Journal of Arthroplasty最新文献

{"title":"Non-Opioid Analgesia Protocols After Total Hip Arthroplasty and Total Knee Arthroplasty: An Updated Scoping Review and Meta-Analysis.","authors":"Albert D Mousad, Pravarut Nithagon, Andrew R Grant, Henry Yu, Ruijia Niu, Eric L Smith","doi":"10.1016/j.arth.2024.11.013","DOIUrl":"10.1016/j.arth.2024.11.013","url":null,"abstract":"<p><strong>Background: </strong>Despite their effectiveness in postoperative analgesia regimens for total knee arthroplasty (TKA) and total hip arthroplasty (THA), opioid medications are accompanied by well-known side effects and a risk of long-term dependence. These drawbacks have prompted the exploration of opioid-free analgesia protocols. The purpose of this study was to summarize the nature and extent of evidence available on opioid-free analgesia protocols in THA and TKA management.</p><p><strong>Methods: </strong>A scoping review of all Medline, Embase, and CENTRAL-indexed studies published between March 2019 and May 2023 was conducted, focusing on opioid-free analgesia regimens following THA and TKA. All included studies were assessed for potential risk of bias. Meta-analyses of pooled opioid-free percentages and pain scores were conducted using odds ratio and standardized mean difference, respectively, in a random-effects model.</p><p><strong>Results: </strong>A total of 23 studies (15 TKAs and eight THAs) were included. Among both TKA and THA, rescue opioids were the most commonly reported postoperative intervention. The most commonly investigated nonopioid analgesic modality was local anesthetics/nerve blocks with 52.2% (12 of 23) of the studies, followed by multimodal combinations (21.7%) and intravenous corticosteroids (13.0%). Only two of the 10 included TKA randomized controlled studies demonstrated statistically significant increases in the postoperative opioid-free rates. Of the six included THA randomized controlled trials, four demonstrated statistically significant increases in patients completing the postoperative period opioid-free. Our meta-analysis demonstrated a statistically significant impact of nerve blocks following TKA on the opioid-free rate and postoperative pain scores. Among the included THA studies, all studies in which patients received postoperative intravenous corticosteroids demonstrated significant increases in opioid-free percentage.</p><p><strong>Conclusions: </strong>Despite some nonopioid analgesics demonstrating promise, rescue opioids remained the most frequently employed postoperative pain medication. The optimized opioid-free analgesic regimen likely requires a multimodal approach, especially using both local anesthetics/nerve blocks and intravenous corticosteroids. Further investigation and reporting of opioid-free episodes of care are needed.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649667","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":"Reoperations After Operatively and Non-Operatively Treated Periprosthetic Knee Fractures: A Nationwide Study on 1,931 Fractures After Primary Total Knee Arthroplasty.","authors":"Stefan K Risager, Kristine B Arndt, Charlotte S Abrahamsen, Bjarke Viberg, Anders Odgaard, Martin Lindberg-Larsen","doi":"10.1016/j.arth.2024.11.010","DOIUrl":"10.1016/j.arth.2024.11.010","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic knee fracture (PPKF) following total knee arthroplasty (TKA) can be difficult to treat. A PPKF can be treated both operatively and nonoperatively, and the treatment varies between fracture sites. This study aimed to assess the risk of reoperation according to the fracture site and treatment of the PPKF.</p><p><strong>Method: </strong>This study is a nationwide cohort study using register data from 1997 to 2022. Cruciate-retaining or posterior-stabilized primary TKA were identified from the Danish Knee Arthroplasty Register. Subsequent PPKFs, fracture treatments, and later reoperations were identified through the International Classification of Diseases, tenth edition (ICD-10) diagnosis and procedure codes in the Danish National Patient Register. In addition, indications for revision total knee arthroplasty (rTKA) in the Danish Knee Arthroplasty Register were used to identify PPKFs and the reason for reoperation.</p><p><strong>Results: </strong>We included 1,931 PPKFs (1,494 femoral, 207 patellae, and 230 tibial) with an overall two-year reoperation risk of 20% (95% confidence interval (CI): 18 to 23). Femoral PPKFs had a two-year reoperation risk of 16% (CI: 12 to 22) after nonoperative treatment and 21% (CI: 18 to 24) after operative treatment. Patellar PPKFs had a two-year reoperation risk in five to 17 after nonoperative treatment and 46% (CI: 30 to 69) after operative treatment. Tibial PPKFs had a two-year reoperation risk of 17% (CI: 11 to 27) after nonoperative treatment and 36% (25 to 53) after operative treatment.</p><p><strong>Conclusions: </strong>The overall two-year reoperation risk was 20% (CI: 18 to 23). Operative-treated PPKFs had a higher risk of reoperation across all fracture locations. The highest reoperation risk was found after operatively treated patella and tibial PPKFs (46 and 36%, respectively), and the lowest reoperation risk was found after nonoperative-treated patella PPKFs.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645055","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":"Value-Based Care in Arthroplasty: Where Are We Headed, and What Is Holding Us Back?","authors":"Ronald E Delanois, Zeev N Kain, Giles R Scuderi, Michael A Mont","doi":"10.1016/j.arth.2024.11.023","DOIUrl":"10.1016/j.arth.2024.11.023","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640246","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 There a Difference Between Modular Versus Monoblock Femoral Stems Used During Revision Total Hip Arthroplasty?","authors":"Alisina Shahi, Hari Bezwada, Daniel Kendoff, Fouad Sadek, Margarita Veloso Duran, Heinz Winkler, Weijun Wang, Xiaogang Zhang","doi":"10.1016/j.arth.2024.10.123","DOIUrl":"10.1016/j.arth.2024.10.123","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630926","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":"Benefits and Adverse Events Associated With Extended Antibiotic Use for One Year Following Periprosthetic Joint Infection in Total Knee Arthroplasty: A Prospective Cohort Analysis.","authors":"Richard Chao, Scott D Rothenberger, Andrew J Frear, Brian R Hamlin, Brian A Klatt, Neel B Shah, Kenneth L Urish","doi":"10.1016/j.arth.2024.10.061","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.061","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infections (PJIs) are common and serious complications following knee and hip arthroplasty. Our previous retrospective study suggested extended antibiotics following debridement, antibiotics, and implant retention (DAIR) decreased failure rates and were not associated with increased adverse events (AEs) as compared to a standard 6 weeks of antibiotic therapy. Further, extended antibiotics beyond one year did not provide additional benefits. These observations were tested in this prospective cohort study.</p><p><strong>Methods: </strong>A prospective cohort of patients who underwent DAIR for total knee arthroplasty PJI and received primary antibiotics were compared to patients who received primary antibiotics combined with extended antibiotics for one year. Participants had a minimum of 2-year follow-up after the final dose of antibiotics.</p><p><strong>Results: </strong>A prospective cohort of 79 patients was followed, where 39 participants (52.7%) received primary antibiotics and 35 participants (47.3%) received both primary and extended antibiotics following DAIR. Multivariable time-to-event analyses revealed that extended antibiotic use was an independent predictor of treatment success. Infection-free survival differed significantly between the two treatment regimens, as the hazard of PJI failure was significantly lower for extended antibiotics as compared to primary antibiotics alone (adjusted hazard ratio [HR] = 0.46 [0.24 to 0.87], P = 0.017). The AE rates did not significantly differ between patients treated with primary antibiotics only versus primary combined with extended antibiotics.</p><p><strong>Conclusions: </strong>This prospective cohort study supports our previous observations that extended antibiotics for one year were associated with lower failure rates as compared to primary antibiotics alone. Extended antibiotics after primary antibiotics were not found to be associated with increased AEs as compared to only primary antibiotics.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645044","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":"Prediction of Fractures After Open Wedge High Tibial Osteotomy Based on the Distance From the Tibial Osteotomy Point to the Medial Edge of the Tibia.","authors":"Xiangzhi Yin, Quan Wang, Yijie Tang, Yingze Zhang, Tengbo Yu, Yi Zhang","doi":"10.1016/j.arth.2024.11.003","DOIUrl":"10.1016/j.arth.2024.11.003","url":null,"abstract":"<p><strong>Background: </strong>To investigate the relationship between the distance from the medial tibial osteotomy point to the medial tibial edge and the development of lateral tibial hinge fracture (type II) and intra-articular tibial plateau fracture (type III) in patients who have degenerative disease undergoing open wedge high tibial osteotomy (OWHTO). This information will aid surgeons in avoiding the occurrence of fractures.</p><p><strong>Methods: </strong>This retrospective study analyzed 304 patients who underwent OWHTO from January 2018 to January 2024 in the Affiliated Hospital of Qingdao University. The distance from the tibial osteotomy point to the medial tibial edge on imaging was analyzed to determine its association with fracture. A one-way analysis of variance was used to compare the differences in height, weight, body mass index, the distance from the medial tibial osteotomy point to the medial tibial edge, sex, left and right sides of the knee, and osteoporosis in the occurrence of types II and III fractures. Receiver operating characteristic curves were used to identify the critical distances associated with type II and type III fractures. Logistic regression analyses were used to obtain the OR of the critical distance adjusted for age, sex, left and right sides, body mass index, and T value.</p><p><strong>Results: </strong>There were 40 fractures (13.3%) in 304 patients after OWHTO, comprising 21 type II fractures (7.0%) and 19 type III fractures (6.3%). A single-factor variance analysis showed that the tibial bone cutting distance to the medial tibial edge (P = 0.02) and osteoporosis (P = 0.01) were significantly different from the fracture. Receiver operating characteristic curves showed that the critical distances for types II and III fractures were 40.5 and 47.1 mm, respectively. Logistic regression analysis showed that the ORs [odds ratios] of types II and III fractures were 1.061 (95% CI [confidence interval] = 1.010 to 1.115) and 1.064 (95% CI = 1.011 to 1.119), respectively.</p><p><strong>Conclusions: </strong>In patients undergoing OWHTO, the risk factors for type II and III fractures are osteoporosis and the distance from the tibial bone cutting point to the medial tibial edge. This distance should be minimized during OWHTO to avoid type II and III fractures.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631043","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":"Perceived Risk of Elective Total Hip Arthroplasty: A Brazilian Hip Society Survey.","authors":"Anderson Freitas, Cristiano Valter Diesel, Thiago Sampaio Busato, Ricardo Horta Miranda, Osvaldo Guilherme Nunes Pires, Marco Noberto Giordano","doi":"10.1016/j.arth.2024.11.006","DOIUrl":"10.1016/j.arth.2024.11.006","url":null,"abstract":"<p><strong>Background: </strong>As total hip arthroplasty (THA) has become more common and widely available, candidates now often present with multiple risk factors that increase the risk of complications, directly impacting the cost of surgery and provider compensation. The present study was designed to better understand the impact of these factors and the perceptions of hip surgeons in Brazil.</p><p><strong>Methods: </strong>All 880 full members of the Brazilian Hip Society (SBQ) were invited to complete an online questionnaire on preoperative risk factors, adapted from the previous American Association of Hip and Knee Surgeons survey. Statistical analyses of survey response data were performed.</p><p><strong>Results: </strong>A total of 398 responses were received (45.2% of SBQ members). Most (81.7%) work in high-complexity hospitals; 46% have more than 15 years of experience in THA; and 30.2% perform more than 100 THAs/year (47% perform 40 to 100/year). Overall, 56.5% restrict THA eligibility based on modifiable risk factors: 76.6% view malnutrition and 65.8% view poorly controlled diabetes as factors precluding THA; most (89.2%) recommend waiting six to 24 months after bariatric surgery. Although 59.5% of respondents turn down candidates who abuse alcohol, 80.9% are willing to operate on smokers and 75.6% on opioid users. Advanced age was not a relevant factor for 87.2, and 71.1% perceive risk as equal in men and women. Among respondents who restrict THA eligibility, 78% do so based on personal experience or literature, while 32.6% follow the opinion of the patient's primary clinician. 90.4% believe risk-based compensation would expand access to THA.</p><p><strong>Conclusions: </strong>Compared to their peers in Latin America, Asia, Europe, and the United States, SBQ members have a largely similar perception of restrictions to performing THA, but are more willing to operate on smokers and more likely to defer THA in postbariatric patients. Nearly all favor adjusting surgeon compensation to take patient risk factors into account.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631042","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":"Bisphosphonate Use in Patients Who Have Osteoporosis Does Not Increase the Risk of Periprosthetic Fracture Following Total Knee Arthroplasty.","authors":"Enrico M Forlenza, Joseph Serino, Alexander J Acuña, E Bailey Terhune, Omar A Behery, Craig J Della Valle","doi":"10.1016/j.arth.2024.11.004","DOIUrl":"10.1016/j.arth.2024.11.004","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to evaluate the effect of preoperative bisphosphonate use in patients who have osteoporosis on the risk of complications following primary total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>An administrative claims database was queried for patients who have osteoporosis undergoing primary TKA between 2010 and 2019 with a minimum of 2-year follow-up. Bisphosphonate-naive patients and bisphosphonate users, defined as patients who had a continuous prescription for bisphosphonates for a minimum of 6 months preoperatively, were matched 1:1 based on age, sex, and comorbidity burden. Patients undergoing nonelective TKA on chronic glucocorticoid therapy or receiving any other pharmacologic treatment for osteoporosis were excluded. The final cohort included 21,058 matched pairs of patients. The incidence of postoperative complications was identified via International Classification of Disease coding and compared between matched groups. A subgroup analysis was performed to examine outcomes among patients who underwent cemented and cementless TKA.</p><p><strong>Results: </strong>There was no difference in the incidence of periprosthetic fracture on univariate (0.7 versus 0.8%, P = 0.068) or multivariate testing (OR [odds ratio]: 1.24, 95% confidence interval [0.99 to 1.56]; P = 0.060). Bisphosphonate users were statistically less likely to undergo all-cause revision TKA at 2 years (OR: 0.84 [0.72 to 0.97]; P = 0.021). Patients who had osteoporosis were found to have an increased risk of periprosthetic fracture when TKA was performed with cementless implants (1.6 versus 0.4%; P = 0.033). However, when treated with bisphosphonates, patients who have osteoporosis demonstrated equivalent fracture rates regardless of implant type (1.3 versus 1.0%; P = 1.000).</p><p><strong>Conclusions: </strong>While bisphosphonate use in patients who have osteoporosis did not decrease the risk of periprosthetic fracture, it did significantly lower the incidence of all-cause revision at 2 years, although the difference identified was small. Consideration should be given to performing cemented TKA in patients who have untreated osteoporosis, given the higher rate of periprosthetic fracture when cementless implants were utilized.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Radiographic Outcomes of a Long Cementless Monobloc Stem for Revision Total Hip Arthroplasty Due to Chronic Periprosthetic Infection.","authors":"Xing Liu, Yuhang Gao, Yi Leng, Jiarui Zhou, Xin Qi","doi":"10.1016/j.arth.2024.11.007","DOIUrl":"10.1016/j.arth.2024.11.007","url":null,"abstract":"<p><strong>Background: </strong>A long cementless monobloc stem is widely used for aseptic loosening, with satisfactory 5- to-10-year outcomes reported. Nonetheless, related studies on chronic periprosthetic joint infection (PJI) are scant. This study evaluated the clinical and radiographic outcomes of the stem in 2-stage revisions due to PJI.</p><p><strong>Methods: </strong>This prospective multicenter cohort study consisted of patients from three medical centers who were enrolled in a single arm from January 2017 to May 2022. All patients were diagnosed with chronic PJI based on the International Consensus Meeting criteria and underwent 2-stage revisions using a long monobloc cementless revision stem. Among 44 patients, 37 (12 women and 25 men) completed an average follow-up of 35.6 months (range, 14 to 75). The primary outcome was the stability of the stem; secondary outcomes included infection eradication, Harris Hip Score, leg length discrepancy, major complications, and isolated pathogens at intraoperative cultures.</p><p><strong>Results: </strong>At 1 year after revision, the infection-free prosthesis survival rate was 97.3% (95% confidence interval: 96.4 to 98.2). At the last follow-up, the mean subsidence was 2.9 ± 2.1 mm (range, 0.8 to 4.8). Postoperative leg length discrepancy averaged -4.6 ± 4.9 mm (range, -16 to 0). The Engh score averaged 14.1 ± 6.9 (range, zero to 22). The Harris Hip Score improved from a preoperative average of 35.7 ± 8.5 (range, 12 to 50) to 80.4 ± 9.3 (range, 58 to 92) at the 1-year postoperative follow-up (P < 0.01).</p><p><strong>Conclusions: </strong>The long cementless monobloc stem used in the current study presents a feasible option for 2-stage revision in cases of chronic PJI. The bone ingrowth and stability could be observed within the short follow-up time.</p><p><strong>Level of evidence: </strong>Level IV, prospective cohort study.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629939","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":"Should Chronological Age be a Consideration in Patients Undergoing Elective Primary Total Knee Arthroplasty? – Letter to Editor","authors":"Raju Vaishya MS, MCh, FRCS,&nbsp;Abhishek Vaish MS, MCh, DNB","doi":"10.1016/j.arth.2024.05.039","DOIUrl":"10.1016/j.arth.2024.05.039","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"39 12","pages":"Page e66"},"PeriodicalIF":3.4,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631578","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}