Journal of Arthroplasty最新文献

{"title":"The $1,200 Total Joint Arthroplasty Reimbursement: How Did We Get Here, What Is the Impact, and What Comes Next?","authors":"Catherine M Call, David E DeMik, Ameer M Elbuluk, Brian P Chalmers, Carl L Herndon, Nicholas B Frisch, Joshua A Kerr, Adam J Rana","doi":"10.1016/j.arth.2025.03.011","DOIUrl":"10.1016/j.arth.2025.03.011","url":null,"abstract":"","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":"143626637","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":"Platelet-Rich Plasma Injections Are Inferior to Corticosteroid Injections for Short-Term Pain Relief: A Prospective, Double-Blinded, Randomized Controlled Trial.","authors":"Sandeep S Bains, Gabrielle N Swartz, Reza Katanbaf, James Nace, Craig Bennett, Michael A Mont, Ronald E Delanois","doi":"10.1016/j.arth.2025.03.013","DOIUrl":"10.1016/j.arth.2025.03.013","url":null,"abstract":"<p><strong>Background: </strong>We aimed to evaluate and compare the clinical benefits of platelet-rich plasma (PRP) injections compared to corticosteroid (CS) injections in patients who have mild to moderate symptomatic knee osteoarthritis in a double-blinded randomized control trial. We aimed to compare improvements in the following outcomes at six weeks and three months: 1) pain scores, including Visual Analog Scale (VAS) and Numeric Pain Rating Scale (NPRS); and 2) functional scores, including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Injury and Osteoarthritis Outcome Score (KOOS).</p><p><strong>Methods: </strong>In this double-blinded randomized control trial, 52 patients who had symptomatic, radiographically confirmed knee osteoarthritis were enrolled. A power analysis determined that a sample size of 52 was required. Patients were randomized to receive treatment with an intra-articular injection of CS (n = 26) or PRP (n = 26). We evaluated clinical outcomes, including VAS, NPRS, WOMAC, and KOOS scores at baseline, six weeks, and three months after injection. We also determined if our clinical outcomes met the minimal clinically important difference (MCID) based on the following scores reported in the literature: 19.9 for VAS and 2 for NPRS.</p><p><strong>Results: </strong>There was no difference in baseline VAS, NPRS, KOOS, or WOMAC scores between the CS and PRP cohorts. At six weeks, CS patients had significantly greater reductions from baseline in VAS (-24.26 versus -7.38, P = 0.033) and NPRS (-2.24 versus -0.92, P = 0.042). The MCID for both VAS and NPRS was met in the CS cohort at 6 weeks, but not in the PRP cohort. At three months, CS and PRP patients experienced similar improvements in VAS (-18.27 versus 13.27, P = 0.610) and NPRS (-1.81 versus -0.65, P = 0.798), respectively. Neither cohort met the MCID at three months. Both groups experienced similar improvements in KOOS and WOMAC.</p><p><strong>Conclusions: </strong>When comparing PRP to CS injections in patients who have mild to moderate knee osteoarthritis, CS demonstrated greater pain reduction at six weeks. Based on these findings, expectations regarding the clinical utility of PRP should be tempered.</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":"143626636","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":"Closed-Incision Negative Pressure Wound Dressing Improves Outcomes in Obese Aseptic Revision Total Hip and Knee Arthroplasty.","authors":"Johannes M Herold, Isaiah Selkridge, Allina A Nocon, Troy D Bornes, Thomas P Sculco, Alberto V Carli, Peter K Sculco","doi":"10.1016/j.arth.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.004","url":null,"abstract":"<p><strong>Background: </strong>The burden of revision total joint arthroplasty (rTJA) is increasing. Revision procedures are associated with an increased risk of perioperative complications. Obese patients undergoing rTJA may have a higher risk of wound complications due to their soft-tissue envelope. Closed-incision negative pressure wound therapy (ciNPWT) has been rigorously investigated for its effect on reducing wound complications, however, the literature is limited to primary total joint arthroplasty. The purpose of the current study was to investigate the association between ciNPWT and clinical outcomes for obese patients undergoing aseptic revision total hip and knee arthroplasty.</p><p><strong>Methods: </strong>This was a retrospective study examining aseptic rTJA procedures from January 2017 to December 2021 at a high-volume institution. Patients were included if their body mass index (BMI) was > 35 and had a minimum follow-up of two years. The cohorts were rTJA procedures that used ciNPWT versus procedures without ciNPWT use. A total of 214 rTJA (Hip, n = 61; Knee, n = 153) patients qualified for analysis. After surgery, ciNPWT was applied on 130 (60.7%) patients (92 knees, 38 hips), and standard dressing was used on 84 (39.3%) patients (61 knees, 23 hips). There were no significant baseline differences between the groups. Outcomes evaluated were: (1) revision for infection; (2) superficial wound complications; (3) overall complications; (4) all-cause revision; and (5) all-cause readmissions. The association between ciNPWT use and outcomes was evaluated using Chi-square tests.</p><p><strong>Results: </strong>When controlling for all variables, ciNPWT use was associated with significantly fewer revisions for infection (0.8 versus 8.3%), overall complications (3.8 versus 11.9%), all-cause revisions (3.1 versus 13.1%), and readmissions (10.8 versus 21.7%) compared to those who did not use ciNPWT. Secondary superficial wound complication-specific outcomes did not show significant differences.</p><p><strong>Conclusion: </strong>To our knowledge, this study is the largest retrospective study to date examining the effect of ciNPWT on outcomes in obese aseptic revision rTJA patients. Our results demonstrated major benefits associated with the use of ciNPWT in obese patients undergoing aseptic rTJA in reference to infection-related revision, overall complications, all-cause revisions, and early readmission for any reason.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Chitranjan S. Ranawat Award: Factors That Predict Outcome Five Years Following Total Knee Arthroplasty.","authors":"David C Ayers, Hua Zheng, Wenyun Yang, Mohamed Yousef","doi":"10.1016/j.arth.2025.03.006","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.006","url":null,"abstract":"<p><strong>Background: </strong>Previous reports have identified several potential predictors of pain and function after total knee arthroplasty (TKA). However, the results of these studies are conflicting, and most have a short follow-up after TKA. The purpose of this study was to identify factors predictive of pain and function five years after TKA.</p><p><strong>Methods: </strong>A multicenter cohort of 3,688 primary unilateral TKA patients from a comparative effectiveness consortium was enrolled. Demographic data, medical and musculoskeletal comorbidities, and patient-reported outcome measures were collected preoperatively and postoperatively at five years, including the Short-Form Health Survey 36-item (SF-36) and the Knee Disability and Osteoarthritis Outcome Score (KOOS) pain and activities of daily living (ADL) function scores. Multivariate regression models with a 95% confidence interval were used to identify independent predictors of KOOS pain and function scores at five years.</p><p><strong>Results: </strong>The analysis identified the factors that were independently predictive for KOOS pain score at five years: age, insurance, race, Charlson comorbidity index (CCI), back pain, number of other painful hip and knee joints, contralateral knee pain, preoperative SF-36 mental component summary (MCS), and baseline KOOS pain scores. For KOOS ADL, the following predictive factors were identified: age, body mass index, insurance, race, CCI, back pain, number of other painful joints, contralateral knee pain, ipsilateral hip pain, preoperative SF-36 MCS, and physical component summary (PCS) scores, and baseline KOOS ADL scores.</p><p><strong>Conclusion: </strong>We have identified the factors that each independently predict less improvement in pain and function five years after TKA. These potentially modifiable factors, such as musculoskeletal comorbidities, can be targeted with preoperative patient optimization programs to improve patient outcomes and patient satisfaction after primary TKA. Knowledge of these factors that predict less improvement in pain and function can assist the surgeon and patient during shared decision-making and in setting appropriate patient expectations preoperatively.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607112","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":"Automated Versus Manual Femoral Component Rotation Planning in Robotic-Assisted and Conventional Total Knee Arthroplasty: A Retrospective Comparison.","authors":"Alexandra L Hohmann, Jessica H Leipman, Matthew V Dipane, Nicholas F Cozzarelli, Odria Boghozian, Musa B Zaid, Alexandra I Stavrakis, Erik N Zeegen, Jess H Lonner","doi":"10.1016/j.arth.2025.03.009","DOIUrl":"10.1016/j.arth.2025.03.009","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to determine if using automated femoral rotation planning in robotic-assisted total knee arthroplasty (RA-TKA) was associated with differences in functional outcomes compared to patients who underwent manually set femoral rotation in RA-TKA or conventional TKA (C-TKA).</p><p><strong>Methods: </strong>This was a retrospective multicenter study of patients who underwent TKA utilizing conventional methods with femoral component rotation set to 3° externally (C-TKA) [n = 108 knees], RA-TKA with automated femoral rotation planning intrinsic to the system (A-RA-TKA) [n = 111], and RA-TKA with femoral rotation manually set by the surgeon (M-RA-TKA) [n = 152], at least one year before follow-up. Outcome measures included the range of motion, Knee Injury and Osteoarthritis Joint Replacement (KOOS-JR), and Forgotten Joint Score (FJS). Intraoperative intercompartmental laxity measures and the rotational position of the femoral component relative to the posterior condylar axis were recorded.</p><p><strong>Results: </strong>In the A-RA-TKA group, the mean improvement in range of motion was significantly higher compared to both the M-RA-TKA and C-TKA groups (22.7 versus 9.88 and 20.6°, respectively). Significant differences in improvement in KOOS-JR were not seen, but patients in the A-RA-TKA group had significantly higher mean FJS than the M-RA-TKA and C-TKA groups (71.0 versus 52.6 and 60.5, respectively). Femoral component internal rotation was significantly greater in the M-RA-TKA group than in the A-RA-TKA group (4.27 versus 1.00°, P < 0.001). The M-RA-TKA group had a significantly higher number of highly internally rotated femoral components (> 4.5°) compared with the other groups, which was associated with significantly lower rates of achievement of FJS and KOOS-JR patient acceptable symptoms state.</p><p><strong>Conclusions: </strong>Compared to manually set femoral rotation, the use of automated femoral rotational planning facilitates intercompartmental gap balancing and prevents over-rotation of the femoral component, which may be associated with worse functional outcomes.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607096","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 Hip Arthroplasty Performed by Fellowship- and Nonfellowship-Trained Surgeons: A Comparison of Indications, Perioperative Management, and Complications.","authors":"Robert A Burnett, Amr Turkmani, Jeremy M Gililland, Christopher L Peters, Tad L Gerlinger, Craig J Della Valle","doi":"10.1016/j.arth.2025.03.003","DOIUrl":"10.1016/j.arth.2025.03.003","url":null,"abstract":"<p><strong>Background: </strong>Adult reconstruction fellowship-trained (FT) surgeons undergo an additional year of dedicated subspecialized training. The benefits of fellowship training include a comprehensive education in arthroplasty patient care and contemporary surgical techniques. The purpose of the present study was to compare practice variations between FT and nonfellowship-trained (NFT) surgeons, focusing on indications, perioperative prescribing patterns, and complication rates surrounding total hip arthroplasty (THA).</p><p><strong>Methods: </strong>An administrative database was used to compare patients who underwent elective THA with FT and NFT surgeons from 2010 to 2020 with a 5-year surveillance period. Sociodemographic factors as well as opioid and anticoagulant prescriptions were compared. Propensity score matching was used to match patients based on age, sex, comorbidity index, region, and insurance status. The 90-day medical complications and 5-year revision rates were compared. In total, 118,423 THAs were identified, with 44,068 THAs in matched fellowship and nonfellowship cohorts.</p><p><strong>Results: </strong>Patients undergoing THA with FT surgeons had a higher comorbidity burden (the Elixhauser Comorbidity Index: 3.6 versus 3.3, P < 0.001) and prevalence of obesity (12.0 versus 10.9%, P < 0.001). Hip dysplasia, posttraumatic arthritis, and osteonecrosis were more common indications for THA with FT surgeons than NFT surgeons, while osteoarthritis was less common (80.5 versus 82.3%, P < 0.001). The FT surgeons prescribed fewer opioids (127 versus 138 MMEs/patient) and nonaspirin anticoagulants postoperatively (40 versus 51.5%, P < 0.001). Overall complication rates were lower among FT patients (12.4 versus 13.8%, P < 0.001), including dislocation rates (0.9 versus 1.1%, P = 0.002) and 5-year revision rates (3.9 versus 4.3%, P < 0.001).</p><p><strong>Conclusions: </strong>Adult reconstruction FT surgeons perform THA on more complex patients and deliver lower complication rates while prescribing fewer opioids and less potent anticoagulants in the postoperative period.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588052","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":"Increased Utilization of Total Joint Arthroplasty for the Treatment of Distal Femoral Fractures.","authors":"Tyler C Nicholson, Cole M Patrick, Mikel C Tihista, Michael M Polmear, Richard L Purcell, Nata Parnes","doi":"10.1016/j.arth.2025.02.076","DOIUrl":"10.1016/j.arth.2025.02.076","url":null,"abstract":"<p><strong>Background: </strong>Primary and revision arthroplasty has emerged as an alternative option for the treatment of distal femoral fractures. The purpose of this study was to identify any trends in the management of distal femoral fractures among American Board of Orthopaedic Surgery (ABOS) Part II Candidates with regard to the utilization of open reduction and internal fixation (ORIF) versus total joint arthroplasty, and to investigate the complications associated with these two treatment strategies.</p><p><strong>Methods: </strong>This was a retrospective cohort study of the ABOS Part II Oral Examination Case List Database which was queried between the years 2003 and 2021. The inclusion criteria consisted of adult patients who sustained a distal femoral fracture and underwent either ORIF or arthroplasty.</p><p><strong>Results: </strong>The proportion of distal femoral fractures treated with arthroplasty compared to ORIF increased throughout the study period by 0.28% per year (P < 0.001) overall and 1.2% per year (P < 0.001) among arthroplasty-trained surgeons. Medical and surgical complications occurred at a significantly higher rate in patients after arthroplasty as compared to ORIF (31.5 versus 20.9%, P < 0.001; 29.0 versus 17.5%, P < 0.001, respectively). Reoperation and readmission were also higher following arthroplasty (10.8 versus 6.2%, P = 0.002; and 16.5 versus 9.3%, P < 0.001, respectively).</p><p><strong>Conclusions: </strong>Distal femoral fractures occurred more commonly and more of them were treated with arthroplasty. In the hands of surgeons who are early in their career, this treatment option may be associated with increased rates of revision, reoperation, and readmission.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587973","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":"Letter regarding “Return to Cycling After Total Joint Arthroplasty”","authors":"Cumhur Deniz Davulcu MD","doi":"10.1016/j.arth.2024.10.140","DOIUrl":"10.1016/j.arth.2024.10.140","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 4","pages":"Page e32"},"PeriodicalIF":3.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563228","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":"Custom Peri-Articular Injection Cocktail Preparations are Associated with a Major Financial Burden in Total Joint Arthroplasty.","authors":"Walter L Taylor, Jawad N Saleh, Victoria E Bergstein, Aaron I Weinblatt, William J Long","doi":"10.1016/j.arth.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.002","url":null,"abstract":"<p><strong>Introduction: </strong>Periarticular injections (PAI) are an important component in modern multimodal pain management protocols for total joint arthroplasty. There is a wide variety of formulas reported in the literature, from simple bupivacaine to surgeon-specific \"cocktails\" that include up to seven different components. Due to the broad lack of standardization in PAI formulations, this study aimed to evaluate the cost savings associated with our institution's transition to a standardized approach while ensuring no adverse impact on inpatient pain outcomes.</p><p><strong>Methods: </strong>We identified 16 unique PAI formulations used by 20 arthroplasty surgeons at a single institution, each prepared by the institution's pharmacy and nursing staff. Costs associated with the PAI formulations included the cost of each medication comprising the \"cocktail,\" and the labor cost associated with their preparation. These costs were compared to the in-operating room preparation of bupivacaine injections. An evaluation of the potential cost savings was extrapolated based on our annual total joint volume.</p><p><strong>Results: </strong>The average surgeon-specific formulation costs $10.33 for ingredients alone, which is 435% higher than a bupivacaine injection and leads to an annual ingredient cost of $22,496.17 for PAIs. The preparation of these cocktails required a total labor cost of $93,600 annually. Taken together, the elimination of custom cocktails and the adoption of isolated bupivacaine translated into institutional savings of $116,096.17 per year. Inpatient pain scores were not significantly different between bupivacaine-only and surgeon-specific PAI formulations.</p><p><strong>Conclusions: </strong>Surgeon-specific PAI formulations impose a large, somewhat hidden expense on hospital systems through the cost of sourcing medications and, in particular, the labor cost of preparing each unique combination. As bupivacaine-only PAI achieves satisfactory clinical outcomes for joint arthroplasty patients, the elimination of custom cocktails is of major benefit from a value-based care perspective.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587969","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":"Conflict of Interest Statement","authors":"","doi":"10.1016/S0883-5403(25)00119-6","DOIUrl":"10.1016/S0883-5403(25)00119-6","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 4","pages":"Page IBC"},"PeriodicalIF":3.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563230","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}