Journal of Arthroplasty最新文献

{"title":"Non-Opioid Analgesics for Postoperative Pain Management Following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Imran Syed, Sammy Al-Rubaie, Dan Cohen, David Slawaska-Eng, Muhammad N Al-Besher, Vickas Khanna","doi":"10.1016/j.arth.2025.03.027","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.027","url":null,"abstract":"<p><strong>Background: </strong>Hip and knee arthroplasty are a fundamental part of modern orthopaedic practice. These procedures often require extensive postoperative analgesia, including opiate painkillers that are frequently associated with adverse side effects and risk of abuse. This review, therefore, investigated how postoperative administration of non-opioid co-analgesics (e.g., parecoxib, pregabalin) can affect postoperative pain scores and opioid use.</p><p><strong>Methods: </strong>A systematic search of OVID Embase, Medline, and PubMed was conducted, and studies were filtered to trials of patients undergoing arthroplasty who received non-opioid analgesia. Several meta-analyses were conducted to investigate the effects of various medications and classes at multiple postoperative time points on pain scores and opioid use. Standardized mean differences were conducted for analyses involving more than one measure of pain. There were 28 analyses included in the final review.</p><p><strong>Results: </strong>On average, non-steroidal anti-inflammatory drugs (NSAID)s and gabapentinoids reduced between 9.30 and 10.89 mg, respectively of IV morphine in a 24-hour period. Reductions were also observed at various time points for NSAIDs, gabapentinoids, parecoxib, and pregabalin. Non-opioid co-analgesia improved pain at rest for various time points, including NSAIDs at post-op day (POD) one and PODs three and five. Parecoxib and corticosteroids were protective at POD three. Pain during movement was significantly reduced by NSAIDs at six hours, POD one, two, and three, with parecoxib demonstrating similar benefits at POD one and POD two to three.</p><p><strong>Discussion: </strong>This review found that postoperative administration of non-opioid co-analgesia may alleviate the need for opioids and have modest protective effects on postoperative pain. The effects of these analgesics, however, may be clinically non-meaningful for reducing pain. These results may further implicate a need to implement non-opioid co-analgesia in postoperative patient care. Future research may include an updated investigation of this research question as more medication-granular research becomes available.</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":"143639833","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":"Is Patella Resurfacing Associated with Postoperative Extensor Mechanism Disruption After Total Knee Arthroplasty? A Systematic Review and Meta-Analysis.","authors":"Andrew B Harris, Joshua A Valenzuela, Dominic Giuliani, Vishal Hegde, Harpal S Khanuja, Simon C Mears","doi":"10.1016/j.arth.2025.02.059","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.059","url":null,"abstract":"<p><strong>Background: </strong>Patella resurfacing in total knee arthroplasty (TKA) involves surgical manipulation of the extensor mechanism, which can weaken or devascularize the patellar bone, quadriceps, and patellar tendon. Patella resurfacing may, in theory, increase the risk of postoperative extensor mechanism disruption (EMD).</p><p><strong>Methods: </strong>We systematically searched the Cochrane, Embase, and PubMed databases to identify randomized controlled trials that reported the overall incidence of complications and surgery for EMD for resurfaced and unresurfaced patellae in patients who underwent primary TKA with a 2-year follow-up. There were nine studies included in the meta-analysis, representing 1,569 patients, 773 of whom (49%) underwent patella resurfacing. Study selection was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A common-effects model was used to calculate the pooled effects as log odds ratios (ORs) and 95% confidence intervals (CIs). P < 0.05 was considered significant.</p><p><strong>Results: </strong>The unadjusted incidence of postoperative patellar fracture was equivalent for patients who did not have patella resurfacing (0.26%) than for those who had resurfacing (0.38%) (P = 0.51). Postoperative patellar tendon tears were not reported in any patients. Quadriceps tendon tears were also uncommon, with one instance occurring in the unresurfaced group (0.13%) and one instance in the resurfaced group (0.13%) (P = 0.74). Meta-analysis revealed no significant association between patella resurfacing and sustaining any EMD-related complication (OR 0.22, 95% CI: -1.24 to 0.80) or requiring surgery for EMD (OR 0.22, 95% CI: -0.92 to 1.36).</p><p><strong>Conclusion: </strong>In this large patient sample, the 2-year incidence of EMD-related complications after TKA was low. However, a meta-analysis of the pooled data suggests that patella resurfacing in TKA is not associated with the incidence of postoperative EMD-related complications or surgery for EMD.</p><p><strong>Level of evidence: </strong>III.</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":"143639827","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":"One-Stage versus Two-Stage Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Alessandro Bensa, Marco Delcogliano, Giacomo Moraca, Luca Bianco Prevot, Gae Fattini Fellini, Giuseppe Filardo","doi":"10.1016/j.arth.2025.03.026","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.026","url":null,"abstract":"<p><strong>Introduction: </strong>Bilateral total knee arthroplasty (B-TKA) represents an increasingly used option to address advanced bilateral knee osteoarthritis (OA). The aim of this study was to quantify and compare one-stage and two-stage B-TKA results in terms of clinical outcomes, perioperative parameters, complication, revision, and mortality rates.</p><p><strong>Methods: </strong>The literature search was conducted using three databases (PubMed, Cochrane, Web of Science) in February 2024 according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Inclusion criteria were: comparative studies, English language, no time filter, on the comparison of one-stage and two-stage B-TKA for bilateral knee OA treatment. The quality of each article was assessed using the Cochrane risk of bias in non-randomized studies of interventions tool (ROBINS-I).</p><p><strong>Results: </strong>Among the 2,130 articles retrieved, 69 studies (366,722 patients) were included. One-stage B-TKA showed lower rates of TKA-related complications (P = 0.043), deep infections (P < 0.001), wound complications (P = 0.033), operative time (P = 0.028), length of hospital stay (P < 0.001), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (P = 0.013), and Oxford Knee Score (OKS) score (P = 0.004), but higher mortality rates at the 1-month (P < 0.001), 3-month (P < 0.001), and 1-year (P = 0.001) follow-ups, as well as higher rates of neurological (P = 0.013) and gastrointestinal (P < 0.001) complications, deep vein thrombosis (P = 0.016), and pulmonary embolism (P < 0.001). The risk of bias was \"low\" in 26 studies, \"moderate\" in 36 studies, \"serious\" in six studies, and \"critical\" in one study.</p><p><strong>Conclusion: </strong>One-stage B-TKA was associated with a higher mortality rate and thromboembolic risk while presenting lower TKA-related and infective complications compared to two-stage B-TKA. One-stage B-TKA also reduced hospital stay and total surgical time but provided only marginal improvement in clinical outcomes compared to two-stage B-TKA while showing higher risk of neurologic and gastrointestinal complications. These results offer important information for both patients and surgeons in evaluating the most appropriate surgical approach, thereby contributing to optimize the management of patients undergoing B-TKA.</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":"143639836","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":"Recovery of Ambulation After Staged Bilateral Total Knee Arthroplasty is Not Affected by Timing of Second Side Surgery: A Retrospective Analysis of Implanted Sensor Data.","authors":"Rika Ichinose, Patrick Aubin, Scott Schumacker, Fred Cushner","doi":"10.1016/j.arth.2025.03.010","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.010","url":null,"abstract":"<p><strong>Background: </strong>Bilateral knee osteoarthritis is often treated with staged bilateral total knee arthroplasty (BTKA). However, the optimal surgical timing for staging remains contended. In this study, a smart implant sensor was used to assess the association between surgical timing of stages and recovery of ambulation after the second total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>Overall, 246 staged bilateral and 2,209 unilateral TKA patients received a sensor-enabled knee implant between 2021 and 2023. Staged BTKA patients were stratified into three subgroups based on time intervals between surgeries: extra-early (< six weeks), early (< 13 weeks), or standard (≥ 13 weeks). Mixed effects repeated measures modeling methods were used to compare daily qualified step count, walk speed, and functional knee range of motion (ROM) during ambulation between the groups.</p><p><strong>Results: </strong>The three BTKA groups had significantly different daily step counts, walking speed, and knee ROM during the preoperative period before the second TKA. The extra-early bilateral group took fewer qualified steps (P < 0.05), walked slower (P < 0.05), and had less knee ROM (P < 0.05) than both the early and standard groups at the two-week point before their second TKA (P < 0.0 5). At 26 weeks after the second TKA, walking speed, and knee ROM showed no significant difference across the extra-early, early, standard, and unilateral groups (P > 0.05).</p><p><strong>Conclusion: </strong>Close staging of BTKA surgeries, even less than six weeks apart, did not negatively affect the recovery of postoperative ambulation after the second TKA. Our results may help inform surgeons and patients on timing for staging, especially if a shorter staging is preferred for convenience and shorter overall recovery time.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634956","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":"Repeat Two-Stage Exchange Arthroplasty for Recurrent Periprosthetic Knee Infection: Results of 87 Cases.","authors":"Oliver B Dilger, Aaron R Owen, Nicholas A Bedard, Tad M Mabry, Daniel J Berry, Matthew P Abdel","doi":"10.1016/j.arth.2025.03.005","DOIUrl":"10.1016/j.arth.2025.03.005","url":null,"abstract":"<p><strong>Background: </strong>Despite the success of two-stage exchange total knee arthroplasties (TKAs), a subset of patients become reinfected and may be considered for a repeat two-stage exchange TKAs. A small, prior study from our institution demonstrated a 50% re-revision rate in such a cohort. The purpose of the present study was to evaluate a contemporary and larger cohort of repeat two-stage exchange TKAs with an emphasis on implant survivorship, risk factors, and clinical outcomes.</p><p><strong>Methods: </strong>We retrospectively identified 87 repeat two-stage exchange TKAs performed between 2014 and 2021. The mean patient age was 66 years, 32% were women, and the mean body mass index was 29. At the time of resection, 98% of patients were treated with a high-dose antibiotic spacer (58 nonarticulating and 27 articulating). The mean time from resection arthroplasty to reimplantation was 22 weeks. Kaplan-Meier survivorship analyses were performed, and risk factors (including the McPherson staging system) were assessed. The mean follow-up was five years (range, two to nine).</p><p><strong>Results: </strong>The 5-year survivorships free of rerevision for reinfection, any rerevision, and any reoperation were 88, 67, and 54%, respectively. Leading causes for rerevision were periprosthetic joint infection (36%) and aseptic loosening (27%). There were no statistically significant independent risk factors identified. However, patients who had McPherson host grade C trended toward higher rates of reoperation (hazard ratio: 2, P = 0.057). Despite the high reoperation rate, at the final follow-up (mean five years), 91% of patients had a TKA in situ, 8% had been treated with above-knee amputation, and 1% with a definitive resection arthroplasty.</p><p><strong>Conclusions: </strong>Despite its challenges, including a 54% reoperation rate, repeat two-stage exchange TKAs may be considered in a subset of patients given 91% of patients had a TKA in situ at a mean of five years, and the 5-year survivorship free of rerevision for infection was 88%. Notably, patients who were McPherson host grade C trended toward failure.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634957","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":"Rates of Postoperative Heart Failure Among Type 2 Diabetics With Use of Nonsteroidal Anti-Inflammatory Drugs for Total Knee Arthroplasty.","authors":"Sophia S Antonioli, Michelle A Richardson, Alana Prinos, Ran Schwarzkopf, William Macaulay","doi":"10.1016/j.arth.2025.03.015","DOIUrl":"10.1016/j.arth.2025.03.015","url":null,"abstract":"<p><strong>Background: </strong>Nonsteroidal anti-inflammatory drugs (NSAIDs) can increase fluid retention and the risk of heart failure (HF). Type 2 diabetes mellitus (T2DM) is known to increase the risk of cardiac disease, including HF. As part of a modern multimodal pain protocol, NSAIDs are commonly used in total knee arthroplasty (TKA), but the risk of NSAID use in TKA for T2DM patients is not well understood. The purpose of this study was to compare rates of new-onset HF following TKA in type 2 diabetics with varying NSAID use.</p><p><strong>Methods: </strong>We reviewed 3,906 patients who underwent primary TKA from 2015 to 2023 at a single academic institution. Data collected included demographics, preoperative diagnosis of T2DM, postoperative development of new-onset HF, NSAIDs taken perioperatively, and aspirin use for deep vein thrombosis prophylaxis. Propensity matching was conducted to control for age, American Society of Anesthesiologists score, and aspirin use. Rates of postoperative HF within T2DM patients who took meloxicam versus celecoxib were compared using Chi-square analyses.</p><p><strong>Results: </strong>Among patients who took meloxicam or celecoxib perioperatively, a preoperative diagnosis of T2DM was disproportionately associated with postoperative HF (P = 0.006). When comparing peri-TKA use of meloxicam versus celecoxib in T2DM patients, the use of celecoxib was disproportionately associated with the development of postoperative HF (2.2% [meloxicam], 4.8% [celecoxib], P = 0.002).</p><p><strong>Conclusions: </strong>We found patients who had T2DM developed postoperative HF at higher rates than nondiabetics following peri-TKA NSAID use and that T2DM patients developed new-onset HF at higher rates when utilizing celecoxib than meloxicam in the peri-TKA period. Along with the many other factors that contribute to an orthopaedic surgeon's decision on which NSAID to use postoperatively, we advocate for consideration of the risk of new-onset HF in T2DM patients when prescribing meloxicam and celecoxib in the post-TKA period.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631043","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":"Total Knee Arthroplasty Design Without Cruciates to Achieve Anatomic Femoral-Tibial Motion and Laxity.","authors":"Peter S Walker, Daniel Hennessy, Sophia Warren, Joseph Bosco","doi":"10.1016/j.arth.2025.03.014","DOIUrl":"10.1016/j.arth.2025.03.014","url":null,"abstract":"<p><strong>Background: </strong>A frequently stated goal of an artificial knee arthroplasties is to achieve normal kinematics. However, this is not easily defined based on variations in motions previously measured for a range of activities. For activities such as crouching up and down, a fan pattern has been measured, where the lateral femoral contact displaces progressively posteriorly with flexion, and the medial contact remains almost constant. In walking and other activities, femoral-tibial contacts vary considerably in position, and even lateral pivoting has been measured at the start of the motion cycle. Fluoroscopic studies of total knee arthroplasty (TKA) patients have shown that such kinematics is not usually achieved for most TKA designs. In recent years, there has been an increasing interest in noncruciate retaining knee arthroplasties, where both cruciate ligaments are resected. A challenge with such designs is to define the design criteria, taking account of the extensive kinematic data of normal knees, as well as clinical factors.</p><p><strong>Methods: </strong>A TKA design was formulated where the main bearing surfaces produced medial stability and lateral mobility, but where the addition of an offset cylindrical bearing surface in the center induced progressive axial rotation and lateral \"rollback\" with flexion. At the same time, anterior-posterior and rotational laxity were provided, as in the normal knee. The new design was compared experimentally with four types of contemporary noncruciate total knee arthroplasties. There were three-dimensional printed models fabricated. A test machine was constructed where shear and torque forces were applied at a range of flexion angles, and contact positions were determined.</p><p><strong>Results: </strong>It was found that the design with the intercondylar cylindrical surface satisfied the design criteria more closely compared with the other designs.</p><p><strong>Conclusions: </strong>For noncruciate designs to produce more normal motion characteristics, some mechanical configuration acting in concert with the lateral and medial condyles is likely to be necessary.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631045","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":"A Novel Radiographic Methodology to Measure Knee Adduction Moment Using Routine Biplane Radiographs: Initial Results of 20 Patients.","authors":"Fernando J Quevedo Gonzalez, Peter K Sculco, Theofilos Karasavvidis, Cale A Pagan, Edward Grabov, Tsion Yared, Karlos Zepeda, Joseph D Lipman, Cynthia A Kahlenberg, Eytan M Debbi, Timothy M Wright, David J Mayman, Jonathan M Vigdorchik","doi":"10.1016/j.arth.2025.03.008","DOIUrl":"10.1016/j.arth.2025.03.008","url":null,"abstract":"<p><strong>Background: </strong>Compromised function is a common reason for patient dissatisfaction after total knee arthroplasty. However, objectively evaluating function often requires costly, time-consuming, and highly specialized data collection and analysis in a dedicated motion analysis laboratory. To overcome this practical barrier, we developed a radiographic-based method to quantify knee joint moments in routine clinical care and to explore the relationship between knee moments in the sagittal plane and the Knee Osteoarthritis Outcomes Score for Joint Replacement (KOOS JR).</p><p><strong>Methods: </strong>Motion analysis was performed on 20 patients (nine women, aged: 38 to 76 years; body mass index: 22.1 to 31.6) during level ground walking preoperatively and 6 weeks after total knee arthroplasty. At the same time points, patients underwent frontal and lateral biplane radiographs that were synchronized spatially and temporally with ground force measurements during bipedal and single leg stances on the operated leg. The knee adduction moment (KAM), in percent body weight times height (%BW·H), was calculated in the coronal plane as the product of the ground force and the perpendicular distance between the force's line of action and the knee center. The dynamic KAM during walking was compared to the radiographic KAM and related to KOOS JR.</p><p><strong>Results: </strong>The peak dynamic KAM range was -0.5 to 4.3% BW·H preoperatively and 1 to 4.4% BW·H postoperatively. The static KAM, particularly during single leg stance, was strongly correlated with the peak dynamic KAM; however, the KAM was not correlated with KOOS JR.</p><p><strong>Conclusions: </strong>The radiographic KAM, particularly during single leg stance, was an excellent surrogate metric for the peak dynamic KAM. The KAM was not correlated with KOOS JR; however, our follow-up was short, and we did not consider additional kinetic metrics, like the knee flexion moment. The proposed methodology allows routine clinical evaluation of knee kinetic markers of functional recovery that can complement patient-reported outcome measures.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626632","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":"Uncemented Total Knee Arthroplasty in the State of Michigan has Higher Rates of Revision Through 5-Year Follow-Up.","authors":"Thomas Z Paull, Martin J Weaver, Brendan J Comer, Huiyong T Zheng, Brian R Hallstrom, Richard E Hughes, David C Markel","doi":"10.1016/j.arth.2025.03.007","DOIUrl":"10.1016/j.arth.2025.03.007","url":null,"abstract":"<p><strong>Background: </strong>While cemented total knee arthroplasty (TKA) is considered the gold standard, uncemented designs are gaining popularity, especially in young men who are at higher risk of cemented failure. Assessing this growth's impact, the Michigan Arthroplasty Registry Collaborative Quality Initiative analyzed adoption rates of uncemented TKA and the effect of fixation technique on revision rates with the goal of assessing the revision rates and survivorship at five years of cemented versus uncemented TKA to further classify which patients may be more ideal candidates for cementless fixation.</p><p><strong>Methods: </strong>The Michigan Arthroplasty Registry Collaborative Quality Initiative data from 2017 to 2022 was analyzed to determine the survivorship of cemented versus uncemented TKAs. Descriptive statistics, demographics, and implant type were collected. Cumulative percent revision (CPR) was calculated based on the fixation method. The primary endpoint was time for the first revision. Kaplan-Meier survival curves were compared. Subanalyses were performed based on age, sex, body mass index, and implant type. Confidence intervals were set to 95%.</p><p><strong>Results: </strong>The registry query yielded 147,838 TKAs. There were 18,523 (12.5%) uncemented TKAs. Uncemented TKA use increased yearly from 2017 to 2022 in all groups. Uncemented TKA had higher CPR through five years at all time points versus cemented (3.65 versus 3.19%, P < 0.0001). Uncemented TKA performed worse in both men and women (P < 0.01, P < 0.01). Unexpectedly, men < 55 years had higher CPR at all time points for the four most used implants (P < 0.05).</p><p><strong>Conclusions: </strong>The use of uncemented TKA has grown in Michigan across all patient subgroups. Uncemented TKAs had an overall higher risk of revision compared to cemented TKAs. The poorer outcomes appeared consistent across sex, age, and implant type. Younger men who are often preferred for uncemented fixation had higher failure rates. This study suggests that surgeons should be mindful of revision rates and patient selection when moving to uncemented TKA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626638","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":"GLP-1 Agonists for Weight Loss: Do They Increase Complications in Non-diabetic Patients Undergoing Primary Total Hip Arthroplasty?","authors":"Jens T Verhey, Roman P Austin, Saad Tarabichi, Benjamin Paul, David G Deckey, Zachary K Christopher, Mark J Spangehl, Joshua S Bingham","doi":"10.1016/j.arth.2025.03.012","DOIUrl":"10.1016/j.arth.2025.03.012","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide 1 (GLP-1) agonists are an effective medication for glycemic control and weight loss. These effects may reduce complications in diabetic patients undergoing total hip arthroplasty (THA). However, there remains a paucity of data on the impact of GLP-1 medications in nondiabetic patients using the medication solely for weight reduction. There is concern that rapid weight loss associated with GLP-1 agonists may lead to malnutrition and increase the risk of postoperative complications in patients undergoing THA.</p><p><strong>Methods: </strong>A retrospective query was performed from January 1, 2010, to January 1, 2022, using an insurance claims database to identify patients undergoing primary THA on GLP-1 agonists (n = 839,715). Patients on GLP-1 therapy (n = 5,345) at the time of surgery were propensity score-matched 1:1 to controls who were not on GLP-1 agonists (n = 5,345) based on age, sex, the Elixhauser Comorbidity Index, and its components. Patients who had diabetes mellitus were excluded. The 90-day outcomes were evaluated, including medical complications, readmission, and reoperation rates. We also examined the incidence of all-cause revision and implant-related complications at a 2-year follow-up. Odds ratios (ORs) were generated using logistic regression analyses.</p><p><strong>Results: </strong>Patients who were on GLP-1 agonist medications were less likely to develop acute blood loss anemia (OR: 0.57; 95% confidence interval [CI]: 0.34 to 0.96) and require postoperative transfusion (OR: 0.53; 95% CI: 0.36 to 0.78) or visit the emergency department within 90 days of surgery (OR: 0.81; 95% CI: 0.69 to 0.92) when compared to patients who did not have GLP-1 therapy. Patients were at comparable risk of deep venous thrombosis, pulmonary embolism, mortality, stroke, myocardial infarction, acute kidney injury, and sepsis regardless of GLP-1 status (P > 0.05). Notably, the rate of aspiration pneumonia was similar between groups (OR: 1.17; 95% CI: 0.62 to 2.19). Also, GLP-1 therapy did not put patients at higher risk of surgical complications, including periprosthetic joint infection, instability, fracture, loosening, or all-cause revision, at 90 days and two years (P > 0.05).</p><p><strong>Conclusions: </strong>Use of a GLP-1 agonist does not appear to increase the odds of postoperative medical and surgical complications after THA in nondiabetic patients taking GLP-1 medications for weight loss alone.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626634","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}