Arthroplasty最新文献

{"title":"Higher tissue concentrations of cefuroxime achieved with preoperative stand-alone intraosseous regional prophylaxis in robotic-assisted total knee arthroplasty: a randomized controlled trial.","authors":"Te Liu, Heng Zhang, Ming Guo, Runkai Zhao, Ye Tao, Zhuo Zhang, Guoqiang Zhang, Jun Fu, Ming Ni","doi":"10.1186/s42836-026-00436-0","DOIUrl":"10.1186/s42836-026-00436-0","url":null,"abstract":"<p><strong>Background: </strong>Intraosseous regional administration (IORA) of antibiotics can achieve higher local tissue concentrations than intravenous administration in conventional total knee arthroplasty (TKA). This study aimed to evaluate the tissue concentration and systemic concentration of preoperative stand-alone intraosseous cefuroxime in robotic-assisted total knee arthroplasty (RA-TKA) and identify a candidate dose for further evaluation.</p><p><strong>Methods: </strong>Thirty-nine patients undergoing MAKO RA-TKA were randomly allocated in a 1:1:1 ratio to receive intraosseous cefuroxime 750 mg (R750_IO), intraosseous cefuroxime 1,500 mg (R1500_IO), or intravenous cefuroxime 1,500 mg (R1500_IV). No additional intravenous antibiotics were administered before incision or during surgery. During surgery, nine tissue samples were collected: bone samples from the femur or tibia, synovial and fat samples from the surgical area, and systemic blood samples twice for cefuroxime level detection. Intraoperative vital signs, inflammatory markers on days 1 and 3 postoperative, and complications within 3 months were recorded.</p><p><strong>Results: </strong>The final analysis included 38 patients: 13 in the R750_IO group, 13 in the R1500_IO group, and 12 in the R1500_IV group. Compared with the R1500_IV group, both R1500_IO and R750_IO groups showed significantly higher tissue concentrations (p < 0.05) but lower initial blood concentrations (p < 0.05). While the R1500_IO group had higher tissue concentrations than the R750_IO group, its post-tourniquet-release blood concentration was significantly higher (p = 0.005). No significant differences were found in postoperative inflammatory markers and intraoperative vital signs among the three groups (p > 0.05), and no complications occurred within 3 months.</p><p><strong>Conclusions: </strong>Despite multiple intramedullary pins and longer operative time in robot-assisted TKA, a single intraosseous dose of cefuroxime still achieved high tissue concentrations. Compared to conventional intravenous infusion of 1,500 mg cefuroxime, preoperative stand-alone intraosseous administration of either 750 mg or 1,500 mg cefuroxime achieved higher local tissue concentrations. Moreover, the 750 mg intraosseous regimen was associated with a lower post-tourniquet-release systemic concentration than the 1,500 mg intraosseous regimen, supporting its further clinical evaluation as a candidate dose in RA-TKA.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220750","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":"Acetabular-only robot-assisted total hip arthroplasty is associated with lower surgeon stress index and perceived workload than conventional total hip arthroplasty: a prospective comparative cohort study.","authors":"Muyang Yu, Mingwei Hu, Te Liu, Yiming Xu, Xingdong Yang, Huiming Peng, Xisheng Weng, Bin Feng","doi":"10.1186/s42836-026-00442-2","DOIUrl":"10.1186/s42836-026-00442-2","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted THA (RATHA) has been associated with greater component-positioning accuracy, but surgeon workload during RATHA remains unclear. This study compared objective physiologic stress and perceived workload during conventional THA (CTHA) and RATHA.</p><p><strong>Methods: </strong>This exploratory, hypothesis-generating study prospectively evaluated 60 elective primary THAs, comprising 30 CTHAs and 30 RATHAs, as repeated procedural observations from a single high-volume, fellowship-trained arthroplasty surgeon. All procedures were performed through a standardized posterolateral approach. RATHA used the MAKO system for acetabular preparation and cup implantation only. Intraoperative physiologic data were collected using a Hexoskin smart garment. Whole-case outcomes included heart rate, stress index, root mean square of successive differences (RMSSD), respiratory rate, minute ventilation, and energy expenditure rate. Perceived workload was assessed using the Surgery Task Load Index (SURG-TLX). Phase-specific stress index and RMSSD were analyzed across exposure, acetabular preparation, femoral preparation, and wound closure.</p><p><strong>Results: </strong>Baseline patient characteristics were comparable between groups. Operative time was significantly longer during RATHA than CTHA (141.50 ± 30.76 vs 116.86 ± 21.88 min, p < 0.001). Despite this, RATHA was associated with a lower SURG-TLX composite score (adjusted mean difference, - 0.47; 95% CI - 0.85 to - 0.09; p = 0.039), with lower scores for task complexity and situational stress. Whole-case stress index was lower during RATHA (adjusted mean difference, - 2.52; 95% CI - 4.21 to - 0.83; p = 0.004), whereas the between-group difference in whole-case RMSSD was not statistically significant (geometric mean ratio, 1.35; 95% CI 0.98-1.86; p = 0.067). Heart rate, respiratory rate, minute ventilation, and energy expenditure rate did not differ significantly between groups. Phase-specific analysis showed lower stress index during RATHA in exposure, acetabular preparation, and femoral preparation, but higher stress index during wound closure. RMSSD was higher during RATHA in exposure and acetabular preparation.</p><p><strong>Conclusions: </strong>In this single-surgeon cohort, the acetabular-only RATHA workflow was associated with lower perceived workload and a lower mean whole-case stress index than the CTHA workflow despite longer operative time. These hypothesis-generating findings warrant validation in multisurgeon studies.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197827","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":"Intra-articular antibiotic delivery combined with one-stage revision for periprosthetic joint infection: a systematic review.","authors":"Xinyue Chang, Michelle Hilda Luk, Amy Cheung, Lawrence Chun Man Lau, Thomas Ka Chun Leung, Henry Fu","doi":"10.1186/s42836-026-00440-4","DOIUrl":"10.1186/s42836-026-00440-4","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) is a serious complication after joint arthroplasty requiring surgical and antibiotic management. One-stage revision has gained attention because it reduces the number of procedures while yielding acceptable outcomes. Intra-articular (IA) antibiotic delivery has been investigated to enhance local antimicrobial exposure and address biofilm-related challenges. However, a focused systematic review of IA antibiotic delivery combined with one-stage revision for PJI is lacking. This systematic review evaluated the techniques, safety, and outcomes of this strategy.</p><p><strong>Methods: </strong>A literature search was conducted up to 30 November 2025 across PubMed (including MEDLINE), Web of Science, Embase, and the Cochrane Library. Studies enrolling adults with PJI treated by one-stage revision combined with IA antibiotic delivery and reporting clinical outcomes with at least 12 months of follow-up were included. Study characteristics, treatment protocols, outcomes, and safety data were extracted and descriptively synthesized.</p><p><strong>Results: </strong>Ten studies were identified. IA antibiotic delivery combined with one-stage revision showed satisfactory infection-control outcomes across individual studies. Antibiotics were selected according to microbiological findings and administered via catheter infusion or direct intra-articular injection for 14-42 days. Reported complications were descriptively summarized and included catheter-related, local, surgical, and systemic adverse events. Renal-related adverse events were reported, with no documented long-term renal impairment in the included studies. Heterogeneity in treatment protocols and study designs was noted across studies.</p><p><strong>Conclusion: </strong>Intra-articular antibiotic delivery combined with one-stage revision for PJI was associated with satisfactory reported infection-control outcomes and safety findings. While the current evidence is largely retrospective and heterogeneous, further prospective comparative studies with standardized protocols would help clarify its clinical role.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186018","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":"Overlooked and underestimated: the prevalence and impact of mechanical cement-related complications in unicompartmental knee arthroplasty.","authors":"Zhenggui Yu, Baijian Wu, Yiming Lin, Ruan Chen, Guochang Bai, Xinyu Fang, Wenming Zhang, Zida Huang","doi":"10.1186/s42836-026-00439-x","DOIUrl":"10.1186/s42836-026-00439-x","url":null,"abstract":"<p><strong>Background: </strong>This study aims to elucidate the prevalence, clinical manifestations, and potential risk factors of residual bone cement following unicompartmental knee arthroplasty (UKA) to inform effective diagnostic and therapeutic strategies.</p><p><strong>Methods: </strong>This retrospective analysis included 321 patients from a single centre who underwent UKA. Residual bone cement was diagnosed using postoperative imaging and classified as residual cement extrusion (RCE) or free cement fragmentation (FCF). Patient data, including clinical records, laboratory findings, and selected management strategies, were collected to analyse risk factors for residual bone cement. The primary outcomes were the prevalence and clinical features of residual bone cement; secondary outcomes included risk factor identification and management outcomes.</p><p><strong>Results: </strong>Residual bone cement occurred in 84 patients (26.16%), 66 (20.56%) of whom had RCE, and 18 patients (5.61%) had FCF. All RCE patients were asymptomatic or experienced only mild discomfort (66 in 66, 100%). Six patients with FCF required additional surgical intervention due to pain and/or impaired mobility. The thinner polyethylene insert emerged as a risk factor for postoperative residual bone cement (OR 2.59, 95% CI 1.38-4.98, p = 0.005).</p><p><strong>Conclusions: </strong>The prevalence of residual bone cement following UKA is notably higher than previously recognized. Residual bone cement occurred in 84 patients (26.16%) in our study. As CT was performed only in symptomatic patients, this figure likely represents a lower-bound estimate of the true prevalence. Although most patients with residual cement are asymptomatic, further surgery is needed when FCF causes consistent pain and affects joint function. Arthroscopic removal appears effective for fragments in symptomatic patients. A thinner insert is a risk factor for residual bone cement.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186080","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":"Evaluation of DeepSeek with a RAG-based knowledge base in preoperative assessment for arthroplasty to improve the decision-making accuracy of junior physicians.","authors":"Haibo Wu, Mingzhuang Hou, Gongkai Chen, Zhenlin Wen, Changao Yang, Songlin Li, Xiangfei Meng, Peilai Liu, Qunshan Lu","doi":"10.1186/s42836-026-00437-z","DOIUrl":"10.1186/s42836-026-00437-z","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing elective joint replacement are mostly elderly individuals with multiple chronic diseases. These patients have a higher risk, so preoperative assessment for joint replacement is vital for surgical safety but remains challenging for junior physicians. This study aimed to evaluate the decision-making performance of different versions of DeepSeek (Chat and R1) and their knowledge base (KB)-enhanced schemes in perioperative risk assessment and their impact on junior physicians' decision-making quality.</p><p><strong>Methods: </strong>A total of 292 anonymized medical records from joint replacement patients were retrospectively analyzed. A professional knowledge base was constructed using 21 perioperative management guidelines and retrieval-augmented generation (RAG) technology. The performance of four models (DeepSeek-Chat, DeepSeek-Chat + KB, DeepSeek-R1, and DeepSeek-R1 + KB) was compared in ASA scoring, RCRI scoring, surgical tolerance judgment, and risk prediction. These indicators are related to specific decisions in joint replacement surgery, including preoperative optimization before elective TKA/THA, mitigation of infection risk, planning of VTE prophylaxis, and indication for postponing elective arthroplasty, etc. Senior physicians evaluated model performance using a Likert scale. A 5 × 5 balanced Latin square crossover design was used to assess the impact of model assistance on junior physicians' clinical decision-making.</p><p><strong>Results: </strong>No significant difference was found in ASA scoring accuracy (p > 0.05). For RCRI scoring and risk stratification, DeepSeek-R1 models (79.1%-79.7%) outperformed Chat models (56.5%-66.0%, p < 0.05). In surgical tolerance assessment, DeepSeek-R1 + KB showed relatively better performance, with significantly better predictive precision (p = 0.0284) and a lower missed diagnosis rate (p = 0.005) compared to the Chat models. The R1 series also showed higher predictive efficiency (87.2%-86.4% vs. 63.6%-61.8%, p < 0.05). The R1 models showed better performance than Chat models in medical comprehension, retrieval accuracy, and reasoning logic. After adjusting for physician variability and patient case mix, the DeepSeek-R1 + KB showed a statistically significant improvement over independent decision-making (OR = 1.58, p = 0.004), as well as the DeepSeek-R1 and Chat series.</p><p><strong>Conclusion: </strong>The DeepSeek-R1 model, with chain-of-thought reasoning, shows a marginal advantage over the Chat version in preoperative assessment for joint replacement. As a cost-effective clinical auxiliary tool, its integration with a professional knowledge base scheme can optimize the decision-making quality of junior physicians, particularly in terms of providing helpful and comprehensive decision support and providing novel insights for individualized assessment in the context of precision medicine.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165754","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":"Using machine learning to evaluate a non-selective enhanced recovery pathway for hip and knee arthroplasty: perioperative factors associated with same-day and early discharge.","authors":"Amr Selim, Abdelrahman Ibrahim, Abdul-Rahman Gomaa, Niall Graham, Geraint Thomas","doi":"10.1186/s42836-026-00435-1","DOIUrl":"10.1186/s42836-026-00435-1","url":null,"abstract":"<p><strong>Introduction: </strong>Same-day and early discharge after total hip and knee arthroplasty (THA/TKA) depend not only on patient characteristics but on the perioperative pathway itself. This study used supervised machine learning (ML) to evaluate a universal, non-selective enhanced recovery after surgery (ERAS) pathway at a high-volume tertiary centre, identifying the perioperative factors most strongly associated with failure of Day 0 or Day 1 discharge, and of same-day (Day 0) discharge.</p><p><strong>Methods: </strong>All patients undergoing primary THA, TKA, or partial knee replacement (PKR) within a universal, non-selective ERAS pathway (April 2024-May 2025) were included, with no exclusion on the basis of age, comorbidity, or anticipated day-case suitability. ML models (Logistic Regression, Random Forest, Gradient Boosting, Support Vector Machine, Decision Tree) were developed in Python using the full set of preoperative, anaesthetic, and postoperative pathway variables, with SHAP used for interpretation.</p><p><strong>Results: </strong>A total of 3,025 patients were included (median age 70.1 years, IQR 62.3-76.6). With discharge failure as the positive class, test ROC-AUC for failure of Day 0 or Day 1 discharge ranged from 0.66 to 0.76 (PR-AUC 0.34-0.50; baseline failure prevalence 18%). For same-day discharge failure, ROC-AUC ranged from 0.76 to 0.82 (F1 0.76-0.83; PR-AUC 0.89-0.93; baseline prevalence 73%). SHAP analysis ranked the factors most strongly associated with discharge failure. For same-day discharge, time to mobilisation was the most significant factor, followed by postoperative radiography before return to the ward and mobiliser designation. For Day 0 or Day 1 discharge, the strongest associations were ASA grade, sex, operative side, and time to mobilisation.</p><p><strong>Conclusion: </strong>Supervised ML is an effective framework for evaluating a non-selective ERAS pathway. Time to mobilisation dominated same-day discharge and was a leading factor for Day 0 or Day 1 discharge; it warrants prospective confirmation as a modifiable target.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167526","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":"Patellar resurfacing in primary total knee arthroplasty is associated with fewer reoperations but comparable clinical and functional outcomes: an umbrella review of meta-analyses.","authors":"Filippo Migliorini, Nicola Maffulli, Luise Schäfer, Gennaro Pipino, Marcel Betsch, Raju Vaishya","doi":"10.1186/s42836-026-00438-y","DOIUrl":"10.1186/s42836-026-00438-y","url":null,"abstract":"<p><strong>Background: </strong>Patellar management in primary total knee arthroplasty (TKA) remains controversial despite numerous clinical trials and meta-analyses. While patellar resurfacing has been advocated to reduce anterior knee pain (AKP) and reoperation rates, reported effects on functional outcomes are inconsistent. This umbrella review synthesised and critically appraised published meta-analyses comparing patellar resurfacing and patellar retention in primary TKA, with a focus on anterior knee pain, reoperation rates, and patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>An umbrella review of meta-analyses was conducted in accordance with 2020 PRISMA guidelines. Meta-analyses comparing patellar resurfacing with patellar retention in primary TKA were eligible. Outcomes of interest were AKP, reoperation rates, knee range of motion, and PROMs. Quantitative synthesis was performed at the meta-analysis level using random-effects models, with heterogeneity assessed using the I² statistic and robustness evaluated through prediction intervals.</p><p><strong>Results: </strong>Fourteen meta-analyses published between 2011 and 2025 were included. When AKP was analysed using odds ratios (OR), no significant association with patellar resurfacing was observed (OR 1.13, 95% CI 0.71-1.82; I² 88%). In contrast, relative risk (RR)-based analyses demonstrated a significantly reduced risk of AKP with resurfacing (RR 0.75, 95% CI 0.65-0.86; I² 0%). OR-based analyses showed no significant difference (OR 1.44, 95% CI 0.54-3.84; I² 94%), whereas relative risk-based analyses indicated a significantly lower reoperation risk with patellar resurfacing (RR 0.59, 95% CI 0.52-0.67; I² 51%). Functional outcomes showed no clinically relevant differences. Knee Function Score did not differ between groups (MD 0.63, 95% CI -0.42 to 1.68), while Knee Society Score showed a small statistically significant difference (MD 0.92, 95% CI 0.34-1.50) that was not consistently reproducible. No significant differences in postoperative ROM were observed.</p><p><strong>Conclusions: </strong>Patellar resurfacing in primary TKA reduces the risk of reoperation but does not confer clinically meaningful benefits in PROMs and shows only limited and inconsistent effects on AKP.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118704","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":"Unicompartmental knee arthroplasty after failed high tibial osteotomy in appropriately selected patients: a systematic review and meta-analysis.","authors":"Fardis Vosoughi, Mobina Taghva Nakhjiri, Amir Arshia Saghafi, Faryar Koolinia, Golnaz Nikeghbali, Iman Menbari Oskouie","doi":"10.1186/s42836-026-00434-2","DOIUrl":"https://doi.org/10.1186/s42836-026-00434-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;High tibial osteotomy (HTO) is an established treatment for medial knee osteoarthritis in younger, more active patients than typical arthroplasty candidates, but some may require conversion over time. Total knee arthroplasty (TKA) has traditionally been the preferred procedure after failed HTO. With advances in implant design and surgical techniques, the role of medial unicompartmental knee arthroplasty (UKA) in this setting warrants re-evaluation. This systematic review and meta-analysis aims to summarize and descriptively compare the outcomes of UKA and TKA following HTO.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review and meta-analysis was conducted on MEDLINE, Embase, Scopus, and Web of Science until 14th August 2025 (date last searched). Randomized and observational studies (cohort, case-control, and case series) reporting outcomes of UKA or TKA following HTO were included, while case reports, technical notes, reviews, and studies without sufficient data were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty-one studies (6 UKA-only, 33 TKA-only, and 2 comparative studies contributing to both groups) met inclusion criteria. Due to the limited number of comparative studies, comparisons between procedures are indirect/descriptive and should not be interpreted as evidence of relative treatment performance. After HTO, UKA demonstrated pooled revision and reoperation rates of 10.2% (95% CI = 4.5-21.6%, I&lt;sup&gt;2&lt;/sup&gt; = 61.6%) (in 226 knees) and 14.4% (95% CI = 9.1-21.9%, I&lt;sup&gt;2&lt;/sup&gt; = 37.0%) (in 226 knees), respectively, with PJI rates of 0-3.3% (in 71 knees). Mean improvement in the Knee Society Score (KSS) ranged from 34.09 to 38.80 points. For TKA, the pooled revision, reoperation, and PJI rates were 5.0% (95% CI = 3.5-7.2%, I&lt;sup&gt;2&lt;/sup&gt; = 79.5%) (in 6208 knees), 11.1% (95% CI = 7.3-16.3%, I&lt;sup&gt;2&lt;/sup&gt; = 92.8%) (in 6236 knees), and 2.9% (95% CI = 2.0-4.0%, I&lt;sup&gt;2&lt;/sup&gt; = 33.5%) (in 2107 knees), with a KSS improvement range of 25.0 to 57.0 points. Direct comparative studies found no significant differences in survivorship or function. In an exploratory analysis of studies published after 2020, the revision rate for UKA and TKA was 6.3% and 3.9%, respectively. The most common cause of UKA revision was lateral progression of osteoarthritis. The meta-analysis showed a pooled infection rate of 2.9% (in 2107 knees) following TKA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study suggests that UKA after HTO should not be considered an absolute contraindication and may have a role in a carefully selected subset of patients with isolated medial osteoarthritis, sufficient MCL, and acceptable residual alignment. However, these findings should be interpreted cautiously, as the current evidence base consists predominantly of retrospective observational studies. Accordingly, the present findings should be viewed as hypothesis-generating rather than as evidence establishing equivalence or comparative effectiveness between UKA and ","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118668","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":"Outcomes after total first metatarsophalangeal joint arthroplasty for hallux rigidus: a systematic review and meta-analysis.","authors":"Karthik Chinnaswamy, Archisha Marya, Anand Pillai","doi":"10.1186/s42836-026-00433-3","DOIUrl":"https://doi.org/10.1186/s42836-026-00433-3","url":null,"abstract":"<p><strong>Background: </strong>The role of first metatarsophalangeal (MTP) joint arthroplasty in hallux rigidus remains controversial. Although used as a motion-preserving alternative to arthrodesis, outcomes vary between studies and implant designs. This systematic review and meta-analysis evaluated clinical outcomes, range of motion (ROM), and implant survivorship following total first MTP arthroplasty.</p><p><strong>Methods: </strong>A systematic review identified studies reporting pre- and postoperative outcomes following total first MTP arthroplasty for hallux rigidus. Pooled outcomes were the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI) score, visual analogue scale (VAS) pain score, and ROM. One postoperative timepoint per study was selected using a prespecified rule, prioritising the timepoint closest to 24 months, or follow-up between 12 and 36 months where discrete timepoints were not reported. Random-effects pre-post meta-analysis used an assumed pre-post correlation of 0.5. Heterogeneity, prediction intervals, leave-one-out analysis, and sensitivity analyses were performed.</p><p><strong>Results: </strong>Twelve studies were included in the AOFAS-HMI meta-analysis, seven in the VAS meta-analysis, and thirteen in the ROM meta-analysis. Arthroplasty was associated with a pooled improvement in AOFAS-HMI of 42.76 points (95% CI 38.44-47.09; p < 0.001), a pooled reduction in VAS pain of 5.24 points (95% CI 3.82-6.67; p < 0.0001), and a pooled improvement in ROM of 27.02° (95% CI 17.19-36.86; p < 0.001). Heterogeneity was high. Prediction intervals remained wholly positive for AOFAS-HMI and VAS, but crossed zero for ROM, indicating less consistent motion gain. Secondary complication outcomes were reported as crude observational frequencies across studies with variable follow-up durations. Radiographic failure occurred in 14.5% of reported feet and revision in 10.0%; these figures are not annualised incidence rates or formal meta-analytic survivorship estimates. Longer follow-up cohorts suggested reduced implant durability over time.</p><p><strong>Conclusions: </strong>Total first MTP arthroplasty is associated with improvement in pain and function, but these benefits should be interpreted alongside appreciable revision and radiographic failure rates. ROM improves on average, although restoration of motion remains inconsistent and non-physiological. Current evidence therefore supports total arthroplasty as an option in select patients rather than a uniformly reliable alternative to arthrodesis and highlights the need for further implant development and longer-term evaluation of newer designs.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118615","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":"Anatomic versus reverse total shoulder replacement with an intact rotator cuff: a comparative musculoskeletal simulation study of glenohumeral joint biomechanics.","authors":"Iman Soodmand, Thomas Tischer, Sven Herrmann, Tilman Klose, Leo Ruehrmund, Christoph Lutter, Christoph Woernle, Rainer Bader, Maeruan Kebbach","doi":"10.1186/s42836-026-00432-4","DOIUrl":"https://doi.org/10.1186/s42836-026-00432-4","url":null,"abstract":"<p><strong>Background: </strong>Reverse total shoulder replacement (rTSR) is increasingly being conducted, including in selected elderly patients with intact-cuff osteoarthritis, due to concerns about subsequent cuff failure or glenoid component loosening after anatomic total shoulder replacement (aTSR). However, the biomechanical differences between rTSR and aTSR remain insufficiently understood. This computational study aimed to compare the biomechanics of aTSR and rTSR with an intact rotator cuff under identical conditions, representing selected intact-cuff osteoarthritis cases in which either implant design may be considered.</p><p><strong>Methods: </strong>A validated musculoskeletal multibody simulation framework of the upper extremity was used to compare the glenohumeral (GH) biomechanics during arm elevation in the scapular plane. The GH joint was modeled in detail with six degrees of freedom and explicit contact between the articulating implant components. This enabled the evaluation of muscle forces, deltoid-to-cuff force ratio, GH joint contact forces, shear-to-compression joint force balance, contact area, contact pressure, center of pressure, and GH translations.</p><p><strong>Results: </strong>Compared with aTSR, rTSR reduced the mean middle deltoid muscle force by 16% and decreased overall rotator cuff force requirements, while increasing deltoid-to-cuff dominance throughout most of the motion. Furthermore, rTSR showed 26.5% and 33.4% lower compressive and resultant GH contact forces, but earlier and 98.7% higher peak superior shear force and a higher shear-to-compression joint force ratio. Contact pressure was 3.5 times lower in rTSR, whereas the contact area was nearly three times larger. Center-of-pressure trajectories differed substantially between designs, in both magnitude and direction. GH translations were more constrained in rTSR, with negligible posterior-anterior displacements and smaller overall translations.</p><p><strong>Conclusion: </strong>Under an intact-cuff condition, aTSR and rTSR produced altered mechanical strategies for arm elevation. rTSR was characterized by more deltoid-dominant loading, lower joint compression, altered shear force patterns, and more constrained joint translations. This study provides a biomechanical insight for interpreting clinically relevant differences between the two mechanically distinct TSR designs. These findings may help surgeons better understand design-specific trade-offs in joint loading, shear-to-compression joint force balance, and muscle function, and may support clinical decision-making, particularly in intact-cuff conditions.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118665","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}