Journal of Arthroplasty最新文献

{"title":"Increased Lengths of Stay and Denial Rates Seen with Managed Care Organizations Following Total Hip Arthroplasty.","authors":"Reza Katanbaf, Gabrielle N Swartz, Jeremy A Dubin, Sandeep S Bains, Michael A Mont, James Nace, Ronald E Delanois","doi":"10.1016/j.arth.2025.03.028","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.028","url":null,"abstract":"<p><strong>Introduction: </strong>As Medicaid has expanded in response to the Affordable Care Act, managed care organizations (MCOs) have become the main healthcare delivery service for beneficiaries. These plans have prior authorization denial rates of over 12%. This finding warrants an ongoing evaluation of potentially modifiable barriers to access to care, such as denial rates, and how this restriction ultimately impacts patient care. This study compared patient characteristics, including age and the Charlson Comorbidity Index (CCI), lengths of stay, discharge dispositions, and denial rates following primary and revision total hip arthroplasty (THA) between patients who had MCOs and commercial insurance from 2020 to 2023.</p><p><strong>Methods: </strong>We reviewed our institutional database to identify patients who underwent primary or revision THA from 2020 to 2023. After excluding patients who had other insurance payer types, a history of hip fracture, and a history of malignancy, we identified 543 patients who underwent primary THA (MCO (n = 211); Commercial (n = 332)) and 96 patients who underwent revision THA (MCO (n = 26); Commercial (n = 72)). We analyzed patient demographics (age and the CCI), LOS, and denial rates between the two cohorts for primary and revision THA.</p><p><strong>Results: </strong>For patients who underwent primary THA, those who had MCO plans had similar CCIs (1.7 versus 1.7, P = 0.86) but were younger (54 versus 58 years, P < 0.0001) than those who had commercial plans, respectively. For patients who underwent revision THA, those who had MCO plans had a similar average age (53 versus 57 years, P = 0.25) and CCI (1.6 versus 1.7, P = 0.71) as those who had commercial plans, respectively. The average length of stay was significantly higher in the MCO cohort compared to the commercial cohort for primary THA (2.5 versus 1.2, P < 0.0001) and revision THA (6.6 versus 2.9 days, P = 0.0001), respectively. The denial rate was significantly higher in the MCO cohort compared to the commercial cohort for primary THA (2.8 versus 0.7%, P < 0.0001) and revision THA (2.4 versus 0.6%, P < 0.0001), respectively.</p><p><strong>Conclusion: </strong>Lengths of stay and denial rates were higher in the MCO cohort than in the commercial cohort. This could lead to decreased provider participation and potentially serve as a barrier to care for patients who have MCO plans.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665253","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":"Impact of Preoperative Colonoscopy on Revision Surgery Risk in Primary Total Knee Arthroplasty: A Comprehensive Population-Based Analysis.","authors":"Talal Al-Jabri, Matthew J Wood, Lauren L Nowak, Emil Schemitsch","doi":"10.1016/j.arth.2025.03.022","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.022","url":null,"abstract":"<p><strong>Background: </strong>In the same age group of patients undergoing TKA, colonoscopies are performed commonly as part of national colorectal cancer screening pathways. Several authors have reported PJI cases after colonoscopy, suggesting transient bacteremia as a potential mechanism for hematogenous seeding. However, the effect of preoperative colonoscopy on the risk of PJI in prospective TKA patients has been minimally studied. This study aimed to investigate the relationship between preoperative colonoscopy and reoperation and revision rates in TKAs performed for osteoarthritis, using data from Ontario's healthcare databases.</p><p><strong>Methods: </strong>This retrospective cohort study identified adults undergoing TKA for osteoarthritis in Ontario, Canada, between 2003 and 2022 through linked databases (CIHI, DAD, and OHIP). Propensity-score matching, Cox-Proportional-Hazards regression analysis, Nelson-Aalen curves, and log-log-survival curves were used to evaluate the effect of preoperative colonoscopy on the risk of reoperation and revision arthroplasty due to PJI.</p><p><strong>Results: </strong>Having a colonoscopy in the three months before TKA was associated with a significantly increased risk of TKA-related reoperation and revision TKA (rTKA) (HR [hazard ratio] 2.20; 95% CI [confidence interval] 1.05 to 4.63 and HR 2.59; 95% CI 1.16 to 5.80, respectively). In addition, patients who underwent colonoscopy in the 12 months before TKA had a 1-year rTKA rate of 1.0% compared to 0.5% of patients who did not undergo a colonoscopy in the same time period (P = 0.020). However, having a colonoscopy in the 12 months before TKA was not associated with a significantly increased risk of TKA-related reoperation (HR 1.43; CI 0.88 to 2.32) or rTKA (HR 1.62; CI 0.94 to 2.78) on multivariate logistic regression analyses.</p><p><strong>Conclusion: </strong>This study demonstrated a statistically significant association between having a colonoscopy in the three months preceding TKA and increased rates of both TKA-related reoperation and rTKA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665250","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":"Broach Only Total Hip Arthroplasty Using a Short, Uncemented, and Collarless, Fit-and-Fill Stem: Average 5-Year Follow-Up.","authors":"John B Meding, Lindsey K Meding, Evan R Deckard, Leonard T Buller, R Michael Meneghini","doi":"10.1016/j.arth.2025.03.032","DOIUrl":"10.1016/j.arth.2025.03.032","url":null,"abstract":"<p><strong>Background: </strong>Short femoral stem use in total hip arthroplasty can preserve bone stock and may diminish thigh pain. Tapered-wedge short stems are appealing, because reaming is not typically required as it is with classic \"fit-and-fill\" designed stems. This study aimed to evaluate the minimum 2-year clinical, radiographic, and clinical results of a short, uncemented, and collarless, fit-and-fill stem implanted using a broach-only technique.</p><p><strong>Methods: </strong>The clinical and radiographic results of a consecutive series of 505 cementless THAs were reviewed from 2 to 9 years postoperatively. The average age was 62 years (range, 32 to 91), and 54% of the patients were men. Dorr's class was 31% A, 64% B, and 5% C. All patients were followed for a minimum of 2 years. The average follow-up was 5.6 years (range, two to nine).</p><p><strong>Results: </strong>At the final follow-up, the average Harris hip and pain scores were 90 and 42, respectively. There were 82% of hips rated as pain-free. A single patient reported activity-related thigh pain. There were no cases of femoral aseptic loosening. At operation, 14% of stems were placed in more than five degrees of varus. An intraoperative femur fracture occurred in 13 hips (2.5%). There were two stems revised (one infection and one late femur fracture).</p><p><strong>Conclusions: </strong>The theoretical advantages of using this collarless fit-and-fill stem may be offset by the tendency for varus placement and proximal femur fracture when using a broach-only technique. Nevertheless, the varus stems in this series remain well-ingrown and radiographically stable at an average 5-year follow-up.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665276","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":"Pediatric Patients Undergoing Total Hip Arthroplasty: A Single-Center Experience at Average 5.3-Year Follow-Up.","authors":"Jennifer X Hong, Avi Dravid, Wudbhav N Sankar, Neil P Sheth","doi":"10.1016/j.arth.2025.03.017","DOIUrl":"10.1016/j.arth.2025.03.017","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) is an increasingly popular option for pediatric end-stage hip disease. However, data regarding implant longevity and functional outcomes remain limited. This case series evaluated complication and revision rates, patient-reported outcome measures (PROMs), and implant survivorship in consecutive pediatric THA patients from a single surgeon. We hypothesized that pediatric patients would have low revision rates and excellent functional outcomes at 5-year follow-up.</p><p><strong>Methods: </strong>Following institutional review board approval, 74 patients under age 21 years who underwent 92 THAs between 2013 and 2023 were identified. Age, etiology, follow-up interval, complications, revisions, and preoperative and postoperative PROMs were recorded. The mean follow-up was 5.3 years (range, one to 11.2) and mean age at surgery was 16 years (range, 11 to 21). All patients underwent THA by the senior surgeon through a posterior (92.4%) or anterior (7.6%) approach; 90.2% received a ceramic on a highly cross-linked polyethylene bearing, with the remaining 9.8% receiving a metal femoral head. All patients received a cementless stem based on femoral morphology. No patients were lost to follow-up.</p><p><strong>Results: </strong>The most common etiologies were Perthes disease and corticosteroid-induced osteonecrosis (15.2% each). A patient (1.1%) with Mucopolysaccharidosis type IV required a femoral revision for aseptic loosening; no other patients were revised. All average postoperative PROMs improved significantly (P < 0.00001): Hip Disability and Osteoarthritis Outcome Score, Joint Replacement 53.4 (interquartile range [IQR], 46.7 to 70.4) to 89.9 (IQR, 85.3 to 100), EQ-5D 0.5 (IQR, 0.2 to 0.7) to 0.8 (IQR, 0.7 to 1), and EQ visual analog scale 81 (IQR, 70 to 95) to 85 (IQR, 80 to 100). Revision-free Kaplan-Meier survivorship at 5 and 10 years was 98.9%.</p><p><strong>Conclusions: </strong>Total hip arthroplasty (THA) in patients under age 21 years yields substantial improvements in 5-year functional outcomes, regardless of etiology, with extremely low revision rates and excellent implant survivorship.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665298","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":"Simulated Partial and Complete Resection of the Posterior Cruciate Ligament in Medially Conforming Total Knee Arthroplasty Causes a Graded Reduction in Femoral Rollback and Increase in Posterior Tibial Sag: A Computational Study.","authors":"Reza Pourmodheji, Cynthia A Kahlenberg, Brian P Chalmers, Eytan M Debbi, William J Long, Timothy M Wright, Geoffrey H Westrich, David J Mayman, Carl W Imhauser, Peter K Sculco","doi":"10.1016/j.arth.2025.03.030","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.030","url":null,"abstract":"<p><strong>Background: </strong>Medially conforming (MC) total knee arthroplasty (TKA) has seen increased clinical utilization. This design allows for either retention or resection of the posterior cruciate ligament (PCL); however, the impact of the PCL on femoral rollback and posterior tibial sag is unknown. Therefore, we developed a computational model to quantify how the PCL affects femoral rollback and posterior sag in MC-TKA.</p><p><strong>Methods: </strong>Computational models of ten cadaver knees were virtually implanted with MC-TKAs. Clinical tests of passive flexion and posterior sag were simulated, and femoral rollback and posterior tibial translation (PTT) were quantified. These tests were simulated in MC-TKA with the PCL retained, partially resected, and completely resected. We then assessed how increasing the tibial insert thickness in PCL-resected MC-TKA and switching to posterior-stabilized (PS)-TKA impacted posterior sag.</p><p><strong>Results: </strong>Femoral rollback decreased medially by a median of 2.4 mm (P ≤ 0.001) and laterally by a median of 3.3 mm (P < 0.001) with simulated PCL resection. For the simulated sag test, PTT increased by a median of 4.2 mm (P < 0.05) and 7.4 mm (P ≤ 0.001) with partial and complete PCL resection, respectively. Moreover, PTT was reduced by a median of 7.1 mm (P ≤ 0.01) when converting a PCL-resected MC-TKA to a (PS)-TKA.</p><p><strong>Conclusion: </strong>In a computational model, MC-TKA does not fully compensate for the function of the PCL, which facilitates femoral rollback in passive flexion and resists PTT during a posterior sag test. Resecting the antero-lateral (AL) bundle, with preservation of the postero-medial (PM) bundle of the PCL, yields more femoral rollback and less PTT than complete PCL resection in MC-TKA. Increasing tibial insert thickness in MC-TKA also does not account for the role of the PCL in reducing PTT during a sag test, while a PS-TKA does.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651897","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":"Special Considerations Before Total Hip Arthroplasty for Rapidly Progressive Osteoarthritis with a Recent Corticosteroid Injection.","authors":"Joshua Rainey, Adam Taylor, Logan Radtke, Amanda Crawford, Brenna Blackburn, Lucas Anderson, Christopher Peters, Jeremy Gililland, Christopher Pelt","doi":"10.1016/j.arth.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.023","url":null,"abstract":"<p><strong>Background: </strong>Rapidly progressive osteoarthritis (RPOA) has been associated with hip corticosteroid injections (CSIs), but may also mimic septic arthritis, which demonstrates similar erosive findings. This retrospective review evaluated a consecutive series of patients who had RPOA of the hip following CSI who underwent total hip arthroplasty (THA) and assessed outcomes and potential infection screening implications.</p><p><strong>Methods: </strong>All radiographic reports concerning RPOA were retrospectively identified at a single academic referral center from January 2014 to January 2023. A total of 4,279 reports were identified, and after removing duplicates, 2,175 patients were individually chart-reviewed. Occurrence of RPOA was defined as chondrolysis of at least two millimeters per year or 50% of joint space loss within one year of a CSI of the hip. Patients who had prior malignancy, septic arthritis, oral corticosteroid use, or prior femoral head avascular necrosis were excluded.</p><p><strong>Results: </strong>Ultimately, 81 patients, who had a mean follow-up time of two years, were identified who had undergone THA for RPOA following CSI. The average time between CSI and THA was 183.6 days (SD = 140.2). Preoperative infectious workup was performed in 31 patients who have inflammatory markers and eight patients who have a hip aspiration based on surgeon discretion. The mean aspiration cell counts and polymorphonuclear percentages were 1,410.8 (SD = 1,574.2) and 52.3% (SD = 23.3), respectively. Cultures were negative in all aspirations. All eight patients had negative aspirations and negative intraoperative cultures, and none developed periprosthetic joint infection (PJI). Of interest, two patients developed PJI within one month following THA, and neither underwent a preoperative infectious workup with labs or aspirations. Aside from these two PJIs, no other patients underwent repeat surgery.</p><p><strong>Conclusion: </strong>The occurrence of RPOA of the hip following CSI was associated with an estimated 2.5% risk of PJI. Preoperative screening with inflammatory markers and possible joint aspiration should be considered prior to THA for patients who have CSI-related RPOA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651900","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":"Complete and Selective Resection of the Posterior Cruciate Ligament Reduces Contact Forces Asymmetrically in Cruciate-Retaining Total Knee Arthroplasty: A Computational Study.","authors":"Reza Pourmodheji, Brian P Chalmers, Eytan M Debbi, William J Long, Timothy M Wright, Geoffrey H Westrich, David J Mayman, Carl W Imhauser, Peter K Sculco, Cynthia A Kahlenberg","doi":"10.1016/j.arth.2025.03.031","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.031","url":null,"abstract":"<p><strong>Background: </strong>Assessing intraoperative ligament balance in the posterior cruciate ligament (PCL)-retaining total knee arthroplasty (CR-TKA) can be achieved by quantifying tibio-femoral contact forces. Ligament balancing may involve selectively releasing PCL fibers; however, the effects of the extent and location of PCL release on compartmental contact forces are not well understood. To investigate these effects, we developed a computational model to quantify changes in medial and lateral contact forces resulting from targeted PCL fiber release.</p><p><strong>Methods: </strong>Computational models of ten cadaveric knees (five men, five women; mean age of 63 years) were virtually implanted with a CR-TKA. Passive knee flexion was simulated under three PCL conditions: all PCL fibers retained, all PCL fibers resected, and only the central PCL fibers released. Tibio-femoral contact forces in the medial and lateral compartments at 90° of flexion were measured for each PCL condition.</p><p><strong>Results: </strong>Resecting the PCL resulted in a reduction of contact forces by a median of 24.2 N (P ≤ 0.01) medially and a median of 11.1 N (P ≤ 0.01) laterally. Selective release of only the central PCL fibers reduced medial and lateral contact forces by medians of 11.5 N (P ≤ 0.05) and 4.5 N (P ≤ 0.05), representing 47 and 50% of the reduction observed with complete PCL resection, respectively.</p><p><strong>Conclusion: </strong>Resecting the PCL asymmetrically impacts compartmental contact forces, with a greater reduction observed in the medial compartment. Given the contribution of the releasing PCL's central portion to the reduction in compartmental contact forces, surgeons may consider first focusing on this region when conducting intraoperative releases to achieve ligament balance via PCL resection in CR-TKA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651843","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 Quadriceps Vector in the Lower Extremity of Indian Patients is Similar in Caucasian and Japanese Patients.","authors":"Fangzhou Chi, Shigeru Takagi, Tomoharu Mochizuki, Hiroyuki Kawashima, Rajesh Malhotra, J David Blaha","doi":"10.1016/j.arth.2025.03.020","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.020","url":null,"abstract":"<p><strong>Introduction: </strong>Correct alignment of knee components contributes to the longevity and function of total knee arthroplasty. The accuracy and reliability of calculating the three-dimensional quadriceps vector (QV) using computed tomography (CT) scans in Caucasian and Japanese study participants have been established in previous studies. In all cases, the QV was directed from the top of the patella to the middle of the femoral neck. The literature describes considerable differences in the morphology of bone in the lower extremities of Indian people compared with that of Caucasian and Japanese people.</p><p><strong>Methods: </strong>An imaging study was conducted using CT scans to determine the QV in a cohort of 36 patients from India [18 women (mean age 59 years), 18 men (mean age 61 years)]. The same measurement methods were used for this cohort as in previous studies. The QV and all measured axes were compared within the cohort.</p><p><strong>Results: </strong>The QV for the Indian cohort was found to be directed from the top of the patella toward the femoral neck, as in Caucasian and Japanese CT scans. In the Indian knees, the passing point of the vector was found to be lateral 30.8 mm (range, 25.2 to 36.4) and anterior 31.2 mm (range, 28.4 to 33.9) to the femoral head. When projected to the coronal plane, the QV was closest to that of the spherical axis, 1.2 ± 0.8° (P < 0.05).</p><p><strong>Conclusion: </strong>As in previous studies, the QV crosses the femoral neck lateral to the femoral head and is most parallel to the spherical axis (center femoral head to center spherical medial condyle) projected onto the coronal plane in the native Indian knee. These data suggest that using the QV for alignment may be applied to most human knees regardless of morphology.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651920","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 of Medial Pivot Total Knee Arthroplasty (MP-TKA) Based on Preoperative Coronal Deformity.","authors":"Zachary Parisi, Jeffrey B Stambough, Eric R Siegel, Simon C Mears, C Lowry Barnes, Benjamin M Stronach","doi":"10.1016/j.arth.2025.03.021","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.021","url":null,"abstract":"<p><strong>Introduction: </strong>The medial pivot total knee arthroplasty (MP-TKA) was developed to better replicate the kinematics of the healthy knee. Although outcomes of MP-TKA have been investigated, previous studies involved primarily varus preoperative deformities. The objective of this study was to determine patient outcomes using the Knee Injury and Osteoarthritis Outcome Score Jr (KOOS Jr) following MP-TKA in relation to the type (varus/neutral/valgus) and severity (moderate/severe) of preoperative coronal deformity.</p><p><strong>Methods: </strong>This was a single-center retrospective cohort study of 311 knees receiving MP-TKA between April 25, 2017, and May 27, 2022, with a pre-operative long-leg hip-knee-ankle (HKA) angle measured by biplanar EOS. Patients were assigned to one of five varus/valgus alignment groups: neutral (0 ± 3 degrees), moderate (3 to 15 degrees), or severe (15+ degrees) pre-operative coronal deformity.</p><p><strong>Results: </strong>Differences in sex were noted, while all other demographic and comorbid conditions were similar. The mean post-operative period between the date of surgery and KOOS Jr. collection was 17.6 months across all groups. Severe valgus knees (n = 5) had an average (mean ± SD) postoperative KOOS Jr of 71.7 ± 10.6, while moderate valgus knees (n = 49) demonstrated a postoperative average KOOS Jr. of 72.5 ± 19.6. Neutral knees (n = 53) had an average postoperative KOOS Jr of 65.2 ± 22.3, while moderate varus (n = 180) and severe varus (n = 24) had an average KOOS Jr of 69.9 ±19.1 and 73.2 ± 16.1, respectively. There was no difference noted in postoperative scores between the five deformity groups.</p><p><strong>Discussion: </strong>The utilization of MP-TKA in patients who have moderate and severe valgus deformity showed similarly favorable outcomes when compared to neutral as well as moderate and severe varus knees. Further studies are needed to determine long-term outcomes with widespread MP-TKA use for all preoperative coronal deformities.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651891","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":"Metal Release in Total Knee Arthroplasty: A Review of Mechanisms, Adverse Local Tissue Reactions, and Biological Effects.","authors":"Michael A Kurtz, Nadim J Hallab, Joshua P Rainey, Cristopher E Pelt, William M Mihalko, Nicolas S Piuzzi, Michael A Mont, Hannah Spece, Steven M Kurtz","doi":"10.1016/j.arth.2025.03.025","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.025","url":null,"abstract":"<p><p>Compared to the hip, where investigators associate metal release with adverse local tissue reactions (ALTRs), metal related complications in total knee arthroplasty (TKA) remain controversial and underexplored. Primary TKA systems use monobloc components, limiting corrosion and subsequent concern. However, like the joints they replace, metal components degrade in vivo. In this narrative review, we aimed to summarize clinically relevant knowledge on metal release within the context of TKA for practicing orthopaedic surgeons. We asked: do ALTRs associated with metal release occur in the knee, and if so, to what extent? To answer this research question, we identified in vivo degradation mechanisms including wear, mechanically assisted crevice corrosion, and electrocautery damage. Next, we synthesized case reports and retrospective clinical studies documenting adverse local tissue reactions in primary and revision TKA. Then, we reviewed the biological response to cobalt chrome debris, focusing on genotoxicity, immune responses, and hypersensitivity. While clinical evidence suggests that patients rarely experience severe biological reactions like pseudotumors, ALTRs associated with metal release can and do occur following TKA. To overcome prevalence related knowledge gaps, prospective clinical trials are needed.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639830","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}