>Background: </strong>Racial disparities exist in the utilization of total hip arthroplasties (THAs). The social vulnerability index (SVI), which measures geographic-level disadvantage and includes themes, such as socioeconomic status, minority status, and language, may partially explain disparities in THA use. Our objectives were to determine the association of the composite SVI with THA use for (1) White Medicare beneficiaries, (2) Black Medicare beneficiaries, and (3) the difference in THA use between White and Black beneficiaries. We also determined the association of SVI themes with these THA-use endpoints.</p><p><strong>Methods: </strong>We used 2013 to 2019 Medicare data to calculate age- and sex-standardized THA use rates for 306 hospital referral regions (HRRs). We estimated multivariable linear regression models to determine the association of the composite SVI and its four themes with THA utilization and with differences in use rates.</p><p><strong>Results: </strong>Living in HRRs with the highest SVI (most vulnerable, quartile 4) was associated with lower hip arthroplasty rates for both White and Black beneficiaries (e.g., quartile 4 for White beneficiaries: -0.9, 95% confidence interval [95% CI]: -1.2 to -0.7, P < 0.001; quartile 4 for Black beneficiaries: -0.9, 95% CI: -1.3 to -0.5, P < 0.001) compared to beneficiaries in the least vulnerable HRRs (quartile 1). Higher vulnerability in minority status and language (theme 3) was associated with lower THA utilization for Black beneficiaries only (e.g., quartile 4 for Black beneficiaries: -0.9, 95% CI: -1.2 to -0.5, P < 0.001) and was associated with widening of the White-Black difference in THA utilization (e.g., quartile 4: 0.7, 95% CI: 0.3 to 1.1, P < 0.001).</p><p><strong>Conclusions: </strong>Higher composite SVI is associated with lower THA utilization for both White and Black beneficiaries. Higher vulnerability in minority status and language is associated with the widening of the disparity in THA rates. Our findings highlight important mechanisms that need to be addressed to ensure equity in THA access.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774332","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":"Trends and Epidemiology in Revision Total Knee Arthroplasty: A Large Database Study.","authors":"Conor M Jones, Alexander J Acuna, Enrico M Forlenza, Joseph Serino, Craig J Della Valle","doi":"10.1016/j.arth.2024.11.051","DOIUrl":"10.1016/j.arth.2024.11.051","url":null,"abstract":"<p><strong>Background: </strong>As the volume of primary total knee arthroplasty (TKA) continues to grow, the clinical and financial burden of revision total knee arthroplasty (rTKA) is expected to increase. The purpose of this investigation was to characterize contemporary indications and complications for rTKA.</p><p><strong>Methods: </strong>Patients undergoing rTKA between 2010 and 2021 were identified within an administrative claims database. Adjusted rTKA incidence was calculated by dividing the annual rTKA volume by the annual primary TKA and multiplying by 100,000. Mann-Kendall trend tests were utilized to trend revision volume, etiology, 90-day postoperative complications, and patient demographics.</p><p><strong>Results: </strong>A total of 397,367 rTKA were identified over our study period, of which 287,492 (72.4%) had coding regarding revision etiology. The volume of annual rTKA (31,091 to 33,850; P = 0.451) did not change over the study period. The adjusted incidence of rTKA decreased (25,568.3 to 19,272.2 per 100,000 annual TKA; P = 0.011). The leading causes of revision TKA were infection (21.2%), aseptic implant loosening (19.3%), and instability (9.8%). The rate of septic revision (4,710.5 to 4,426.1 per 100,000 annual TKAs) and aseptic implant loosening (4,502.5 to 3,636.4 per 100,000 annual TKAs) did not change (both P values > 0.05). The rates of instability increased (1,369.2 to 2,609.85 per 100,000 annual TKAs; P = 0.007). The rates of postrevision surgical site infection, periprosthetic joint infection, deep vein thrombosis, and transfusion decreased over the study period, while rates of emergency department visits and readmission increased (all P values <0.05).</p><p><strong>Conclusions: </strong>The incidence of revision TKA may be slowing. While the risk of revision for infection and aseptic loosening remains unchanged, revision for instability has increased. The rates of postoperative complications appear to have decreased. Improved surgical technique, implant design, and perioperative protocols may have contributed to these findings. Continued work is necessary to reduce the risk of failure and postoperative complications.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774376","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 in Acetabular Revision for Acute Pelvic Discontinuity Utilizing Plating of the Posterior Column.","authors":"Elizabeth A Abe, Brian J Frenz, Ryan M Sutton, Andrew Fraval, Chad A Krueger, P Maxwell Courtney","doi":"10.1016/j.arth.2024.11.050","DOIUrl":"10.1016/j.arth.2024.11.050","url":null,"abstract":"<p><strong>Background: </strong>Acute pelvic discontinuity (PD) is a rare, yet challenging complication following total hip arthroplasty (THA). Although several techniques, such as plating of the posterior column and spanning of the discontinuity with a cup cage, have been described for the management of acute PD, few studies have determined the survivorship of acetabular constructs in this setting. The purpose of this study was to determine the outcomes of acetabular fixation of the posterior column in patients who had acute PD following THA.</p><p><strong>Methods: </strong>We reviewed a consecutive series of 24 patients diagnosed with acute PD at a single institution from 2018 to 2022. All patients were managed with open reduction and internal fixation of the discontinuity with a posterior column plate and highly porous cup. The primary outcome was acetabular component survivorship using Kaplan-Meier analysis. Secondary outcomes included rates of radiographic union of the fracture, aseptic loosening, dislocation, and infection.</p><p><strong>Results: </strong>There were 17 women and seven men who had a mean age of 73 years (range, 50 to 89) included in the analysis. At 3.5 years of (range, 1.0 to 6.2) follow-up, implant survivorship free from aseptic acetabular failure was 91.7% upon Kaplan-Meier analysis. There was one patient who underwent acetabular rerevision secondary to component loosening in the early postoperative period, while one patient had radiographic evidence of acetabular cup loosening at 1-year follow-up. No other revision procedures, periprosthetic fractures, prosthetic dislocations, or nerve injuries were reported. The overall complication rate was 20.8%. There were three patients who required irrigation and debridement, while two patients experienced medical complications.</p><p><strong>Conclusions: </strong>Posterior column plating with a highly porous acetabular cup can be a reliable treatment option for the management of acute PD. However, future studies with longer follow-ups comparing implant survivorship between posterior column plating and cup-cage constructs are necessary.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774389","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}