Journal of Arthroplasty最新文献

{"title":"Does Replicating Native Hip Biomechanics Improve Patient-Reported Outcome Measures After Total Hip Arthroplasty?","authors":"Andrew Schneider, MacKenzie Molina, Lauren I Pitz-Gonçalves, Braeden W Estes, Evan R Deckard, Kevin A Sonn, R Michael Meneghini","doi":"10.1016/j.arth.2025.03.063","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.063","url":null,"abstract":"<p><strong>Background: </strong>Enabling technology, such as computer navigation and robotics, provides more precise implant position, which allows surgeons the ability for personalized alignment in total hip arthroplasty (THA). To date, THA implant position studies have focused on dislocation rates, rather than on patient-reported outcome measures (PROMs). This study evaluated the impact of the THA component position on clinically significant differences in PROMs.</p><p><strong>Methods: </strong>A total of 1,682 consecutive primary THAs were retrospectively reviewed. Acetabular and femoral component position as well as femoral offset and leg length discrepancy (LLD) were measured on all preoperative and postoperative radiographs. Modern PROM scores were evaluated. Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) values were assessed for applicable PROMs. Univariate and multivariate statistical analyses were performed with P < 0.05 as significant. The mean clinical follow-up was 21.9 months (range, one to 128).</p><p><strong>Results: </strong>In multivariate analysis, the acetabular component position closer to the native hip center of rotation was associated with a greater probability of achieving the Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), MCID, SCB, and PASS thresholds (P ≤ 0.008). An increase in postoperative femoral offset was associated with achieving the MCID for the University of California Los Angeles (UCLA) activity level and patients being 'very satisfied or satisfied' (P ≤ 0.004). The mean postoperative LLD was 3.8 mm (range, 24.5 mm short to 36.6 mm long); however, postoperative LLD was NOT a predictor of PROMs (P ≥ 0.167) with statistical power ≥ 87%.</p><p><strong>Conclusion: </strong>Study results demonstrated that replicating the native center of rotation and optimizing femoral offset was associated with clinically relevant improvements in PROMs. Interestingly, in this large cohort, leg-length inequality was not associated with PROMs. Further research is warranted on THA component position, including spino-pelvic parameters and PROMs.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755695","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":"Corrigendum to 'Duloxetine as an Analgesic in Patients Who Do Not Have Central Sensitivity Undergoing Single-Setting, Bilateral Total Knee Arthroplasty: A Prospective, Double-Blinded, Randomized, Placebo-Controlled Trial' [The Journal of Arthroplasty. Volume 39, Issue 8, August 2024, Pages 2055-2060].","authors":"Amyn M Rajani, Anmol R S Mittal, Vishal U Kulkarni, Megha K Desai, Rishab R Dubey, Khushi A Rajani, Kashish A Rajani","doi":"10.1016/j.arth.2025.02.074","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.074","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744448","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":"Accuracy of Joint Center Reconstruction in Total Hip Arthroplasty and Its Effect on Postoperative Femoral Axial Rotation.","authors":"Douglas A Dennis, Christopher Plaskos, Jim W Pierrepont, Michael O'Sullivan, Jason M Jennings, Gerard H Smith","doi":"10.1016/j.arth.2025.03.065","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.065","url":null,"abstract":"<p><strong>Introduction: </strong>Displacement of the native hip center of rotation (COR) following total hip arthroplasty (THA) alters biomechanical load distribution and may adversely affect outcomes. This analysis quantified alterations in the COR following THA and their relationship with postoperative axial femoral rotation.</p><p><strong>Methods: </strong>There were 938 patients evaluated following staged bilateral THA. Each underwent a three-dimensional (3D) preoperative planning analysis. Automated registration between preoperative and postoperative computed tomography (CT) scans enabled the hip COR to be accurately compared preoperatively versus postoperatively. Changes in global anterior-posterior (AP) shift were defined by the combined difference between the anteriorization of the femoral COR and the posteriorization of the pelvic COR. Changes in global AP shift versus femoral internal rotation were assessed using linear regression.</p><p><strong>Results: </strong>The mean acetabular COR was medialized 4.6 mm and femoral COR 5.1 mm relative to the native COR, resulting in a global medial-lateral offset increase of 0.5 mm. Similarly, the achieved acetabular and femoral CORs were shifted proximally by 0.4 and 2.8 mm, respectively, resulting in an average increase in hip length of 2.4 mm. Acetabular and femoral CORs were shifted anteriorly by -1.7 and -0.8 mm, respectively, resulting in a global AP shift decrease of 0.9 mm. Change in global AP shift was moderately correlated with change in femoral internal rotation (R = 0.5), with a regression slope indicating an average increase in femoral internal rotation of 0.6° per millimeter increase in global AP shift (P < 0.0001). Global AP shift increased by > five mm in 24% of cases, resulting in an average increase in femoral internal rotation of 10°.</p><p><strong>Conclusions: </strong>Acetabular COR is medialized approximately five mm following THA with a compensatory increase in femoral offset, increasing muscle moment arms and increasing torque at the bone-stem interface. On average, global AP shift decreased by 1.0 mm, though there was significant patient-specific variability. When these changes exceed five mm, they can significantly alter axial rotational limb alignment.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755574","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":"Preoperative Colonoscopy is a Risk Factor for Reoperation following Primary Total Hip Arthroplasty: A Population-Based Study.","authors":"Talal Al-Jabri, Matthew J Wood, Lauren L Nowak, Emil Schemitsch","doi":"10.1016/j.arth.2025.03.066","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.066","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to investigate the association between preoperative colonoscopy and re-operations following total hip arthroplasty (THA) for osteoarthritis.</p><p><strong>Methods: </strong>We identified patients aged ≥ 18 years who underwent primary THA for osteoarthritis from 2003 to 2020 using administrative databases in Ontario, Canada. We identified patients who underwent colonoscopy up to one year before their THA and matched each colonoscopy patient to 10 controls using propensity score matching. We identified any instances of reoperation related to the primary THA up to five years postoperative. We used Cox Proportional Hazards models to determine the adjusted association between pre-operative colonoscopy and the time to reoperation, and the area under the receiver operating curve to identify the optimal cut-off time for preoperative colonoscopy. Between 2003 and 2020, 107,000 patients underwent THA for osteoarthritis in Ontario, Canada, while 1,733 (1.6%) of these received a pre-operative colonoscopy. We retained 1,515 colonoscopy patients and 15,150 controls following matching and observed no significant between-group differences in patient, hospital, or procedure characteristics in the matched cohort.</p><p><strong>Results: </strong>In the colonoscopy group, 69 patients (4.0%) underwent a reoperation within five years postoperatively (versus 2,977 [2.8%] in the control group). The majority of reoperations in both groups were revision THA (colonoscopy: 65 of 69, 94%; control: 2,837 of 2,977, 95%). Undergoing a preoperative colonoscopy up to 12 months before THA was associated with a 1.39 (1.07 to 1.81) increased risk of re-operation within five years postoperative. This risk increased to 1.91 (1.18 to 3.12) if the colonoscopy was done within 83 days of THA.</p><p><strong>Conclusion: </strong>Our results indicate that THA patients who undergo a diagnostic colonoscopy up to 12-months pre-operatively may have an increased risk of reoperation postoperatively. Furthermore, these data suggest a temporal relationship, where the risk may increase if the colonoscopy is performed closer to the THA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755698","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":"Comparing Patient Preference for Highly Congruent Versus Cruciate-Retaining Inserts in Bilateral Knee Arthroplasties.","authors":"Steven Kurina, John D Higgins, Amr Turkmani, Yehuda E Kerbel, Craig J Della Valle","doi":"10.1016/j.arth.2025.03.074","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.074","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this study was to determine if patients who had undergone bilateral total knee arthroplasty (TKA) with a cruciate-retaining (CR) bearing in one knee and a highly congruent bearing in the other had a preference between the two bearings.</p><p><strong>Methods: </strong>We retrospectively identified 104 patients who had bilateral TKAs performed an average of 15 months apart (range, simultaneous to 11 years apart) by the same surgeon using the same implant system, with each patient having a CR bearing in one knee and a highly congruent bearing in the other. The mean age at surgery was 62 years (range, 43 to 88), and 62% of patients were women. We assessed implant survival, reoperation rate, and range of motion (ROM). Patient knee preference, satisfaction, noise generation, subjective instability, and patient-reported outcome measures (PROM) were also analyzed. A power analysis revealed that 81 knees in each group were required to detect a difference in laterality preference of 20% (alpha = 0.05, beta = 0.80). Univariate analyses with alpha < 0.05 were used in comparisons between groups.</p><p><strong>Results: </strong>At a mean of 5.4 years, 27 patients (26%) preferred their CR knee, 25 patients (24%) preferred their highly congruent knee, and 52 patients (50%) had no preference (P = 0.9). There were 35 patients (34%) who preferred the first knee that was operated on versus 14% who preferred the second knee (P < 0.001). There was no difference in prosthesis survival (P = 0.4) or reoperations (P = 0.1) between groups. Additionally, there was no difference in overall patient satisfaction, knee flexion, or PROMs.</p><p><strong>Conclusion: </strong>Patients who had a CR insert in one knee and a highly congruent insert in the other did not prefer one versus the other. There was no difference in survival, outcomes, or post-operative ROM between the two bearings, demonstrating both as reliable and adequate choices in TKA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755692","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":"Effects and Complications of Apixaban Versus Aspirin for Venous Thromboembolism Prophylaxis After Total Hip or Knee Arthroplasty.","authors":"Shivan N Chokshi, Samuel S Gay, Bardia Barimani, Jeremy S Somerson","doi":"10.1016/j.arth.2025.03.072","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.072","url":null,"abstract":"<p><strong>Background: </strong>Major orthopaedic procedures, such as total hip arthroplasty (THA) and total knee arthroplasty (TKA), carry a risk for thrombotic complications. To reduce the incidence of postoperative venous thromboembolism (VTE), surgical patients are often prescribed antiplatelet or anticoagulant treatment. The objective of this study was to compare rates of VTE events and complications between apixaban and aspirin for VTE prophylaxis following primary THA and TKA.</p><p><strong>Methods: </strong>We searched a research network using Current Procedural Terminology and International Classification of Diseases, Tenth Revision (ICD-10) codes for patients who underwent a THA or TKA from 2018 to 2023. Patients were then categorized into cohorts of patients who received only aspirin (81 or 325 mg, twice daily) or patients who received only apixaban (2.5 mg, twice daily) for VTE prophylaxis. Odds ratios with 95% confidence intervals (OR, 95% CI) were calculated to compare the associations of selected prophylaxis with VTE events and complications, and Chi-square analyses were performed to determine the significance of differences. Statistical significance was defined as a 2-sided alpha value < 0.05.</p><p><strong>Results: </strong>Patients who received apixaban after THA had increased odds of DVT (5.22, 4.60 to 5.93), pulmonary embolism (7.85, 6.55 to 9.41), transfusion (1.5, 1.27 to 1.81), hemarthrosis (1.87, 1.26 to 2.24), myocardial infarction (1.12, 1.03 to 1.23), and readmission (1.18, 1.09 to 1.28) within 90 days after surgery. Patients who received apixaban after TKA had increased odds of DVT (4.57, 4.15 to 5.02), pulmonary embolism (6.05, 5.33 to 6.88), transfusion (1.6, 1.36 to 1.96), hemarthrosis (1.48, 1.03 to 2.12), myocardial infarction (1.42, 1.29 to 1.63), stroke (1.16, 1.09 to 1.53), and readmission (1.84, 1.61 to 2.11) within 90 days after TKA.</p><p><strong>Conclusion: </strong>Apixaban is associated with increased odds of thrombotic events and bleeding complications in the postoperative period of THA and TKA compared to aspirin. This highlights the potential risks associated with apixaban use and the importance of using data to guide patient management in the absence of standardized clinical guidelines.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755657","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":"Comparing Functional Recovery Between Total and Unicompartmental Knee Arthroplasty: A Prospective Health Kit Study.","authors":"David N Kugelman, Kevin A Wu, Rahul K Goel, Eric S Dilbone, Sean P Ryan, Michael P Bolognesi, Thorsten M Seyler, Samuel S Wellman","doi":"10.1016/j.arth.2025.03.061","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.061","url":null,"abstract":"<p><strong>Introduction: </strong>Both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) have demonstrated excellent clinical outcomes for end-stage osteoarthritis. Although UKA has been shown to have lower survivorship, many patients are interested in a partial knee arthroplasty due to the perception of \"better\" function and a \"quicker\" recovery. The purpose of this study was to objectively compare and understand functional recovery between TKA and UKA through the utilization of cutting-edge technological health metrics.</p><p><strong>Methods: </strong>Over a two-year period, 185 patients undergoing TKA or UKA (152 versus 33, respectively) were prospectively followed for one year postoperatively. Smart devices were worn by these patients to track their daily steps, steadiness, standing time, six-minute walk test, and gait speed, and were averaged weekly at multiple time points ranging from immediately preoperatively to one year postoperatively. Propensity matching scores were conducted in a 1:3 UKA to TKA ratio, resulting in a final cohort of 120 patients undergoing TKA or UKA (87 versus 33). Additionally, Euroqol 5 dimension survey (EQ-5D) and Knee Injury and Osteoarthritis Outcome (KOOS) scores were compared between groups.</p><p><strong>Results: </strong>No differences existed between demographics in both groups. At six weeks postoperatively, the mean gait speed was quicker for patients who underwent a UKA in comparison to those who underwent a TKA (0.97 versus 0.89 meters / second, P = 0.02). Furthermore, the average steadiness at six weeks postoperatively was better in the UKA group when compared to the TKA cohort (0.60 versus 0.40 (0 to 1 scale), P = 0.03). No further differences were demonstrated between groups at the 6-week time point. No data or reported outcomes varied between the UKA and TKA cohorts at both 6-month and 1-year postoperative time points.</p><p><strong>Conclusion: </strong>This prospective study compared UKA and TKA through the incorporation of real-time objective technological data. Although steadiness and gait speed were better in the UKA group at the 6-week follow-up, no differences existed beyond this time point. This study demonstrates that both UKA and TKA had the same recovery and functionality in regards to gait speed, daily step counts, standing time, steadiness, and the 6-minute walking test at 6-month and 1-year follow-up.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744389","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 Effect of Titanium Nitride Coatings on the Ingrowth and Interface Strength of Three-Dimensional Printed Porous Implants.","authors":"Michael Tanzer, Chau Ngo, Andrew Wong, Brinda Badwe, Lewis Mullen","doi":"10.1016/j.arth.2025.03.060","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.060","url":null,"abstract":"<p><strong>Background: </strong>The impact of titanium nitride (TiN) coatings on biologic fixation of modern titanium-based porous surfaces fabricated using additive manufacturing (AM) techniques remains unexplored. This study aimed to compare the biological fixation of three-dimensional (3D)-printed porous implants, with and without TiN coating, in a canine model.</p><p><strong>Methods: </strong>A canine femoral transcortical model was used to evaluate the characteristics of bone ingrowth of fully porous Ti-6Al-4V cylindrical implants fabricated using either Laser Rapid Manufacturing (LRM) or Electron Beam Melting (EBM). Implants were further divided into coated (TiN) and uncoated groups. Histological (bone ingrowth evaluation via scanning electron microscopy (SEM)) and mechanical push-out testing on the four groups of implants were performed at four and 12 weeks post-implantation.</p><p><strong>Results: </strong>Both TiN-coated and uncoated implants demonstrated substantial bone ingrowth at both time points. Bone ingrowth ranged from 35 to 50% at four weeks, then increased to 49 to 59% at 12 weeks. Mechanical tests indicated shear fixation strength ranging from 18 to 20 MPa at four weeks, increasing to 34 to 38 MPa at 12 weeks. There was no significant difference in either the amount of bone ingrowth or shear strength between TiN-coated and uncoated implants at either time point for both the LRM and EBM implants.</p><p><strong>Conclusions: </strong>This study demonstrated substantial bone ingrowth as well as comparable shear strength between TiN-coated and uncoated implants, regardless of manufacturing technique. Titanium nitride coatings do not influence biological fixation on modern titanium-based AM porous surfaces.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744461","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 CCJR® Charles A. Engh, Sr, MD. Excellence in Hip Research Award: Pelvic Tilt and Cup Position Change Significantly in Most Young Patients Ten Years After Hip Arthroplasty.","authors":"Joseph Kromka, William Zuke, Caroline Granger, John Clohisy, Robert Barrack","doi":"10.1016/j.arth.2025.03.055","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.055","url":null,"abstract":"<p><strong>Background: </strong>Acetabular cup position is fundamental to total hip arthroplasty (THA) and surface replacement arthroplasty (SRA). Even if initial cup placement is adequate, changes in spino-pelvic relationships alter functional acetabular position over time. This can lead to late complications. The purpose of this study was to examine changes in pelvic tilt and acetabular position in patients with at least 10 years of follow-up after THA or SRA.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients from one academic practice who underwent THA or SRA and had at least 10 years of follow-up. Pelvic ratio was measured and converted to pelvic tilt [1, 2]. Changes in pelvic tilt were compared from initial X-rays to final follow-up and between two subgroups based on age. Clinically meaningful changes in pelvic tilt and estimated acetabular position were calculated.</p><p><strong>Results: </strong>There were 200 patients included: 100 aged 45 to 50 years, and 100 aged 55 to 60 years. Their mean age was 52, 111 were men, and mean BMI was 29.67 (range, 18.79 to 49.31). Pelvic tilt change over the 10-year period was -9.87 degrees (Standard Deviation (SD) 10.22), P <0.001. This corresponds to an increase in acetabular inclination of 1.97 degrees and anteversion of 7.90 degrees. There was meaningful change in 62.5% of patients' posterior tilt with functional change in version or inclination of > 5 degrees. The subgroup of patients aged 45 to 50 had a larger change in pelvic tilt (-11.50 degrees, SD 9.04) than patients 55 to 60 (-8.25 degrees, SD 11.01), P = 0.024.</p><p><strong>Conclusions: </strong>We observed increases in posterior tilt in patients 10 years following THA or SRA, resulting in functionally increased acetabular anteversion and inclination. Larger increases in posterior tilt were seen in the younger group which has implications for initial cup placement in patients with normal spines.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732832","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":"Cost-Volume Analysis of Primary Total Knee and Hip Arthroplasty in the United States.","authors":"Giselle Porter, Jeffrey Balian, Ayesha P Ng, Hugo Mannings, Devon Jeffcoat, Peyman Benharash","doi":"10.1016/j.arth.2025.03.041","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.041","url":null,"abstract":"<p><strong>Background: </strong>Utilization of total knee (TKA) and total hip (THA) arthroplasty is increasing along with associated hospitalization costs. A contemporary analysis of the impact of hospital case volume on the costs of TKA and THA is lacking.</p><p><strong>Methods: </strong>Adults undergoing primary elective TKA or THA who had a diagnosis of osteoarthritis were identified from an inpatient all-payer database from 2012 to 2019. Operative volume was ascertained with restrictive cubic spline analysis. The volume corresponding to the inflection point of the spline was used to stratify hospitals as high volume (HVH) or low volume (LVH). Multivariable regression models were developed to examine the association of volume with hospitalization costs, adverse events, lengths of stay, and non-home discharges.</p><p><strong>Results: </strong>Of the 7,781,233 patients undergoing TKA or THA over the study period, 73.1% of primary TKA and 77.1% of primary THA were managed at HVH. Upon adjustment for patient and hospital covariates, treatment at high-volume TKA or THA hospitals was associated with a cost decrement of $2,200 (95% CI [confidence interval], 2,900 to 2,400, P < 0.001, Ref: LVH) and $1,900 (95% CI, 2,100 to 1,600), respectively. Notably, the disparity in hospitalization costs between HVH and LVH significantly increased during the study period (P < 0.001).</p><p><strong>Conclusions: </strong>Greater TKA and THA volume was associated with reduced hospitalization costs. These findings suggest that regionalization of care to experienced hospitals may improve the value of orthopaedic surgical care.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732823","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}