Journal of Arthroplasty最新文献

{"title":"Residual Hindfoot Valgus Alignment Detected by True Mechanical Axis Is Associated With Poorer Clinical Outcomes After Total Knee Arthroplasty: The Role of Ankle Osteoarthritis.","authors":"Hyung Jun Park, Yeong Jeon, Dong Hun Suh, Se Rang Moon, Jae Gyoon Kim","doi":"10.1016/j.arth.2025.08.067","DOIUrl":"10.1016/j.arth.2025.08.067","url":null,"abstract":"<p><strong>Background: </strong>Lower-limb alignment should be accurately assessed to achieve favorable outcomes after total knee arthroplasty (TKA). Compared to conventional alignment methods, the recently adopted hip-to-calcaneus (HTC) axis better reflects actual weight-bearing alignment by including hindfoot alignment. However, whether discrepancies between two mechanical alignments vary according to ankle osteoarthritis (OA) and whether such discrepancies are clinically meaningful remain unclear.</p><p><strong>Methods: </strong>Data from 145 knees from 107 patients who underwent primary total knee arthroplasty for knee OA were retrospectively analyzed. Postoperative alignment was assessed using conventional hip-to-talus (HTT) and HTC methods. Patients were grouped by ankle OA and residual hindfoot valgus alignment, defined as more valgus on HTC than HTT. Clinical outcomes were evaluated using Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores. Logistic regression analyses determined factors associated with residual valgus alignment and clinical outcomes. Sobel tests assessed whether residual valgus alignment mediated the relationship between ankle OA and postoperative clinical outcomes.</p><p><strong>Results: </strong>Patients who have ankle OA were more likely to exhibit residual valgus alignment as measured by the HTC method (odds ratio = 2.59; 95% confidence interval, 1.18 to 5.72; P = 0.018). In multivariate analyses, residual hindfoot valgus alignment (P = 0.030) and older age (P = 0.033) were independently associated with worse postoperative WOMAC scores. However, ankle OA did not impact WOMAC outcomes (P = 0.94). Hindfoot valgus alignment may have a mediating effect, although this was not statistically significant (P = 0.093).</p><p><strong>Conclusions: </strong>Ankle OA was significantly associated with residual hindfoot valgus alignment based on HTC. Although ankle OA did not directly affect clinical outcomes, residual valgus alignment and older age were independently associated with worse postoperative WOMAC scores.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024749","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":"Surgical Approach Does Not Influence Instability Risk in Primary Total Hip Arthroplasty With Monobloc Dual Mobility Cup.","authors":"Axel Machado, Constant Foissey, Elsayed Ahmed Abdelatif, Cécile Batailler, Sébastien Lustig","doi":"10.1016/j.arth.2025.08.081","DOIUrl":"10.1016/j.arth.2025.08.081","url":null,"abstract":"<p><strong>Background: </strong>The impact of the surgical approach on the risk of dislocation in total hip arthroplasty (THA) remains controversial, particularly when monobloc dual mobility cups (DMCs) are used. This study aimed to compare dislocation and complication rates between the postero-lateral and direct anterior approaches (DAAs) with a DMC in primary elective THA, based on data collected from a single center.</p><p><strong>Methods: </strong>Between 2010 and 2022, 1,378 consecutive primary THAs were performed using a monobloc DMC. There were 824 performed by DAA and 554 by postero-lateral approach (PLA). Exclusion criteria were cemented implants, patients treated for femoral neck fracture, developmental hip dysplasia, osteosynthetic complications, and follow-up of less than one year. Complications and revisions were analyzed retrospectively. The mean follow-up was 39 months (range, 12 to 157).</p><p><strong>Results: </strong>There was no statistically significant difference between the risk of dislocation with the anterior approach (n = 0; 0%) compared with the posterior approach (n = 2; 0.4%) (P = 0.16). There were more major complications, such as femoral fractures, in the PLA group in an older, more overweight, and higher American Society of Anesthesia score population.</p><p><strong>Conclusions: </strong>In total hip arthroplasty using monobloc DMCs, the dislocation rate with the PLA is no higher than with the DAA. The low incidence of dislocations in this large cohort supports the benefits of using monobloc DMCs.</p><p><strong>Level of evidence: </strong>3, Retrospective Cohort Study.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024805","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":"Trends in Utilization of Technology-Assisted Navigation in Unicompartmental and Total Knee Arthroplasty Between 2009 and 2022.","authors":"Jacob A Worden, Andrew Fuqua, Bailey J Ross, Julianne Gillis, Kevin Y Heo, Jacob M Wilson, Ajay Premkumar","doi":"10.1016/j.arth.2025.08.082","DOIUrl":"https://doi.org/10.1016/j.arth.2025.08.082","url":null,"abstract":"<p><strong>Background: </strong>In cases of isolated, single-compartment osteoarthritis of the knee, both unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) can be effective treatment options. This study evaluated rates of technology-assisted utilization in UKA (TA-UKA) using a national claims database over a contemporary 13-year period to determine the trends in use of TA-UKA relative to TKA in the United States.</p><p><strong>Methods: </strong>Patients undergoing primary UKA and TKA from 2009 to 2022 were identified using a large national claims database. Rates of computer and robotic assistance were then determined to ascertain trends in technology-assisted TKA (TA-TKA) and TA-UKA over the study period. Technology assistance was defined as computer navigation or robotics. Utilization trends were also stratified by sex, region, and age, and significance was determined using Mann-Kendall statistical tests.</p><p><strong>Results: </strong>Between 2009 and 2022, 71,396 patients underwent UKA, while 869,794 patients underwent primary TKA. The rate of TA-UKA cases increased by 17.3% from 2009 to 2022 (P < 0.001), while rates of TA-TKA procedures increased by 10.8% (P < 0.001). Higher volumes of TA-UKA cases were performed in urban areas and on women. By 2022, 20.6% of all UKA cases and 17.6% of all TKA cases were performed with technology.</p><p><strong>Conclusion: </strong>While a significant increase in the rates of both TA-UKA and TA-TKA cases was observed, there was a greater increase in use for UKA relative to TKA, potentially due to the greater precision of implant positioning needed during UKA and existing data supporting its use. Despite increases in the usage of technology over time, the majority of both UKA and TKA in the United States are not performed with technology. Further evidence is needed to elucidate whether the use of technology assistance for UKA yields superior surgical and patient outcomes.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024792","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":"Short-Term Complications of Preoperative Weight Loss Strategies in Total Knee Arthroplasty: Bariatric Surgery versus Glucagon-Like Peptide-1 Receptor Agonists.","authors":"Aadi Sharma, Brigitte A Lieu, Suhas R Velichala, Brady Ernst, James Satalich, Matthew Smith, Gregory J Golladay","doi":"10.1016/j.arth.2025.08.073","DOIUrl":"https://doi.org/10.1016/j.arth.2025.08.073","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity is an increasingly prevalent comorbidity that confers greater risks of postoperative complications following total joint arthroplasty, underscoring the need for viable preoperative weight loss. The objective of this study was to compare the risk of 90-day adverse events in patients undergoing total knee arthroplasty (TKA) following bariatric surgery versus treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RA).</p><p><strong>Methods: </strong>A retrospective review of a national research network from May 1, 2005, to February 12, 2025, identified patients undergoing TKA with bariatric surgery or GLP-1 RA prescriptions in the 18 months preceding their joint arthroplasty. Following propensity score matching, 4,652 patients were selected for comparison in both the bariatric surgery and GLP-1 RA cohorts. For each cohort, patient demographics, 90-day orthopaedic and surgical complications, readmissions, and emergency department (ED) visits were collected. Statistical differences in relative risk (RR) between each complication were calculated with t-tests and Chi-square tests.</p><p><strong>Results: </strong>In the 90-day postoperative period, patients who underwent bariatric surgery before TKA experienced greater rates of periprosthetic fractures (RR: 2.4; P = 0.016), periprosthetic joint infections (RR: 1.7; P = 0.002), revision surgeries (RR: 1.926; P = 0.005), cardiac events (RR: 1.255; P < 0.001), readmissions (RR: 1.316; P = 0.015), and ED visits (RR: 1.2; P < 0.001).</p><p><strong>Conclusion: </strong>A significantly increased risk of postoperative events was identified in patients who underwent bariatric surgery. These findings, along with existing literature, suggest that GLP-1 RA use may be a preferred option for preoperative weight loss optimization in TKAs. Overall, greater clinical understanding is provided for this drug and may inform surgical decision-making regarding weight management strategies and their associated risks.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006835","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":"Minimum 10-Year Outcomes of Total Hip Arthroplasty After Periacetabular Osteotomy.","authors":"Hiroshi Asai, Yusuke Osawa, Yasuhiko Takegami, Hiroto Funahashi, Shiro Imagama","doi":"10.1016/j.arth.2025.07.063","DOIUrl":"10.1016/j.arth.2025.07.063","url":null,"abstract":"<p><strong>Background: </strong>Although total hip arthroplasty (THA) post-periacetabular osteotomy (PAO) has yielded excellent short-term and mid-term outcomes, long-term implant survivorship remains unclear. This study aimed to evaluate the long-term (minimum 10 year) outcomes of THA post-PAO and assist in determining surgical indications and planning for THA post-PAO.</p><p><strong>Methods: </strong>This study included 50 hips that underwent THA post-PAO, with a minimum follow-up of 10 years. Propensity score-matching based on age, sex, and Crowe type was used to establish the PAO and control groups. The mean age at the time of THA for the PAO and control groups was 56 (95.7% women) and 56 (91.7% women) years, respectively. There were 11 hips (22%) diagnosed with developmental dysplasia of the hip during childhood and treated conservatively. Key parameters assessed included the Harris Hip Score, complications, horizontal and vertical distances between the teardrop and femoral head center, radiolucent lines (RLLs), and loosening on radiographs. Subgroup analysis was performed to compare outcomes between the elevated and anatomical groups.</p><p><strong>Results: </strong>At the latest follow-up, the PAO group exhibited significantly lower Harris Hip Score than the control group (86.7 ± 9.4 versus 90.3 ± 5.7; P = 0.021). Radiographic analysis revealed RLLs in four (8.0%) and three (6.0%) cases in the PAO and control groups, respectively, without significant differences. Loosening cases were not observed in either group. Acetabular cups were located more superiorly in the PAO group than in the control group (26.1 ± 7.3 versus 22.8 ± 6.4; P = 0.020). Subgroup analysis indicated no significant difference in RLLs between the elevated and anatomical groups (5.5 versus 9.4%; P = 0.62).</p><p><strong>Conclusions: </strong>Although the functional outcomes of THA post-PAO were inferior to those of primary THA, implant survivorship was comparable between the two groups. In cases with large preoperative bone defects, the acetabular component was placed more superiorly in the PAO group, which did not appear to affect long-term (10 year) implant survivorship.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796055","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":"Utility of Multiclass Machine Learning Algorithms in Predicting Same-Day Discharge Following Primary Total Knee Arthroplasty.","authors":"Shane F Chen, Anirudh Buddhiraju, Tony L-W Chen, Muhammad H Ilyas, Michelle Shimizu, Young-Min Kwon","doi":"10.1016/j.arth.2025.08.072","DOIUrl":"10.1016/j.arth.2025.08.072","url":null,"abstract":"<p><strong>Background: </strong>Length of stay (LOS) is a substantial driver of costs following primary total knee arthroplasty (TKA), leading to increased efforts targeting same-day discharge (SDD). However, patient selection for SDD TKA remains a challenge, with 7 to 49% of patients failing to achieve planned SDD with current stratification tools. This study aimed to develop and assess multiclass machine learning (ML) models for patient selection for SDD TKA as well as risk for prolonged LOS using a large national patient cohort.</p><p><strong>Methods: </strong>The database was queried to identify 167,859 primary TKAs between 2017 and 2023. The LOS was categorized into SDD (LOS = zero days), discharge within one to three days, and prolonged LOS (> three days). Machine learning models, including artificial neural networks, random forests (RF), k-nearest neighbors, and XGBoost, were developed and evaluated using the confusion matrix, Cohen's kappa, and the area under the receiver operating characteristic curve.</p><p><strong>Results: </strong>Same-day discharge, discharge within one to three days, and prolonged LOS rates were 2.1, 88.1, and 9.8%, respectively. The RF demonstrated the best performance in predicting different LOS groups with an average precision of 90.2% and a recall of 90.3%. For multiclass classification, RF had an accuracy of 90.3%, a Cohen's kappa of 0.85, and a micro-averaged area under the receiver operating characteristic curve of 0.97. Prominent predictors of LOS included anesthesia type, sex, body mass index, American Society of Anesthesiologists score, hypertension, age, and operation time.</p><p><strong>Conclusions: </strong>Our findings demonstrate the ability of ML models to accurately identify SDD-eligible and at-risk patients for prolonged LOS after primary TKA. Our models may assist surgeons with patient selection for outpatient surgery, thereby improving outcomes, resource allocation, and cost efficiency of TKA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006905","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":"Direct Anterior Approach Combined With Proximal Femoral Osteotomy for Crowe Type IV Developmental Dysplasia in Total Hip Arthroplasty.","authors":"Yong Dai, Zhengliang Luo, Guoyuan Li, Min Chen, Chen Zhu, Xifu Shang","doi":"10.1016/j.arth.2025.06.073","DOIUrl":"10.1016/j.arth.2025.06.073","url":null,"abstract":"<p><strong>Background: </strong>Crowe type IV developmental dysplasia of the hip (DDH) presents unique challenges in total hip arthroplasty. This study compares the clinical outcomes and efficiency of the direct anterior approach (DAA) in the lateral decubitus position combined with proximal femoral osteotomy versus the posterolateral approach (PLA).</p><p><strong>Methods: </strong>A retrospective analysis of 73 hips from 64 patients who had Crowe type IV DDH was conducted. Patients underwent total hip arthroplasty via DAA or PLA. Clinical and radiological outcomes, including postoperative complications, radiological evaluations (implant alignment and osteotomy healing included), Harris Hip Score, limb length discrepancy, Visual Analog Scale pain scores, operative time, and intraoperative bleeding, were evaluated. In addition, the operation time and the learning curve of the DAA group were also evaluated.</p><p><strong>Results: </strong>There was no significant difference in postoperative complications and radiological evaluations between the two groups. The DAA group achieved superior functional recovery, postoperative pain relief, and lower intraoperative bleeding than the PLA group. The DAA group had longer initial operative times, but showed significant reductions with experience.</p><p><strong>Conclusions: </strong>The lateral decubitus DAA combined with proximal femoral osteotomy offers superior functional recovery, pain relief, and reduced bleeding compared to PLA, with comparable implant stability. These findings support DAA as an effective option for Crowe type IV DDH. Further studies are warranted to confirm these results.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006903","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 Oral Direct Factor Xa Inhibitors on the Prevalence of Hip Heterotopic Ossification following Arthroplasty for Acute Femoral Neck Fracture: A Propensity Score-Matched Cohort Study.","authors":"Zhenyu Chen, Yi Xu, Hang Liu, Gang Luo, Wei Wang, Juehong Li, Ziyang Sun, Cunyi Fan","doi":"10.1016/j.arth.2025.08.074","DOIUrl":"https://doi.org/10.1016/j.arth.2025.08.074","url":null,"abstract":"<p><strong>Background: </strong>Heterotopic ossification (HO) is a common complication following hip arthroplasty that can limit hip range of motion (ROM). Oral direct factor Xa (FXa) inhibitors are commonly used anticoagulants after arthroplasty; however, they have a high risk of local bleeding and hematoma formation, which are significant triggers for HO formation. To our knowledge, there is no evidence regarding whether FXa inhibitors will increase HO incidence following hip arthroplasty.</p><p><strong>Methods: </strong>This retrospective, observational, propensity-score-matched (PSM) cohort study was conducted from January 1, 2019, to November 30, 2023. A total of 944 patients who underwent hip arthroplasty following an acute femoral neck fracture were included. The present study excluded patients who had a central nervous system injury, spinal cord injury, burns, or destructive injury; those who had multi-part injuries or fractures; those who had postoperative complications such as surgical field infection and dislocation; those who had a history of hip surgery or trauma (including old femoral neck fractures); and those who refused to participate in the study or had been lost to follow-up. Following 1:1 propensity score matching based on sex, age, body mass index (BMI), injury side, nonsteroidal anti-inflammatory drugs (NSAIDs) use, tranexamic acid (TXA) use, surgical duration, and blood loss during surgery, the FXa inhibitors group and the no-FXa inhibitors group each consisted of 367 patients. All patients underwent hip arthroplasty within 48 hours after injury and received low-molecular-weight heparin (LMWH) before arthroplasty, but no other anticoagulants. All patients received a similar rehabilitation protocol postoperatively.</p><p><strong>Results: </strong>In the PSM population, the incidence of HO was 28.8% in the FXa inhibitors group and 15.5% in the no-FXa inhibitors group (7.6 and 2.4% for clinically important HO, respectively). Logistic regression analyses revealed that FXa inhibitor usage was significantly associated with a higher rate of HO (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.54 to 3.19; P < 0.001) compared to no usage. Additionally, FXa inhibitors were also linked to an increased risk of clinically significant HO (OR, 3.29; 95% CI, 1.59 to 7.48; P = 0.002). None of the baseline covariates demonstrated a significant influence on the association between FXa inhibitor use and HO incidence (P > 0.05 for all). Sensitivity analyses further corroborated these results.</p><p><strong>Conclusions: </strong>Direct factor Xa inhibitor use may be a new risk factor for HO development following hip arthroplasty for acute femoral neck fracture.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006864","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":"Systematic Review of Metal Concentrations in Blood, Serum, and Tissue Following Primary and Revision Total Knee Arthroplasty.","authors":"Shabnam Aslani, Michael A Kurtz, Hannah Spece, Michael A Mont, William M Mihalko, Steven M Kurtz","doi":"10.1016/j.arth.2025.08.078","DOIUrl":"10.1016/j.arth.2025.08.078","url":null,"abstract":"<p><strong>Background: </strong>In a subset of total hip arthroplasty (THA) patients, investigators associate metal release with biological complications. Comparatively, metal release in the knee is less understood. In this study, we systematically reviewed total knee arthroplasty (TKA) metal release studies. We asked: (1) What are the metal concentrations reported in TKA patients? (2) What concentrations do studies use as thresholds? and (3) Does implant design affect metal concentrations in vivo?</p><p><strong>Methods: </strong>The PubMed and Embase databases were searched for studies reporting metal concentrations following TKA. There were 33 studies that met the inclusion criteria and were subsequently screened. Linear regressions were used to assess correlations in whole blood and serum, and nonparametric statistics were used to compare implant designs.</p><p><strong>Results: </strong>Following TKA, studies reported median whole blood concentrations of 1.42 parts per billion (ppb) (cobalt) and 1.44 ppb (chromium). Release of the two metals correlated linearly (R² = 0.98). In serum, the documented median values were 3.19 ppb (cobalt) and 0.95 ppb (chromium). Generally, investigators reported higher concentrations of metal release within the periprosthetic tissue. Of the 11 studies that reported a critical threshold value, most studies (64%) used ≥ two ppb. Revision and modular TKA studies measured significantly higher cobalt and chromium concentrations in whole blood compared to primary and monobloc TKA (P < 0.05).</p><p><strong>Conclusions: </strong>In the knee, gaps persist in our knowledge of metal release. Few studies measure concentrations in the periprosthetic tissue, and the magnitude of metal transport to organs remains unknown. Additionally, studies largely use thresholds derived from metal-on-metal (MoM) total hip arthroplasty, necessitating new guidelines for the knee. Surgeons should (1) know that metal release occurs in primary TKA patients; (2) carefully weigh the necessity of constrained devices versus the potential for metal release; and (3) consider alternative bearings to metal-on-metal hinges due to the high cobalt and chromium concentrations documented in vivo.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006868","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 Semaglutide a Safer Weight-Management Option Than Bariatric Surgery for Patients Undergoing Total Hip Arthroplasty (THA)?","authors":"Zoe Alpert, Jonathan L Katzman, Claudette M Lajam, Ran Schwarzkopf, Joshua C Rozell","doi":"10.1016/j.arth.2025.08.068","DOIUrl":"10.1016/j.arth.2025.08.068","url":null,"abstract":"<p><strong>Background: </strong>Weight management strategies before total hip arthroplasty (THA) include bariatric surgery and Glucagon-like peptide-1 receptor agonists, including semaglutide. Previous studies have reported higher THA implant failure in patients who had prior bariatric surgery. This study aimed to evaluate semaglutide as a weight management alternative for patients undergoing THA and any effects on perioperative outcomes.</p><p><strong>Methods: </strong>A retrospective review of primary, elective THAs performed between 2012 and 2024 was conducted at a single, urban, academic center. The study identified 224 patients who had a history of bariatric surgery, 202 patients who had perioperative semaglutide use, and a control group of 2,991 patients who had a body mass index (BMI) > 35. Demographic variables and clinical outcomes were compared between cohorts.</p><p><strong>Results: </strong>The bariatric patients were younger (57 versus 61, P = 0.012) and more often women (65.6 versus 57.4 versus 55.4%, P < 0.001) than semaglutide and control patients. Preoperative hemoglobin A1c was lowest in semaglutide patients (6.2 versus 5.7 versus 5.8%, P < 0.001). The changes in BMI varied across groups one year before and after THA (P < 0.001). The bariatric and semaglutide groups decreased their BMI by 1.4 and 0.8, respectively, and control patients increased by 0.4. Implant survivorship was 95.5% at 10 years. There was no correlation found between any cohort and 90-day emergency department visits, readmissions, and all-time revision. Higher American Society of Anesthesiologists class and Charlson Comorbidity Index ≥ 5 conferred increased complications.</p><p><strong>Conclusions: </strong>Semaglutide appears to be a safe alternative to bariatric surgery for weight management before THA, with similar implant survival and postoperative complication rates. Further studies are warranted to understand outcomes for THA patients who use semaglutide.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001839","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}