Journal of Arthroplasty最新文献

{"title":"Does the Use of Robotics Increase the Rate of Complications After Total Hip, Total Knee, or Unicondylar Knee Arthroplasty?","authors":"Minjae Lee, Claudia Arias, Vittorio Bellotti, Goran Bicanic, Kelvin G Tan, Joshua Bingham, Sébastien Lustig, Pietro Randelli","doi":"10.1016/j.arth.2024.10.109","DOIUrl":"10.1016/j.arth.2024.10.109","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548819","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":"Iliopsoas Tenotomy Does Not Negatively Affect Hip Flexion Strength in Crowe 3 and 4 Hips Undergoing Total Hip Arthroplasty.","authors":"Remzi Caylak, Aysenur Goksen, Cagrı Ors, Emre Togrul","doi":"10.1016/j.arth.2024.10.113","DOIUrl":"10.1016/j.arth.2024.10.113","url":null,"abstract":"<p><strong>Background: </strong>In total hip arthroplasty (THA), even if there is a dislocated hip, restoring the anatomical center of rotation increases long-term survival and hip function. Even with a shortening osteotomy, the procedure is still challenging due to soft-tissue tension. Therefore, soft tissue releases such as iliopsoas tenotomy may be necessary. In our study, we aimed to examine the effects of iliopsoas tenotomy on hip flexion and abduction strength in patients who underwent THA with shortening osteotomy for Crowe 3 and 4 hip dysplasia by using a hand dynamometer for measurement.</p><p><strong>Methods: </strong>The present study examined 27 patients who underwent THA with shortening osteotomy in unilateral Crowe 3 and 4 hips. The patients' hip flexion and abduction strengths were measured with a hand dynamometer preoperatively and in the first year postoperatively.</p><p><strong>Results: </strong>The average flexion strength of the operated side was less than the nonoperated side before surgery. It also decreased further in the first six weeks. But the strength increased in the 12th week and reached the same level as the non-operated side in the sixth month. The average abduction strength was less than the nonoperated side before the surgery, and it decreased further in the 6th week after surgery. However, the strength increased during follow-ups and reached the non-operated side strengths in the twelfth week.</p><p><strong>Conclusions: </strong>In conclusion, during THA procedures for highly dislocated hips, releasing the iliopsoas tendon at the level of the minor trochanter to facilitate distalization of the hip center of rotation does not adversely affect hip flexion and abduction strengths.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548821","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 in the Outcome of Primary Total Knee Arthroplasty When Mobile-Bearing Versus Fixed-Bearing Implants Are Used?","authors":"Quanjun Cui, Zhichang Zhang, Elizabeth Driskill, Corinne Vennitti, Charles Engh, John F Burke, Abtin Alvand, Ahmad Abbaszadeh, Wendy Novicoff","doi":"10.1016/j.arth.2024.10.084","DOIUrl":"10.1016/j.arth.2024.10.084","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570070","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 Total Hip Arthroplasty in Seronegative Spondyloarthropathies: A Propensity-Matched Cohort Analysis.","authors":"Robert J Burkhart, Aakash K Shah, Monish S Lavu, Davison Beenfeldt, Victoria J Nedder, Andrew J Moyal, Jeremy M Adelstein, Nicholas M Romeo","doi":"10.1016/j.arth.2024.10.111","DOIUrl":"10.1016/j.arth.2024.10.111","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) is a common surgical intervention for patients who have seronegative spondyloarthropathies (SpA). However, there is a paucity of literature addressing the outcomes of THA specifically in SpA patients. This study aimed to investigate both the short-term and long-term systemic and orthopaedic outcomes of THA in SpA patients as a whole, as well as within the individual subtypes of SpA.</p><p><strong>Methods: </strong>This retrospective cohort study used a federated health research network, identifying 3,074 SpA patients who underwent THA between 2005 and 2022. Propensity score matching was used to compare SpA and non-SpA patients, balancing baseline characteristics. Short-term (30 days, 180 days, and 1 year) and long-term (5 years) postoperative complications were analyzed. The outcomes included systemic and joint complications. Chi-square analyses were done to compare outcomes across categorical data.</p><p><strong>Results: </strong>The SpA patients had increased rates of revision THA, prosthetic dislocation, periprosthetic joint infection, and aseptic loosening at various postoperative intervals. Surgical site infections and myocardial infarctions were more frequent at 1 month, 6 months, and 1 year. Additionally, SpA patients exhibited a higher incidence of deep vein thrombosis at 6 months and 1 year. Subtype analysis revealed that ankylosing spondylitis patients were more likely to have revision surgery and prosthetic dislocation, while psoriatic arthritis patients had a lower risk of hip dislocation and femur fractures.</p><p><strong>Conclusions: </strong>The SpA patients undergoing THA are at greater risk for systemic and orthopaedic complications compared to non-SpA patients. The increased incidence of infections, thromboembolic events, and prosthetic issues highlights the need for careful preoperative assessment and postoperative management.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570023","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 Prescribed Postoperative Physical Therapy Necessary after Routine Primary Total Knee or Total Hip Arthroplasty?","authors":"Claudio Diaz-Ledezma, Ilda Molloy, Rob Nelissen, Lipalo Mokete, Julian Costantini","doi":"10.1016/j.arth.2024.10.105","DOIUrl":"10.1016/j.arth.2024.10.105","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570102","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":"Low Socioeconomic Status Is Associated With Worse Patient-Reported Outcomes Following Total Joint Arthroplasty: A Systematic Review.","authors":"Emily M Pilc, Uzoma Ahiarakwe, Kirin Anand, John Cyrus, Gregory J Golladay, Nirav K Patel","doi":"10.1016/j.arth.2024.10.120","DOIUrl":"10.1016/j.arth.2024.10.120","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic status (SES)-an individual or group's social standing or class, as measured by education, income, and occupation-has been associated with poor surgical outcomes in orthopaedics. Total knee arthroplasty and total hip arthroplasty (THA) are the most commonly investigated orthopaedic surgeries regarding SES and patient-reported outcome measures (PROMs), yet the results are contradictory. The aim of this systematic review was to assess the impact of SES on PROMs following total joint arthroplasty (TJA).</p><p><strong>Methods: </strong>We performed a literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines utilizing MEDLINE (Ovid), EMBASE (Ovid), and Cochrane Library from database inception (1971, 1974, and 1996, respectively) to August 2, 2023, to identify studies investigating SES and PROMs in adults undergoing primary elective TJA. Studies were included if they evaluated one of three SES variables (income, education, or employment status) and reported at least one-year scores using a validated PROM. There were two reviewers who independently screened studies and extracted data.</p><p><strong>Results: </strong>There were 16 studies included in this systematic review. A total of 55,875 arthroplasties, including 24,055 total knee arthroplasties and 31,820 THAs, were analyzed. Of the studies, eight evaluated income, 15 evaluated education, and two evaluated employment status. The majority of studies investigating income found a statistically significant association between lower income and worse postoperative PROMs. There were ten studies, involving 90% of all patients from the included education studies, which found a statistically significant association between education and postoperative PROMs. There were two studies that found unemployed THA patients had lower improvements in PROMs compared to employed and retired patients.</p><p><strong>Conclusions: </strong>Our systematic review found several significant associations between income, education, employment, and PROMs after TJA. Providers should pay special attention to lower-income, less educated, and unemployed patients. These patients may benefit from targeted interventions to achieve substantial clinical benefit after TJA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570001","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":"Use of Dual Mobility Cups Reduce Dislocation Risk After Internal Fixation for Acetabular Fracture Concomitant With Total Hip Arthroplasty in Patients Who are Over 60 Years Old.","authors":"Victor Germon, Marie Le Baron, Richard Volpi, Pascal Maman, Xavier Flecher","doi":"10.1016/j.arth.2024.10.101","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.101","url":null,"abstract":"<p><strong>Background: </strong>Treatment of complex acetabular fractures in patients over 60 remains challenging. Functional treatments for these fractures have yielded disappointing outcomes. Internal fixation may fail facing this porotic bone, and postoperative non weight bearing may expose the patient to decubitus complications. Our hypothesis was that use of a dual mobility cup (DMC) reduces dislocation risk after concomitant internal fixation and total hip arthroplasty (THA) for acetabular fracture in patients who are over 60 years old.</p><p><strong>Methods: </strong>A retrospective, observational non comparative and continuous study was conducted from January 2015 to September 2022. Patients aged over 60 years who had displaced acetabular fractures, treated surgically via concomitant internal fixation and THA, utilizing a DMC exclusively through the Kocher-Langenbeck approach and a minimum follow-up was of one year, were included. There were 45 patients (45 hips) who had an average age of 71 (range, 60 to 88) who were included (75.5% men). The main mechanisms of injury were the motor vehicle accidents (in 21 cases (46,7%)). Bi-column fractures were prevalent (46.6%). The analysis of complications included intraoperatively nerve palsy, postoperatively dislocations, deep infections, periprosthetic fractures and loosening. Clinical assessment included the Harris hip score (HHS) and the level of return to previous activities. Radiological evaluation assessed fracture union, periprosthetic osteolysis, graft integration, the presence of leg length discrepancy (LLD) and heterotopic ossification.</p><p><strong>Results: </strong>There was one case of dislocation (2.2%) requiring reoperation for replacement of the prosthetic neck, and one patient (2.2%) experienced early THA infection, successfully treated with surgical lavage and antibiotics. Functional outcomes showed a mean HHS of 88 (range, 69 to 99) and 84% of patients resumed their previous activities. Radiological follow-up revealed no loosening.</p><p><strong>Conclusion: </strong>This study has shown that the use of DMC in concomitant THA with Open Reduction and Internal Fixation (ORIF) for acetabular facture in patient over age 60 years achieved a low dislocation rate with favorable clinical and radiological outcomes and a low complication rate.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548825","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":"Effect of Race and Socioeconomic Status on the Attainment of Substantial Clinical Benefit on Patient-Reported Outcome Measures Following Total Joint Arthroplasty.","authors":"Soham Ghoshal, Adriana P Liimakka, Joyce Harary, Zaid Al-Nassir, Antonia F Chen","doi":"10.1016/j.arth.2024.10.116","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.116","url":null,"abstract":"<p><strong>Background: </strong>Utilization of and access to total joint arthroplasty (TJA) are disproportionately skewed in patients who have low socioeconomic status (SES) and in minority populations. Patient-reported outcome measures (PROMs) are critical markers of post-surgical outcomes following TJA. This study aimed to 1) evaluate differences in race, SES, and demographic factors between TJA patients who achieved substantial clinical benefit (SCB) and those who did not; 2) assess differences between preoperative PROMs in these patients; and 3) identify whether race and SES are associated with SCB achievement at 1-year post-TJA.</p><p><strong>Methods: </strong>This retrospective cohort study included 1,154 total hip arthroplasty (THA) and 1,879 total knee arthroplasty (TKA) patients who underwent surgery at a single academic medical center from May 2019 to February 2023. Preoperative and postoperative PROMs were collected using the Knee Injury and Osteoarthritis Outcome Score (KOOS JR) and Hip Disability and Osteoarthritis Outcome Score (HOOS JR) surveys. Demographic and comorbidity data were collected from charts. Multivariable logistic regression analyzed the association between predictive variables and SCB achievement.</p><p><strong>Results: </strong>No differences in race were found between patients who achieved SCB and those who did not for both TKA and THA (P > 0.05). However, preoperative KOOS JR scores were lower in Black (P = 0.004) and Hispanic (P < 0.001) patients and preoperative HOOS JR scores were lower in Black patients (P < 0.001) compared to White patients. A higher proportion of patients in the lowest income category achieved SCB for both THA and TKA compared to those in other income categories (P = 0.04, P = 0.03, respectively). However, race was not associated with SCB likelihood at one year. For TKA patients, men were negative, and bilateral simultaneous TKA was positively associated with SCB achievement when controlling for race, income, and BMI (P < 0.001, P = 0.01, respectively).</p><p><strong>Conclusion: </strong>Race and income category were not significantly associated with achieving SCB at one year among TJA patients. However, non-White patients had a similar likelihood of achieving SCB as White patients, even with lower preoperative PROMs, indicating that these patients may benefit greatly from TJA despite delays in care. Men were negatively associated with TKA SCB achievement, while bilateral simultaneous TKA was positively associated with SCB.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548820","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":"Utilization of Machine Learning Models to More Accurately Predict Case Duration in Primary Total Joint Arthroplasty.","authors":"Gennaro DelliCarpini, Brandon Passano, Jie Yang, Sallie M Yassin, Jacob C Becker, Yindalon Aphinyanaphongs, James D Capozzi","doi":"10.1016/j.arth.2024.10.100","DOIUrl":"10.1016/j.arth.2024.10.100","url":null,"abstract":"<p><strong>Background: </strong>Accurate operative scheduling is essential for the appropriation of operating room esources. We sought to implement a machine learning model to predict primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) case time.</p><p><strong>Methods: </strong>A total of 10,590 THAs and 12,179 TKAs between July 2017 and December 2022 were retrospectively identified. Cases were chronologically divided into training, validation, and test sets. The test set cohort included 1,588 TKAs and 1,204 THAs. There were four ML algorithms developed: linear ridge regression (LR), random forest, XGBoost, and explainable boosting machine. Each model's case time estimate was compared to the scheduled estimate measured in 15-minute \"wait\" time blocks (\"underbooking\") and \"excess\" time blocks (\"overbooking\"). Surgical case time was recorded, and SHAP values were assigned to patient characteristics, surgical information, and the patient's medical condition to understand feature importance.</p><p><strong>Results: </strong>The most predictive model input was \"median previous 30 procedure case times.\" The XGBoost model outperformed the other models in predicting both TKA and THA case times. The model reduced TKA 'excess time blocks' by 85 blocks (P < 0.001) and 'wait time blocks' by 96 blocks (P < 0.001). The model did not significantly reduce 'excess time blocks' in THA (P = 0.89) but did significantly reduce 'wait time blocks' by 134 blocks (P < 0.001). In total, the model improved TKA operative booking by 181 blocks (2,715 minutes) and THA operative booking by 138 blocks (2,070 minutes).</p><p><strong>Conclusions: </strong>Machine learning outperformed a traditional method of scheduling total joint arthroplasty cases. The median time of the prior 30 surgical cases was the most influential on scheduling case time accuracy. As ML models improve, surgeons should consider ML utilization in case scheduling; however, prior 30 surgical cases may serve as an adequate alternative.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548826","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":"Outpatient Versus Inpatient Total Hip and Knee Arthroplasty in Morbidly Obese Patients.","authors":"Mohammad Daher, Jonathan Liu, Nathaniel Smith, Alan H Daniels, Mouhanad M El-Othmani, Thomas J Barrett, Eric M Cohen","doi":"10.1016/j.arth.2024.10.112","DOIUrl":"10.1016/j.arth.2024.10.112","url":null,"abstract":"<p><strong>Background: </strong>Morbidly obese patients undergoing total joint arthroplasty (TJA) face increased postoperative complications, yet studies assessing the safety of this surgery in the outpatient setting for this population are lacking. This study aimed to fill this gap by assessing the safety and benefits of outpatient TJA in morbidly obese patients.</p><p><strong>Methods: </strong>This study is a retrospective review of a commercial claims database. Based on the setting of the procedure, the patients were divided into four groups as follows: inpatient-TKA (total knee arthroplasty), outpatient-TKA, inpatient-THA (total hip arthroplasty), and outpatient-THA. The two TKA groups were matched based on age, sex, and the Charlson Comorbidity Index. The THA groups were matched similarly. The 30- and 90-day medical and surgical complications were compared between these groups. There were 5,500 patients included in each of the outpatient and inpatient TKA groups and 1,550 in each of the outpatient and inpatient THA groups.</p><p><strong>Results: </strong>Patients undergoing inpatient TKA had higher rates of pulmonary embolism, urinary tract infection, transfusions, intensive care unit admissions, emergency department visits, readmissions at 30 days, surgical site infections, periprosthetic joint infection, prosthetic dislocations, and costs. As for the inpatient THA group, they had higher rates of pulmonary embolism, urinary tract infection, transfusions, intensive care unit admissions, emergency department visits, and costs.</p><p><strong>Conclusions: </strong>It is well-established that morbidly obese patients undergoing TJA have higher complication rates than normal-weight patients, and patients should be counseled before arthroplasty. This study highlights the safety and benefits of outpatient TJA in morbidly obese patients. However, one should note that this was done using an insurance database, in which results may differ if it was done in a public and lower socioeconomic setting. Therefore, future prospective studies are needed to confirm the findings before implementing outpatient TJA in morbidly obese patients.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570043","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}