Arthroplasty最新文献

{"title":"Predicting postoperative coronal alignment in medial unicompartmental knee arthroplasty using the arithmetic hip-knee-ankle angle.","authors":"Chengyuan Ma, Zifan Luo, Guanghui Zhao, Jianbing Ma, Jianpeng Wang","doi":"10.1186/s42836-025-00326-x","DOIUrl":"10.1186/s42836-025-00326-x","url":null,"abstract":"<p><strong>Background: </strong>Proper coronal alignment plays a critical role in the effectiveness of medial unicompartmental knee arthroplasty (UKA). This research seeks to explore the connection between the arithmetic hip-knee-ankle angle (aHKA) and the actual postoperative (postop) HKA angle after undergoing medial UKA.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on individuals who received medial UKA at a specialized orthopedic hospital between January 1, 2024, and July 31, 2024. The aHKA was determined using the formula: medial proximal tibial angle (MPTA) minus lateral distal femoral angle (LDFA), plus 180°. The relationships between the postop HKA angle and the aHKA, MPTA, and LDFA were analyzed. Patients were further divided into three categories based on their postop HKA angle: greater than 180°, between 175° and 180°, and less than or equal to 175°. These groups were then compared in terms of aHKA, LDFA, MPTA, and preoperative HKA angle.</p><p><strong>Results: </strong>A total of 242 patients (254 knees) were included in this study. The postop HKA was nearly equal to the preoperative aHKA (176.09° ± 2.86° vs. 176.23° ± 3.15°). Statistical analysis revealed a positive association between aHKA and postop HKA angle (R² = 0.4595, P < 0.05), as well as between MPTA and postop HKA angle (R² = 0.2072, P < 0.05). Conversely, a negative correlation was identified between LDFA and postop HKA angle (R² = 0.2448, P < 0.05). These patterns held true for both fixed-bearing and mobile-bearing UKA prostheses. Notable differences among the three HKA groups were found regarding aHKA, MPTA, LDFA, and preoperative HKA angle (P < 0.05).</p><p><strong>Conclusion: </strong>The findings indicate that aHKA has a strong relationship with the postop HKA angle, suggesting its potential as an effective predictor for postop coronal alignment after medial UKA, irrespective of the type of prosthesis used.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"7 1","pages":"42"},"PeriodicalIF":4.3,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790718","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":"What is the best cutoff point of leukocyte esterase for diagnosis of periprosthetic joint infections? a systematic review and meta-analysis.","authors":"Mohammad Poursalehian, Ali Soltani Farsani, Pouya Tabatabaei Irani, Mohammad Ayati Firoozabadi, Javad Parvizi, Sm Javad Mortazavi","doi":"10.1186/s42836-025-00325-y","DOIUrl":"10.1186/s42836-025-00325-y","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) is a significant complication following total joint arthroplasty that demands rapid, accurate diagnosis. The leukocyte esterase (LE) test shows promise, but studies vary in cut-off values and omit the centrifugation's effect. In this study, we assessed the sensitivity and specificity of the LE test across different cut-off values, both with and without centrifugation. We aimed to identify the optimal threshold for diagnosing PJI and to compare its diagnostic odds ratio (DOR) to those of biomarkers recommended by the International Consensus Meeting (ICM).</p><p><strong>Methods: </strong>A comprehensive literature search was performed in PubMed, Scopus, Web of Science, and Embase up to May 2024. Studies were included if they evaluated the diagnostic accuracy of LE for PJI in TJA and provided sufficient data for constructing 2 × 2 contingency tables. Data extraction and quality assessment were independently conducted by two reviewers using a standardized form and the QUADAS-2 tool. Statistical analysis involved pooling data using a bivariate random-effects model and constructing summarized receiver operating characteristic (sROC) curves.</p><p><strong>Results: </strong>Out of 2195 records, 26 studies involving 4,206 joints (1,282 with PJI) were included. The optimal LE cut-off point without centrifugation was 3 + , yielding a sensitivity of 0.877, a specificity of 0.957, and a DOR of 159.2. With centrifugation, a 2 + cut-off provided a sensitivity of 0.899, a specificity of 0.924, and a DOR of 108.6. Direct comparison with other biomarkers indicated that polymorphonuclear neutrophils percentage (PMN%), white cell count (WCC), and alpha defensin (AD) had a slightly higher diagnostic odds ratio and Youden index than LE. Direct comparison with other biomarkers also indicated that erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), synovial CRP, and D-dimer had lower DOR and Youden index than LE.</p><p><strong>Conclusions: </strong>The LE test is an effective diagnostic tool for PJI. Adopting a 3 + cut-off point without centrifugation and a 2 + one with centrifugation optimizes diagnostic accuracy.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"7 1","pages":"41"},"PeriodicalIF":4.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12323279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785910","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":"Early migration patterns of calcium phosphate versus hydroxyapatite-coated stem in uncemented total hip arthroplasty: a prospective randomized clinical trial using radiostereometric analysis.","authors":"Emelie S Kristoffersson, Daniel Wästerlund, Anette Nyberg, Sead Crnalic, Kjell G Nilsson, Volker Otten","doi":"10.1186/s42836-025-00324-z","DOIUrl":"10.1186/s42836-025-00324-z","url":null,"abstract":"<p><strong>Background and purpose: </strong>The design and coating of uncemented joint implants impact bone ingrowth and thereby the stability of the implant. This prospective randomized clinical trial aimed to compare early migration of two uncemented, similarly shaped femoral stems with either calcium phosphate or hydroxyapatite coating.</p><p><strong>Patients and methods: </strong>93 patients (102 hips) were randomized to either an intervention calcium phosphate or a conventional hydroxyapatite-coated stem. Migration measurements were performed postoperatively, and at 6 weeks, 3, 12 months, and 2 and 5 years after operation, and analyzed with radiostereometric analysis.</p><p><strong>Results: </strong>There were no significant differences in migration between the two stems from postoperative to 5-year follow-up. With 6 weeks follow-up as baseline, the calcium phosphate coated stem showed a tendency towards migrating less with a maximum total point motion up to 2 years of 0.84 mm (0.68 to 1.00 95% CI) compared to the hydroxyapatite-coated stem which migrated 1.25 mm (0.99 to 1.52 95% CI) (P = 0.010).</p><p><strong>Conclusions: </strong>Our data show that the calcium phosphate-coated stem is a safe implant in terms of ingrowth stability, and with migration patterns comparable to a hydroxyapatite-coated stem.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"7 1","pages":"40"},"PeriodicalIF":4.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776910","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":"The P Balasubramaniam Award-2024 Singapore Orthopaedic Association Annual Scientific Meeting Award: Novel artificial intelligence algorithm for soft tissue balancing and bone cuts in robotic total knee arthroplasty improves accuracy and surgical duration","authors":"Matthew Song Peng Ng, Ryan Wai Keong Loke, Melvin Kian Loong Tan, Yau Hong Ng, Zi Qiang Glen Liau","doi":"10.1186/s42836-025-00322-1","DOIUrl":"10.1186/s42836-025-00322-1","url":null,"abstract":"<p><strong>Background: </strong>Robotic Total Knee Arthroplasty (rTKA) has become increasingly popular. Intraoperative manual planning of femur and tibia implant positions in all degrees of freedom to achieve surgeon-defined targets and limits of bone cuts, gaps, and alignment is challenging. The final manually defined solution may not be optimal, and surgical duration increases significantly. We aim to demonstrate the effectiveness of our novel algorithm in terms of accuracy and surgical duration.</p><p><strong>Methods: </strong>We developed a novel AI computational algorithm to optimize rTKA implant positioning in three-dimensional space. The initial parameters of 3D implant positioning and surgeon-defined target gaps and bone cuts are set. The algorithm determines permutations achieving ideal 3D implant positioning with ± 0.5 mm accuracy, ranking them by surgeon preference and evidence-based criteria. We compared accuracy in achieving surgeon-defined target gaps, intraoperative soft tissue balancing duration, and total surgical time.</p><p><strong>Results: </strong>A prospective study of 67 consecutive rTKA patients at a tertiary institution (Nov 2021-Dec 2023) was conducted. 25 patients (mean age 70.4 ± 7.34 years) had our algorithm used intraoperatively, while 42 (mean age 70.5 ± 6.90 years) did not. 92% of rTKAs using our algorithm achieved target gaps ± 1.5 mm, vs. 52% of non-algorithm rTKAs (P = 0.003). The average difference between surgeon-defined target gaps and final achieved gaps was 1.1 ± 0.5 mm in the algorithm group vs. 1.8 ± 1.0 mm in the non-algorithm group (P = 0.003). Soft tissue balancing duration was significantly shorter: 1.16 min ± 0.11 with algorithm use vs. 14.5 min ± 8.3 (P < 0.0001). Total surgical duration was also significantly lower: 38.4 min ± 14.9 vs. 73.7 min ± 19.6 (P = 0.0002).</p><p><strong>Conclusion: </strong>Our novel AI algorithm significantly improves accuracy in achieving surgeon-defined target extension and flexion gaps while reducing soft tissue balancing and total surgical duration. This is highly promising for achieving both reproducibility and efficiency in rTKAs. Video Abstract.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"7 1","pages":"39"},"PeriodicalIF":4.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776911","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":"Clinical results of reverse shoulder arthroplasty after failed arthroscopic rotator cuff repair compared to primary cases: a case-control study.","authors":"Noriaki Shimada, Jun'ichi Inoue, Ryota Takei, Kazuo Saita, Hiroshi Inui","doi":"10.1186/s42836-025-00323-0","DOIUrl":"10.1186/s42836-025-00323-0","url":null,"abstract":"<p><strong>Background: </strong>Although reverse shoulder arthroplasty (RSA) is a popular treatment, its efficacy in patients with failed rotator cuff repair (ARCR) remains unclear. In this study, we aimed to evaluate the clinical results of RSA for following failed ARCR. We hypothesized that RSA after failed ARCR would lead to improved clinical outcomes comparable to those of RSA performed without prior surgeries.</p><p><strong>Methods: </strong>Between January 2017 and December 2022, 143 patients underwent RSA at our institution. We included 85 patients who met the study criteria and followed them for a minimum of 2 years. The patients were divided into two groups: those who underwent RSA for failed ARCR (group A: 25 patients; mean age, 77.7 years) and those who underwent primary RSA (group B: 60 patients; mean age, 77.9 years). The University of California, Los Angeles (UCLA) scores, Japanese Orthopaedic Association (JOA) scores, range of motion (ROM), Numerical Rating Scale (NRS) scores, and complication rates were compared between the two groups.</p><p><strong>Results: </strong>At the 2-year postoperative follow-up, both groups showed significant improvements in all items. Postoperative outcome or complication rate demonstrated no significant difference between group A and group B: UCLA scores (29.7 ± 3.9 vs 29.3 ± 3.6), JOA scores (87.4 ± 6.1 vs 87.4 ± 8.6), ROM forward elevation (129.1 ± 20.1 vs 133.9 ± 24.1), ROM external rotation (29.1 ± 12.7 vs 29.4 ± 10.7), ROM internal rotation (2.4 ± 1.0 points vs 2.3 ± 1.1 point), NRS scores (0.9 ± 1.2 vs 1.1 ± 1.3), and complication rates (4.0% vs 3.3%). Group A exhibited improvement in all items, and the results were comparable to those in group B.</p><p><strong>Conclusions: </strong>RSA in patients with prior rotator cuff repair demonstrated similar functional outcomes and complication rates to those in patients who underwent RSA without prior surgeries. The study demonstrated that prior ARCR would not be a negative predictor. For patients who are afraid of or cannot consent to artificial joint surgery, recommending ARCR first may be an option.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"7 1","pages":"38"},"PeriodicalIF":4.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762317","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":"The impact of femoral flexion angle and tibial slope on knee gap in total knee arthroplasty.","authors":"Varah Yuenyongviwat, Chirathit Anusitviwat, Tawan Intiyanaravut, Payap Payapanon, Nimit Thongpulsawasdi","doi":"10.1186/s42836-025-00321-2","DOIUrl":"10.1186/s42836-025-00321-2","url":null,"abstract":"<p><strong>Background: </strong>Inadequate gap balance during total knee arthroplasty (TKA) can result in postoperative pain, restricted range of motion, and suboptimal long-term outcomes. The sagittal alignment of the femoral and tibial components plays a pivotal role in determining both the flexion and extension gaps. This study systematically investigates how variations in femoral and tibial sagittal alignment affect knee gap dynamics during TKA, utilizing intraoperative data from a robotic-assisted surgical system.</p><p><strong>Method: </strong>This retrospective study analyzed data from 40 robotic-assisted TKA procedures. Surgical planning data were obtained using the landmark registration process. The tibial posterior slope was fixed at 3°, while the femoral flexion angle was adjusted incrementally from 3° to 8° in 1° intervals. Medial and lateral flexion gaps were measured at each increment. To examine the effect of tibial posterior slope on knee gap dynamics, the femoral flexion angle was maintained at 3°, and the tibial posterior slope was varied from 3° to 7° in 1° increments. Medial and lateral extension and flexion gaps were recorded for each configuration.</p><p><strong>Results: </strong>Both medial and lateral flexion gaps progressively increased as the femoral flexion angle was adjusted from 3° to 8°. Similarly, both flexion and extension gaps demonstrated a corresponding increase as the tibial posterior slope was elevated from 3° to 7°. Spearman correlation analysis showed that increasing femoral flexion and tibial slope significantly increased medial and lateral gaps (ρ > 0.99).</p><p><strong>Conclusion: </strong>Increasing femoral flexion results in a larger flexion gap, while a higher tibial slope leads to proportional increases in both flexion and extension gaps. Future studies incorporating intraoperative validation will be crucial for refining surgical techniques and improving outcomes in TKA.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"7 1","pages":"37"},"PeriodicalIF":2.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576950","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":"Effects of preoperative systemic administration of tranexamic acid alone on postoperative inflammation and pain in total hip arthroplasty: a retrospective cohort study.","authors":"Fumihiro Mukasa, Tomonori Baba, Koju Hayashi, Taiji Watari, Muneaki Ishijima","doi":"10.1186/s42836-025-00320-3","DOIUrl":"10.1186/s42836-025-00320-3","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have demonstrated that tranexamic acid (TXA) effectively reduces postoperative blood loss after total hip arthroplasty (THA) and is a safe treatment option. However, the anti-inflammatory effect of using TXA without dexamethasone (DEX) in THA remains unclear. In this study, we evaluated the anti-inflammatory effects, postoperative pain reduction, hidden blood loss (HBL), and postoperative complications associated with the use of TXA in THA.</p><p><strong>Methods: </strong>This retrospective cohort study included 126 patients who underwent primary THA via a direct anterior approach (DAA) between January 1, 2023, and February 29, 2024. Patients were divided into two groups based on the administration of TXA (1000 mg IV preoperatively): Group A (with TXA) and Group B (without TXA). The postoperative inflammatory response (C-reactive protein [CRP] levels) and pain (numerical rating scale [NRS]) were assessed on postoperative days (PODs) 1, 3, and 7. HBL was assessed on PODs 3 and 7. Postoperative complications were counted based on occurrences from the postoperative period until discharge.</p><p><strong>Results: </strong>CRP levels were significantly lower on POD 1 in Group A than in Group B (P = 0.002). Postoperative pain levels in Group A peaked later, with a significant reduction in the NRS score on POD 3, compared with that in Group B (P = 0.031). HBL in Group A was significantly reduced on PODs 3 (P < 0.001) and 7 (P = 0.013) compared to that in Group B. Postoperative complications did not differ significantly between Groups A and B.</p><p><strong>Conclusion: </strong>TXA can effectively reduce postoperative blood loss, inflammation, and pain in patients undergoing THA without postoperative complications. Using TXA alone remains a highly effective and practical approach for improving early postoperative outcomes in patients undergoing THA.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"7 1","pages":"35"},"PeriodicalIF":2.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561948","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":"Intraoperative kinematics of the bicruciate retaining TKA using functional alignment and their influence on the clinical outcomes.","authors":"Hiroshi Inui, Ryota Yamagami, Kenichi Kono, Kohei Kawaguchi, Haruhiko Nakamura, Kazuo Saita, Shuji Taketomi, Sakae Tanaka","doi":"10.1186/s42836-025-00319-w","DOIUrl":"10.1186/s42836-025-00319-w","url":null,"abstract":"<p><strong>Background: </strong>Our surgical team has been performing bicruciate-retaining total knee arthroplasty (BCR-TKAs) with functional alignment (FA). This study aimed to investigate knee kinematics before and after FA BCR-TKA, as well as the influence of these changes on clinical outcomes.</p><p><strong>Methods: </strong>Fifty cases of BCR-TKAs were included. Intraoperative rotational kinematics and anteroposterior translations between before (preinsertion group) and after (postinsertion group) BCR-TKA were compared. The relationship between clinical outcomes and intraoperative kinematic parameters between the two groups was evaluated.</p><p><strong>Results: </strong>The tibial internal rotational angles of the preinsertion group were significantly larger than those of the postinsertion group at 0°, 60°, 90°, and maximum flexion angles. Anteroposterior (AP) translation of the femur center relative to the tibial center of the preinsertion group was significantly smaller than that of the postinsertion group at 60° and 90° of flexion angles. No difference was found between the two groups at 0°, 30°, and maximum flexion angle. A negative relationship was found between the difference in rotational angles at maximum flexion and knee injury, and osteoarthritis outcome score (KOOS) activity of daily living (ADL), and improvement of KOOS symptom and ADL subscale scores. A positive relationship was found between the difference in rotational angles at 0° and improvement of KOOS pain, sports, and quality of life subscale scores.</p><p><strong>Conclusions: </strong>AP translation of the femur after BCR-TKA with respect to the tibia was similar to that of the preoperative knee. The change in rotational knee kinematics after BCR-TKA showed associations with clinical outcomes; however, the relationship remains multifactorial and should be interpreted with caution.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"7 1","pages":"34"},"PeriodicalIF":2.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12224591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555696","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":"Restricted kinematic total knee arthroplasty provided better functional outcomes and higher satisfaction rates for Asians of genu varum with apex distal joint line over unrestricted kinematic total knee arthroplasty.","authors":"Jia Yi Loh, Ming Han Lincoln Liow, Glen Purnomo, Merrill Lee, Jerry Yongqiang Chen, Hee-Nee Pang, Keng Jin Darren Tay, Seng-Jin Yeo","doi":"10.1186/s42836-025-00318-x","DOIUrl":"10.1186/s42836-025-00318-x","url":null,"abstract":"<p><strong>Background: </strong>Coronal Plane Alignment of the Knee (CPAK) phenotypes I, II, and IV can achieve favorable soft tissue balance following kinematic total knee arthroplasty (KA-TKA). Given that this classification was developed from a Caucasian population, limited studies have evaluated clinical outcomes following restricted vs unrestricted KA-TKA in South-East Asian patients, this study aimed to: (1) outline the prevalence of CPAK types in a South-East Asian population, (2) compare clinical outcomes of patients undergoing restricted versus unrestricted KA-TKA.</p><p><strong>Methods: </strong>Prospectively collected data from 232 patients who underwent KA-TKA between 2015 and 2018 were reviewed. The prevalence of CPAK in our cohort was determined using preoperative medial proximal tibial (MPTA) and lateral distal femoral (LDFA) angles measured from long-limb radiographs. Unrestricted calipered KA-TKA targeted equal bone cuts while restricted KA-TKA utilized intraoperative navigation to restrict tibia varus to 4°. Patients were assessed preoperatively, at 6 months, and 2 years using the Knee Society Score, Oxford Knee Score, and Short-Form 36. Postoperative satisfaction and expectation fulfillment were recorded. Intra- and interclass correlation of all radiographic measurements and both parametric and non-parametric statistical analysis were used.</p><p><strong>Results: </strong>The prevalence of CPAK in our cohort: I (47.8%), II (30.6%), III (9.1%), IV (7.8%), V (3.9%), VI (0.9%), VII (0%), VIII (0%) and IX (0%). Intra- and interclass correlation of radiographic measurements were excellent at 0.98 (95%CI: 0.95-0.99, P < 0.01). Subgroup analysis of CPAK I patients demonstrated that restricted KA-TKA had better KSS objective (P = 0.04), a higher proportion of satisfied patients (P = 0.02) at 6 months, and better OKS (P = 0.03) than unrestricted KA-TKA.</p><p><strong>Conclusion: </strong>CPAK I was the most prevalent phenotype in an Asian population. CPAK I patients undergoing restricted KA-TKA had better functional outcomes and satisfaction rates than those who underwent unrestricted KA-TKA. Future studies should focus on evaluating outcomes of different alignment strategies to personalize treatment for Asian CPAK phenotypes.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"7 1","pages":"33"},"PeriodicalIF":2.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546136","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":"Does the use of shortened stems reduce early femoral complications in total hip arthroplasty using the direct anterior approach?","authors":"François Fauré, Cécile Batailler, Constant Foissey, Elvire Servien, Sébastien Lustig","doi":"10.1186/s42836-025-00317-y","DOIUrl":"10.1186/s42836-025-00317-y","url":null,"abstract":"<p><strong>Introduction: </strong>The choice of femoral stem design during total hip arthroplasty (THA) through the Direct Anterior Approach (DAA) is critical. Shortened stems offer potential benefits such as bone preservation and reduced stress shielding. This study aimed to compare early complications at one year of follow-up between shortened and standard stems in DAA THA.</p><p><strong>Methods: </strong>A retrospective monocentric case-control study included patients undergoing DAA THA from 2013 to 2023. Two cohorts were analyzed: 537 THA with standard stems and 346 THA with shortened stems. Three hundred forty-three patients in each group were matched (1:1) based on age, sex, and Body Mass Index (BMI). Two independent observers assessed femoral complications at one year. Femoral stem positioning was measured.</p><p><strong>Results: </strong>The mean follow-up was 12 ± 0.5 months. The mean age was 64.1 ± 11.7 years. The mean BMI was 26.4 ± 4.4 kg/m². Shortened stems showed a significantly lower rate of femoral complications (1.4% vs. 5.5%, P = 0.005), particularly for the GT fractures (P = 0.006). In the shortened group, stem alignment was neutral in 69% of cases, varus in 27%, and valgus in 4%.</p><p><strong>Conclusion: </strong>Shortened stems in DAA THA were associated with a lower rate of femoral complications, particularly fewer GT fractures. Although shortened stems were more often positioned in varus, this did not impact short-term complication rates.</p><p><strong>Trial registration: </strong>The Advisory Committee on Research Information Processing in the Field of Health (CCTIRS) approved this study on June 4, 2015 (Study ID 15-430). Video Abstract.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"7 1","pages":"32"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12211780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531033","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}