Arthroplasty最新文献

{"title":"Does weight gain from time of indication to date of surgery affect outcomes in total knee arthroplasty?","authors":"Anzar Sarfraz, Theodor Di Pauli von Treuheim, Garrett Ruff, Braden V Saba, Farouk Khury, Ran Schwarzkopf, Joshua C Rozell, Vinay K Aggarwal","doi":"10.1186/s42836-026-00379-6","DOIUrl":"https://doi.org/10.1186/s42836-026-00379-6","url":null,"abstract":"<p><strong>Background: </strong>The impact of body mass index (BMI) on outcomes after total knee arthroplasty (TKA) is a highly debated topic. Our study aims to investigate the implications of BMI changes from the day of surgical booking to the surgery date on perioperative and postoperative outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who underwent elective, primary, unilateral TKA at an urban academic institution from 2015-2024 with a minimum 90-day follow-up. The cohort was classified into three groups by percent BMI change from surgical booking date to TKA date: Group 1, decrease in BMI; Group 2, 0-5% increase in BMI; and Group 3, > 5% increase in BMI. Propensity-score matching (1:1:1) based on age, gender, BMI at surgical booking, and smoking status was performed; perioperative and postoperative outcomes were compared. Multivariate regression analysis evaluated risk factors for interval change in BMI.</p><p><strong>Results: </strong>Before matching, 12,990 patients were included, with 39.6% in Group 1, 41.2% in Group 2, and the remaining 19.2% in Group 3. Notably, Group 3 had the longest length of stay (50.3 h vs. 48.6 [1] & 47.1 [2]; P = 0.002) and the lowest discharge-to-home rates (88.7% vs. 89.8% [1] & 91.7% [2]; P = 0.014). No significant difference was seen in 90-day ED visits, 90-day readmissions, or revision rates. Logistic regression of the pre-match cohort found that prolonged surgical booking delays were associated with decreased all-cause revisions (OR = 0.98; P = 0.038), while percent BMI change in this period did not impact revision incidence. Duration of surgical booking delay had no impact on BMI changes in obese patients.</p><p><strong>Conclusion: </strong>Our study evaluated preoperative BMI change between surgical booking and TKA, finding that most patients (60.4%) gain weight during this time. While patients with significant BMI increases (> 5%) had longer hospital stays and lower discharge-to-home rates, Percent BMI change during this period did not impact all-cause or septic revision incidence.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the learning curves of the osteotomy guide robot and guide plate-based robot-assisted total knee arthroplasty.","authors":"Xin Zhi, Te Liu, Peng Ren, Qingyuan Zheng, Ming Ni, Guoqiang Zhang","doi":"10.1186/s42836-026-00388-5","DOIUrl":"https://doi.org/10.1186/s42836-026-00388-5","url":null,"abstract":"<p><strong>Background: </strong>This study compared the learning curves and clinical outcomes of osteotomy guide robot and guide plate-based robot-assisted total knee arthroplasty (TKA).</p><p><strong>Patients and methods: </strong>From January to May 2023, 100 patients were prospectively enrolled to receive either a guide plate-based robot or an osteotomy guide robot-assisted total knee arthroplasty. The thickness of the osteotomy planned by the robot and the actual thickness were recorded in real time during the operation, as was the time taken for each step in the operation, including bone registration and osteotomy. The SF-12, HSS score, and FJS of the patients before surgery and 6 weeks and 24 months after surgery were also collected.</p><p><strong>Results: </strong>For surgeon 1, the average operating time with the guide plate-based robot and osteotomy guide robot was 98.16 ± 9.68 and 118.52 ± 15.95 min, respectively; the difference was significant. The average time of the last 10 cases was shorter than that of the first 10 cases. The inflection points of the osteotomy learning curve of surgeon 1 with two robotic systems were at case 5 and case 9. The average operative times for Surgeon 2's two robotic surgery groups were 104.52 ± 12.65 min and 105.76 ± 33.03 min, respectively. The inflection points of the osteotomy learning curves using the two robotic systems occurred at case 13, respectively. Patients who underwent guide plate-based robot or osteotomy guide robot-assisted TKA had similarly improved knee recovery, reflected in the SF-12, HSS score, and FJS.</p><p><strong>Conclusions: </strong>There was no significant difference in the osteotomy learning curve between the two robotic systems. The improvement in knee functional recovery was similar after the guide plate-based robot and the osteotomy guide robot-assisted TKA.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical technique of robotic arm-assisted total knee arthroplasty via the lateral parapatellar approach for valgus knee deformity.","authors":"Yasushi Oshima, Hiroki Yoshida, Tokifumi Majima","doi":"10.1186/s42836-026-00387-6","DOIUrl":"https://doi.org/10.1186/s42836-026-00387-6","url":null,"abstract":"<p><strong>Background: </strong>Valgus knee deformity, which is less common, is not a mirror image of varus knee deformity and poses unique technical challenges in total knee arthroplasty (TKA). Although the lateral parapatellar approach may be advantageous for severe valgus knee, the medial approach is often preferred due to surgeons' limited familiarity with valgus TKA and the lateral approach. Recently, robotic technology has demonstrated superior accuracy in bone resection and soft-tissue balancing during TKA. Hence, we introduce the application of robotic technology for valgus knees via the lateral approach in TKA. As the standard patella drill template of the onlay oval patellar implant was designed for the medial approach, we created a reversed-asymmetric patella drill template for the lateral approach. In the recent cases, patellar tracking following prosthesis implantation was also evaluated using robotic technology.</p><p><strong>Methods: </strong>We included cases of primary TKA performed for Ranawat classification types II and III with uncorrectable valgus knee alignment, as well as for valgus deformity > 20°. In TKA, arthrotomy was performed via the lateral approach, and the patella was retracted medially. After soft-tissue balancing was adjusted, bone resection was performed using the Mako robotic system. The patella was replaced with an onlay oval patellar implant using our novel patella drill template in the lateral approach. Patellar tracking on the femoral trochlear groove after implantation was visualized and assessed using robotic technology.</p><p><strong>Results: </strong>The surgical procedures were performed smoothly in 10 knees of 9 patients. The pre-operative limitations of knee extension, Visual Analog Scale scores, and radiographic knee alignment significantly improved following TKA. Pre-operatively, the tibiofemoral joint gaps were tighter laterally in both extension and flexion; post-operative medial laxity was effectively corrected. The accuracy and precision of prostheses positioning were confirmed radiographically. Patellar tracking was found to be appropriate after replacement with the oval patellar implant.</p><p><strong>Conclusions: </strong>The combination of robotic assistance, the lateral approach, and onlay oval patellar implants using our originally developed patella drill template showed feasibility for precise bone resection, optimal soft-tissue balancing, and proper patellar tracking for TKA in cases of valgus knee deformity.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amygdala and nucleus accumbens activation are associated with treatment choice in knee osteoarthritis: an fMRI study.","authors":"Fabiola Ojeda, Gerard Martínez-Vilavella, Laura Blanco-Hinojo, Joan Deus, Laura Tío, Jordi Monfort","doi":"10.1186/s42836-026-00382-x","DOIUrl":"10.1186/s42836-026-00382-x","url":null,"abstract":"<p><strong>Background: </strong>Pain in knee osteoarthritis (KOA) often shows a limited correlation with radiographic severity, complicating clinical assessment and highlighting the relevance of central pain mechanisms. Functional magnetic resonance imaging (fMRI) enables the investigation of brain regions such as the amygdala and nucleus accumbens, which are increasingly recognized as key components of the affective-motivational dimension of chronic pain and may show differential activation across clinical treatment contexts. This study is part of the HOLOA Project (Clinical and virtual examination of patients for holistic and objective description of the osteoarthritis progression mechanisms).</p><p><strong>Methods: </strong>We conducted a cross-sectional observational study nested within the HOLOA cohort. Thirty-one patients with KOA (20 managed conservatively [CM] and 11 observed in the surgical treatment context) with Kellgren Lawrence (KL) grades 2-3 were included. Participants underwent two fMRI paradigms involving pressure stimulation (Knee Interline and Tibial Surface tests). Clinical assessment included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Numeric Rating Scale (NRS). Group comparisons and correlation analyses were performed to examine associations between clinical measures and brain activation patterns.</p><p><strong>Results: </strong>Groups were broadly comparable with no statistically significant differences in demographic or radiographic severity measures. These patients showed higher WOMAC and PCS scores, indicating greater functional impairment and pain catastrophizing. Across the whole cohort, painful stimulation elicited robust activation of classical pain-processing regions, while no significant amygdala or nucleus accumbens activation was observed at the group level. However, nucleus accumbens activity was positively associated with PCS scores. In between-group analyses, patients observed in the surgical treatment context exhibited significant bilateral amygdala activation during Tibial Surface stimulation, which was absent in the conservatively managed group, and reported higher post-test NRS scores.</p><p><strong>Conclusion: </strong>Limbic system activation and pain catastrophizing were associated with the surgical treatment context in patients with knee osteoarthritis within a similar range of radiographic severity. The observed involvement of the amygdala and nucleus accumbens underscores the relevance of affective-motivational and cognitive processes in chronic KOA pain. These findings support the value of integrating clinical, psychological, and neurobiological perspectives when interpreting symptom burden and treatment context in knee osteoarthritis.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibromyalgia is associated with increased 90-day readmission and procedural utilization during readmission after elective primary total hip arthroplasty.","authors":"David Maman, Yaniv Steinfeld, Yaron Berkovich","doi":"10.1186/s42836-026-00391-w","DOIUrl":"https://doi.org/10.1186/s42836-026-00391-w","url":null,"abstract":"<p><strong>Purpose: </strong>Fibromyalgia is a chronic pain syndrome characterized by central sensitization and frequent comorbidity clustering. Its impact on early readmission and procedural utilization during readmission after elective primary total hip arthroplasty (THA) remains incompletely defined. We evaluated the association between fibromyalgia and 90-day readmission and readmission-associated procedural outcomes after elective primary THA.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using the Nationwide Readmissions Database (NRD) (2020-2022). Elective primary THA hospitalizations were identified and restricted to procedures performed on hospital day 0. Fibromyalgia status was defined using ICD-10-CM diagnosis code M79.7 (captured in the database as diagnosis codes beginning with M797) during the index hospitalization. To improve comparability, we performed 1:5 propensity score matching without replacement. Outcomes included index hospitalization complications, all-cause 90-day readmission, and readmission-associated procedural outcomes, including component-level revision-type procedures, hip-related reoperation, and any inpatient procedure during readmission.</p><p><strong>Results: </strong>Among 366,374 elective primary THA hospitalizations, 7,868 patients (2.1%) carried a diagnosis of fibromyalgia. After 1:5 propensity score matching, 46,126 patients remained (7,868 fibromyalgia; 38,258 controls), with standardized mean differences < 0.1 across matched covariates. During the index hospitalization, fibromyalgia was associated with higher rates of blood loss anemia (20.0% vs 16.5%; OR 1.27, 95% CI 1.19-1.35; p < 0.001), blood transfusion (3.5% vs 2.8%; OR 1.25, 95% CI 1.09-1.43; p = 0.001), pulmonary embolism (0.2% vs 0.1%; OR 2.21, 95% CI 1.20-4.08; p = 0.009), sepsis (0.2% vs 0.1%; OR 1.84, 95% CI 1.00-3.41; p = 0.048), and urinary tract infection (1.3% vs 1.1%; OR 1.25, 95% CI 1.01-1.55; p = 0.042). Ninety-day readmission occurred in 7.4% of patients with fibromyalgia compared with 5.0% of matched controls (OR 1.53, 95% CI 1.39-1.69; p < 0.001). During readmission, fibromyalgia was associated with increased odds of component-level revision-type procedures (1.6% vs 1.0%; OR 1.53, 95% CI 1.25-1.87; p < 0.001), hip-related reoperation (1.9% vs 1.4%; OR 1.37, 95% CI 1.14-1.65; p = 0.001), and any inpatient procedure (4.9% vs 3.4%; OR 1.48, 95% CI 1.32-1.67; p < 0.001).</p><p><strong>Conclusions: </strong>In a nationwide propensity-matched cohort of elective primary THA, fibromyalgia was associated with higher 90-day readmission and greater procedural utilization during readmission. Because important clinical variables and medication exposures are not captured in the NRD, these findings should be interpreted as associative rather than causal.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Programmed intermittent adductor hiatus block enhances early recovery after total knee arthroplasty: a randomized controlled trial.","authors":"Zhanghuan Tian, Kaihua He, Jun Dong, Zhiqiao Wang, Jiaxing Chen, Wenlong Yan, Wei Ran","doi":"10.1186/s42836-026-00390-x","DOIUrl":"https://doi.org/10.1186/s42836-026-00390-x","url":null,"abstract":"<p><strong>Background: </strong>Multimodal analgesia based on ultrasound-guided regional block is widely used after total knee arthroplasty (TKA). The goal of this study was to investigate the analgesic efficiency and knee motor function of programmed intermittent infusion combined with adductor hiatus block in total knee arthroplasty.</p><p><strong>Methods: </strong>This prospective randomized controlled trial was approved by the Medical Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (ethical approval number: 2024-302-01) and was registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn , ChiCTR2400090031); the study was conducted from October 2024 to March 2025. A total of 148 patients undergoing unilateral total knee arthroplasty with general anesthesia were assigned to the continuous adductor canal block (CACB) group (G1, n = 50), the continuous adductor hiatus block (CAHB) group (G2, n = 50), or the programmed intermittent adductor hiatus block (PIAHB) group (G3, n = 48). The main outcome was the active flexion angle of the knee joint. The secondary outcomes were performance on the timed up-and-go (TUG) test; the muscle strength of the quadriceps femoris, ankle dorsiflexors, and metatarsal flexor; and Visual Analogue Scale (VAS) scores of anterior and posterior sides of the knee at rest and during active 30-degree flexion.</p><p><strong>Results: </strong>The PIAHB group had a significantly greater active knee flexion angle than the CAHB and CACB groups on the 1st, 2nd, and 3rd post-operative days (F = 14.313, p < 0.001; F = 16.793, p < 0.001; and F = 18.097, p < 0.001, respectively); the TUG times in the PIAHB group were shorter than those in the CAHB and CACB groups on the 1st and 2nd post-operative days (F = 26.059, p < 0.001) (F = 18.102, p < 0.001), but there was no difference in TUG test results on the 3rd post-operative day. There was no significant difference in the muscle strength of lower limb; VAS scores of the posterior side of the knee at rest and during active flexion were significantly lower in the PIAHB group than in the CAHB and CACB groups (F = 5.860, p = 0.004; F = 80.015, p < 0.001), but there was no difference in the VAS scores of the anterior side of the knee. The number of patients receiving remedial analgesia within 72 h was reduced in the PIAHB group (F = 7.405, p = 0.030), and the consumption of ropivacaine was significantly reduced in that group (F = 24.995, p < 0.001), but there was no difference in the incidence of postoperative complications or in HSS (post-operativeHospital for Special Surgery) scores 6 months post-operatively.</p><p><strong>Conclusions: </strong>PIAHB increased the analgesic effect on the popliteal fossa without decreasing the strength of the quadriceps femoris, resulting in improved ROM on the 1st and 2nd post-operative days in patients who underwent TKA.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13088542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-time intraoperative motion-following robotic assistance improves efficiency and accuracy in total knee arthroplasty: a retrospective comparative study.","authors":"Zihan Li, Zhuwen Xu, Dajiang Li, Hui Shao, Huiwu Li, Keyu Kong, Zanjing Zhai","doi":"10.1186/s42836-026-00384-9","DOIUrl":"https://doi.org/10.1186/s42836-026-00384-9","url":null,"abstract":"<p><strong>Background: </strong>Conventional robotic-assisted total knee arthroplasty (RA-TKA) relies on rigid limb fixation to suppress intra-operative motion, adding complexity and potential inefficiency. A novel motion-following control system dynamically compensates for limb movement, allowing real-time adjustment of the tool-bone relationship without immobilization. This study evaluated whether motion-following improves efficiency and osteotomy accuracy while preserving alignment and early function.</p><p><strong>Methods: </strong>Sixty consecutive primary RA-TKA cases performed with the SkyWalker robotic platform (MicroPort, Shanghai, China) between September 2022 and August 2024 were retrospectively reviewed. Thirty procedures used conventional rigid fixation (control group) and thirty employed motion-following tracking (motion-Following group). Primary endpoints were operative time and resection thickness error, measured intraoperatively with a caliper. Secondary outcomes included coronal alignment assessed by HKA (hip-knee-ankle angle), CFCA (coronal femoral component angle), and CTCA (coronal tibial component angle), as well as functional recovery assessed by WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) at 6 months. Values are expressed as mean ± standard deviation unless otherwise specified.</p><p><strong>Results: </strong>Mean operative time was shorter with motion-following (118.8 ± 9.3 min) than with conventional fixation (133.9 ± 11.9 min; p < 0.001). Mean resection-thickness error was lower with motion-following (0.53 mm vs 0.82 mm), with 93.9% versus 68.3% of cuts within ≤ 1 mm. At the plane level, motion-following achieved smaller errors on all six surfaces, with four planes: DF-M (distal femur medial), distal femur lateral (DF-L), posterior femur medial (PF-M), and tibial plateau lateral (TP-L) reaching statistical significance (p < 0.05). Post-operative coronal alignment closely reproduced the pre-operative plan in both groups, with mean deviations of approximately 1° across all parameters and no statistically significant between-group differences. WOMAC scores improved substantially in both groups, with no significant between-group difference (ΔWOMAC 32.8 ± 8.5 vs 30.1 ± 7.9; p = 0.21).</p><p><strong>Conclusions: </strong>Motion-following robotic control streamlines TKA by eliminating rigid fixation, improving workflow efficiency, and slightly enhancing osteotomy precision without compromising alignment or recovery. This dynamic, real-time tracking approach refines execution of the surgical plan and may represent a meaningful evolution toward more efficient, surgeon-friendly robotic arthroplasty.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tranexamic acid in local infiltration analgesia cocktail for pain and swelling after total knee arthroplasty: a randomized controlled trial.","authors":"Qiuru Wang, Dongmei Zhao, Changjun Chen, Ting Ma, Pengde Kang","doi":"10.1186/s42836-026-00385-8","DOIUrl":"10.1186/s42836-026-00385-8","url":null,"abstract":"<p><strong>Background: </strong>Peri-articular local infiltration analgesia (LIA) is a cornerstone technique in multimodal pain management during the peri-operative period of total knee arthroplasty (TKA). Tranexamic acid (TXA), an antifibrinolytic agent, is widely used to reduce post-operative bleeding in TKA. However, no study has systematically evaluated the impact of adding TXA as an adjuvant to the LIA cocktail on post-operative pain and swelling following TKA. The purpose of this study is to investigate the efficacy and convenience of incorporating TXA into the analgesic cocktail for alleviating pain and swelling after TKA.</p><p><strong>Methods: </strong>In this double-blind, randomized controlled trial, 100 patients undergoing TKA were allocated to either a TXA group or a control group. The TXA group received LIA with an analgesic cocktail consisting of ropivacaine, epinephrine, dexamethasone, and TXA, while the control group received an identical cocktail without TXA. The primary outcome was the pain score at rest at 24 h post-operatively. Secondary outcomes comprised pain scores at other time points, post-operative morphine consumption for rescue analgesia, time to first rescue analgesia, knee swelling rate, decrease in hemoglobin level, range of motion (ROM) of the knee, and incidence of complications.</p><p><strong>Results: </strong>The TXA group demonstrated significantly lower VAS pain scores at rest at 24 h post-operatively (3.5 ± 0.6 vs. 4.0 ± 0.7, p = 0.001, and a markedly smaller decline in hemoglobin levels (26.2 ± 7.1 g/L vs. 33.5 ± 7.5 g/L, p < 0.001. Knee swelling rates were also significantly reduced in the TXA group. However, the absolute difference in VAS scores did not exceed the reported minimal clinically important difference (MCID) for pain in TKA (typically 1.0 point). No significant differences were observed between the two groups in post-operative morphine consumption, time to first rescue analgesia, knee ROM, or complication rates.</p><p><strong>Conclusion: </strong>The addition of TXA to a commonly used LIA cocktail led to a statistically significant reduction in early post-operative pain and swelling, along with decreased blood loss, which may offer added convenience by streamlining the workflow. However, the reduction in pain did not meet the MCID, indicating limited clinical relevance in terms of analgesia. Future studies are needed to optimize the analgesic efficacy of TXA-containing cocktails.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2400086985. Registered 16 July 2024.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13072563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinopelvic mobility patterns in patients with dislocation after THA: Direct anterior versus posterior approach.","authors":"Thomas Aubert, Antoine Mouton, Guillaume Auberger, Michael Butnaru, Nicolas Guegan, Christopher Plaskos","doi":"10.1186/s42836-026-00386-7","DOIUrl":"10.1186/s42836-026-00386-7","url":null,"abstract":"<p><strong>Background: </strong>Dislocation remains a common reason for revision after total hip arthroplasty (THA), and adverse spinopelvic mobility is increasingly recognized as a major contributor to instability. Whether its prevalence differs between surgical approaches is unclear. This study compared adverse spinopelvic mobility and associated risk factors in patients who sustained a dislocation after a posterior approach (PA) or a direct anterior approach (DAA), and evaluated whether implant positioning differed between groups.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 133 patients with post-operative dislocation and available functional lateral radiographs and low-dose CT scans, including 85 PA and 48 DAA dislocations. Spinopelvic parameters, dynamic pelvic motion between standing, sitting, and supine postures, and established spinopelvic risk factors were assessed. Cup orientation, femoral version, combined anteversion, limb length, and global offset were compared.</p><p><strong>Results: </strong>Spinopelvic morphology was similar, with no significant differences in standing spinopelvic tilt, pelvic incidence, PI-LL mismatch, lumbar lordosis, or lumbar flexion. However, dynamic motion differed markedly. A change in spinopelvic tilt (SPT) of ≥ 20° from standing to seated occurred in 41.3% of DAA dislocations versus 21.1% after PA (p = 0.029). A change in SPT ≤  - 13° from supine to standing occurred in 17.8% after DAA compared with 4.7% after PA (p = 0.048). Other spinopelvic risk factors showed no significant differences. Implant positioning was largely comparable; femoral and combined anteversion, cup inclination, and limb length were similar. Although femoral head size and global offset differed between groups, the association between surgical approach and adverse spinopelvic mobility persisted after accounting for these implant-related factors.</p><p><strong>Conclusion: </strong>Patients dislocating after DAA demonstrated a substantially higher prevalence of adverse spinopelvic mobility despite similar implant orientation and hip restoration. These findings suggest that dynamic pelvic behavior may contribute to anterior instability patterns and highlight the potential relevance of hip-spine assessment in patients undergoing anterior-approach THA.</p><p><strong>Trial registration: </strong>Retrospectively registered, CNIL MR004 2,225,508.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13072476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between functional combined anteversion and dislocation after revision total hip arthroplasty.","authors":"Yuta Hieda, Hyonmin Choe, Koki Abe, Hiroyuki Ike, Masashi Shimoda, Hironori Yamane, Akira Morita, Kosuke Sumi, Ken Kumagai, Naomi Kobayashi, Yutaka Inaba","doi":"10.1186/s42836-026-00383-w","DOIUrl":"10.1186/s42836-026-00383-w","url":null,"abstract":"<p><strong>Background: </strong>Dislocation is a serious complication that should be avoided in total hip arthroplasty (THA). Combined anteversion (CA) of the cup and stem is a concept for appropriate implant positioning; however, the effect of functional changes in femoral rotation has not been well investigated. In this study, we investigated whether functional CA, considering femoral rotation, is associated with dislocation in patients who underwent revision THA.</p><p><strong>Methods: </strong>Overall, 82 patients who underwent revision THA and had at least one year of follow-up with pre-operative and post-operative supine computed tomography imaging were included. The cup and stem were placed with a target combined angle of 37.3° using Widmer's formula. Anatomical and functional CAs were calculated post-operatively. Functional CA was defined as the sum of cup anteversion and stem anteversion, with femoral external rotation. Patient demographics, component alignment parameters, CA, and their association with post-operative dislocation were statistically evaluated.</p><p><strong>Results: </strong>Dislocation was observed in 12 patients. In these dislocated cases, there were no significant differences in cup angle, stem angle, and anatomical CA compared to non-dislocated cases. However, dislocated cases showed significantly higher values of functional CA (50.0 ± 17.4° [range, 5.5-67.6] vs. 35.6 ± 13.0° [range, 4.0-68.8], p = 0.022) and significant deviation from identical CA [15.0 ± 8.9° [range, 3.1-31.8] vs. 7.5 ± 8.1° [range, 0.1-33.3], p = 0.014).</p><p><strong>Conclusions: </strong>Functional CA, considering femoral rotation, was associated with post-operative dislocation after revision THA. Therefore, consideration of femoral rotation may be important for implant positioning in revision THA.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13067479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}