Arthroplasty最新文献

{"title":"Five-year patient-reported outcomes after fixed-bearing medial UKA with broad patient selection.","authors":"Emily M London, Damian A Bull, Katy L Mason, Tahir Idrees, Jacobus H Müller, Nick J London","doi":"10.1186/s42836-026-00380-z","DOIUrl":"10.1186/s42836-026-00380-z","url":null,"abstract":"<p><strong>Purpose: </strong>Evaluate the impact of patient age, body mass index (BMI), medial/central patellofemoral arthritis, and anterior cruciate ligament (ACL) deficiency on five-year patient-reported outcome measures (PROMs) of fixed-bearing medial unicompartmental knee arthroplasty (UKA).</p><p><strong>Methods: </strong>A consecutive group of 229 patients (240 knees) received fixed-bearing medial UKA. At minimum two (n = 231 knees) and five years (n = 221 knees), patients completed the Oxford Knee Score (OKS), the EuoQol-5D (EQ-5D), Knee injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), University of California, Los Angeles (UCLA) activity score, Forgotten Joint Score (FJS), and their level of satisfaction. Sub-group analyses compared PROMs in patients based on: (i) Grade III/IV vs. Grade 0-III medial/central patellofemoral arthritis, (ii) ACL deficiency vs. intact ACL, (iii) age groups (< 50, 50-59, 60-69, 70-79, > 80), and (iv) BMI categories (< 30, 30-35, 35-40, ≥ 40).</p><p><strong>Results: </strong>Satisfaction rates remained consistent at the 2- and 5-year follow-up points, with 96% being satisfied or very satisfied. The OKS, EQ-5D, KOOS PS, or FJS-12 were not statistically significantly different between 2 and 5 years. Five-year UCLA activity scores differed significantly across age groups (50-59 vs 80 + (MD = 1.5; p = 0.027), 60-69 vs 70-79 (MD = 0.9; p = 0.014), and 60-69 vs 80 + (MD = 1.7; p = 0.004)), and between patients with a BMI < 30 vs ≥ 40 (MD = 2.3; p = 0.045). These findings were supported by multivariable regression, which showed that increasing age and higher BMI were independently associated with worse UCLA activity scores. Grade III/IV patellofemoral arthritis was associated with worse EQ-5D scores but was not associated with worse OKS, UCLA, KOOS-PS, or FJS-12. ACL deficiency was associated with higher KOOS-PS scores.</p><p><strong>Conclusion: </strong>Five-year outcomes following fixed-bearing medial UKA demonstrated high patient satisfaction, unchanged from two years. Although older age was associated with lower activity and higher BMI (> 40) with worse function, the effect sizes were small and not clinically meaningful. Patellofemoral arthritis and ACL deficiency had no negative functional impact. Therefore, age, BMI, patellofemoral arthritis, and ACL status should not be considered contraindications; instead, broad selection criteria for fixed-bearing UKA are supported.</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/PMC13067698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655516","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":"Reliability of the CPAK classification assessed on long-leg X-rays in patients undergoing total knee arthroplasty.","authors":"Xavier Gasparutto, Daniel Chantre, Alice Bonnefoy-Mazure, Pierre-Alban Bouché, Didier Hannouche, Stéphane Armand, Hermès Howard Miozzari","doi":"10.1186/s42836-026-00381-y","DOIUrl":"10.1186/s42836-026-00381-y","url":null,"abstract":"<p><strong>Background: </strong>Patient-specific knee alignment is regarded as a major target for improving total knee arthroplasty (TKA) outcomes. The Coronal Plane Alignment of the Knee (CPAK) classification has been proposed to capture the native patient-specific knee alignment, according to the Joint Line Obliquity (JLO) and arithmetic Hip Knee Ankle angle (aHKA), themselves based on the Lateral Distal Femoral Angle (LDFA) and Medial Proximal Tibial Angle (MPTA). This study aims to evaluate intra-operator, inter-operator, and test-retest reliability of the CPAK classification and associated angles in both knees with osteoarthritis (KOA) and TKA.</p><p><strong>Methods: </strong>From our local arthroplasty registry, patients who sequentially underwent TKA on both knees within 18 months, with long-leg X-rays before and after each surgery between 2018 and 2023, were retrospectively selected. The contralateral knees before the 1st and 2nd TKA were used as test-retest for KOA and TKA knee, respectively. Four operators with increasing experience performed two measures of MPTA and LDFA for each image. The intra-operator, inter-operator, and test-retest reliability were assessed with Intraclass Correlation Coefficient (ICC(3,1)), Smallest Detectable Change (SDC), and Cohen's Kappa.</p><p><strong>Results: </strong>The study included 34 patients. Angles showed good to excellent ICC apart from JLO in the KOA condition (moderate). Measures of LDFA on KOA and all TKA angles presented good to excellent SDC (< 3°), including test-retest conditions. MPTA, JLO, and aHKA on KOA showed moderate SDC (< 4.2°). CPAK classification was moderate to substantial for KOA (Kappa of 0.5 to 0.64) and substantial to almost perfect for TKA (Kappa of 0.69 to 0.81). Reliability increased with experience.</p><p><strong>Conclusions: </strong>For experienced operators, CPAK classification and associated angles demonstrated levels of inter-rater reliability acceptable for clinical use in knees with TKA but at the limit of acceptability for knees with severe OA. In severe OA, one should interpret CPAK types cautiously, and angles may be preferable. MPTA in the knees with OA appeared as the main factor undermining reliability. Clarification on this angle may be needed to improve reliability, especially when using philosophies aiming at restoring the native alignment. Finally, test-retest reliability levels suggested that these measures are appropriate for longitudinal assessment.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610693","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":"Abstracts from the 11th Annual Meeting of Arthroplasty Society In Asia (ASIA), the 4th Annual Meeting of the Malaysian Society for Hip and Knee Surgeons (MSHKS), and the 17th Annual Meeting of the ASEAN Arthroplasty Association (AAA).","authors":"","doi":"10.1186/s42836-026-00376-9","DOIUrl":"10.1186/s42836-026-00376-9","url":null,"abstract":"","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 Suppl 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522767","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":"Glucagon-like peptide-1 receptor agonists in total joint arthroplasty: a comprehensive systematic review of what orthopaedic surgeons should know.","authors":"Omar Abdelaziz, Ziad G Zayed, Mohamed Abdo Khalafallah, Mohamed A Hanafy, Abdalla M Hadhoud, Khaled A Elmenawi","doi":"10.1186/s42836-026-00375-w","DOIUrl":"10.1186/s42836-026-00375-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The rising prevalence of obesity and type 2 diabetes mellitus (T2DM) among patients undergoing total joint arthroplasty (TJA) presents a significant clinical challenge, increasing the risk of postoperative complications. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a potential perioperative optimization strategy, but their impact on TJA outcomes remains debated. This systematic review was conducted to synthesize the evidence on the risks and benefits of GLP-1 RA use in adult patients undergoing primary TJA-specifically, total hip arthroplasty (THA), total knee arthroplasty (TKA), and total shoulder arthroplasty (TSA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, Scopus, and Web of Science databases were searched from their inception to June 16, 2025, for studies comparing postoperative outcomes in adult patients undergoing primary total joint arthroplasty (TJA) and using GLP-1 RAs versus a control group. Data on study characteristics, patient demographics, and postoperative outcomes were extracted. Due to significant heterogeneity and overlap in data sources, a narrative synthesis rather than meta-analysis of the findings was conducted. Study quality was assessed using the Newcastle-Ottawa Scale (NOS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fifteen retrospective cohort studies involving an aggregate total of 318,143 patients (114,365 THA, 125,505 TKA, 78,273 TSA) were included, with 56,132 receiving GLP-1 RAs. In THA and TKA, GLP-1 RAs use was associated with a reduced risk of periprosthetic joint infection (PJI) (e.g., 1.6% vs. 2.9% at 2 years for THA) and lower 90-day readmission rates (e.g., 1.1% vs. 2.0% for TKA and 1.6% vs. 2.0% for THA). When analyzed by exposure timing, the reduced PJI risk was most consistent in studies that defined GLP-1 RA use in the immediate perioperative period. Reported mean length of stay (LOS) was generally similar or slightly shorter among GLP-1 RA users compared to controls. Multiple studies reported either a reduction or no significant difference in the risk of 90-day emergency department visits. The short-term revision rates and dislocations were infrequent and did not differ significantly between groups in most of the included studies. In the TSA, evidence was inconsistent, with reduced odds of 90-day surgical site infection (SSI) (OR 0.25) in one study; however, no clear trend was observed. Gastrointestinal side effects and conflicting systemic risks were noted across procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Current observational data suggest that perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty is not associated with a consistent increase in short-term revision rates and may be associated with a reduced risk of postoperative infection. Evidence regarding TSA remains inconclusive.","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13007374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505606","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":"A tribute to our reviewers: Arthroplasty 2025 review and future outlook.","authors":"Yan Wang","doi":"10.1186/s42836-026-00378-7","DOIUrl":"https://doi.org/10.1186/s42836-026-00378-7","url":null,"abstract":"","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470271","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":"Safety and efficacy of day-case hip and knee arthroplasty in the NHS: a nationwide UK cohort study.","authors":"Omar Musbahi, Ahmed Al-Saadawi, Saran Singh Gill, Sara Sousi, Alex Bottle, Justin P Cobb, Gareth G Jones","doi":"10.1186/s42836-026-00377-8","DOIUrl":"https://doi.org/10.1186/s42836-026-00377-8","url":null,"abstract":"<p><strong>Introduction: </strong>In recent years, day-case hip and knee arthroplasty has emerged as a potential solution to the elective backlog within the NHS. While international literature on this topic is extensive, only a handful of single-centre studies have been conducted in the United Kingdom. This study aimed to examine the safety and efficacy of day-case hip and knee arthroplasty in the UK using a 20-year linked national NHS dataset.</p><p><strong>Methods: </strong>A cohort study was conducted using the Clinical Practice Research Datalink (CPRD), linked to Hospital Episode Statistics (HES) and the Office for National Statistics death registry. Adults undergoing primary hip or knee arthroplasty between 1998 and 2021 were included. Procedures were classified as day-case or inpatient, using two distinct approaches: patient classification and length of stay. Day-case is defined as discharge on the same day of the procedure, while inpatient procedures involve undergo at least one overnight stay in hospital. The primary outcomes assessed were A&E attendance, readmission, and critical care admission within 90-days post-operatively. Secondary outcomes included 90-day complication rates and survival analysis. Propensity score matching was implemented to adjust outcomes for age, gender, comorbidity burden, deprivation index, and ethnicity.</p><p><strong>Results: </strong>In total, 1,822 (0.16%) procedures were classified as day-case, while 4,355 (0.37%) had a recorded length of stay of 0 days. On average, patients undergoing day-case arthroplasty were younger, more often male, and had fewer comorbidities than their inpatient counterparts. Higher rates of A&E attendance (12% vs 9.1%; P = 0.001) and readmission (5.7% vs 3.7%; P < 0.001) were observed in the day-case cohort. In contrast, deep vein thrombosis (0.5% vs 0.9%; P = 0.010) and infection rates (1.0% vs 1.9%; P = 0.014) were lower in this patient group. Survival analyses demonstrated significantly higher adjusted survival probabilities associated with day-case arthroplasty (HR: 0.84; [95% CI: 0.72-0.99]; P = 0.034) over a 20-year follow-up period.</p><p><strong>Conclusion: </strong>Day-case hip and knee arthroplasty has been demonstrated to be  safe and feasible, with comparable complication rates to the traditional inpatient setting. However, within the context of the NHS, it is currently associated with higher rates of 90-day A&E attendance and readmission. While increasing day-case volumes may help address elective backlogs, it is important to ensure that the appropriate patient selection criteria, optimised peri-operative care, and post-discharge support are in place before this approach is expanded in the UK.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12983480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147460959","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":"Medial femoral condyle restoration technique in total knee arthroplasty.","authors":"Quanbo Ji, Yan Wang, Lin Hao, Yang Luo, Peng Ren, Ming Ni, Lei Geng, Guoqiang Zhang","doi":"10.1186/s42836-025-00353-8","DOIUrl":"10.1186/s42836-025-00353-8","url":null,"abstract":"<p><strong>Objective: </strong>To introduce a medial femoral condyle restoration (MFCR) technique for total knee arthroplasty (TKA) and compare its clinical outcomes with conventional mechanical alignment (MA) in varus osteoarthritis.</p><p><strong>Methods: </strong>In this prospective randomized trial, 126 consecutive patients with varus osteoarthritis undergoing TKA (January 2021-January 2023) were assigned to MFCR or MA. MFCR surgical key points were medially focused quantitative compensation of cartilage loss by reducing distal/posterior medial femoral resections using thickness-specific shims (0.5-2.0 mm, 0.5-mm steps) guided by Outerbridge grading and calibrated probing. Participants were randomized to receive either the MFCR technique or the conventional MA technique. Intraoperative outcomes (blood loss, operative time, hospital stay, and medial release) and postoperative ROM were recorded; functional outcomes included WOMAC and walking VAS pain. Continuous variables were expressed as mean ± standard deviation and analyzed using one-way analysis of variance.</p><p><strong>Results: </strong>The mean age of the MFCR group and control group was 68.3 ± 7.4 years and 67.9 ± 8.7 years, respectively (P = 0.4236). Preoperatively, the mean WOMAC score of the groups was 67.2 ± 9.8 and 62.3 ± 16.4, respectively (P = 0.2524). The mean varus knee angle was 18.2° ± 7.2° and 17.3° ± 8.9°, respectively (P = 0.6735). The mean time for soft tissue balancing was 5.1 ± 2.6 min and 12.1 ± 4.3 min in the MFCR and control group, respectively (P = 0.017). The mean operative time was 50.6 ± 12.1 min and 58.9 ± 13.8 min in the MFCR and control group, respectively (P = 0.011). The mean hospital stay time was 1.8 ± 0.7 days and 3.2 ± 0.9 days in the MFCR and control group, respectively (P = 0.028). At 2 years postoperatively, the WOMAC scores were 29.9 ± 17.9 and 43.6 ± 13.7, respectively (P = 0.0325). Postoperative nausea/vomiting occurred less frequently in the MFCR group (P = 0.0391), with no other complications observed during follow-up.</p><p><strong>Conclusion: </strong>MFCR restored the anatomy of the medial femoral condyle by quantitatively preserving medial femoral bone to compensate for cartilage loss within a bony-first, minimal-release workflow. Compared with MA, MFCR reduced perioperative burden and improved early function, and can be implemented using a simple, reproducible technique without advanced imaging or robotics. Video Abstract.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12977828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437645","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":"Risk analysis index demonstrates superior predictive performance compared to traditional frailty metrics in elderly female patients undergoing inpatient total shoulder arthroplasty.","authors":"Cameron J Sabet, Bhav Jain, Bara M Hammadeh, Abdulhalim Kikhia, Mohammad D Alfawareh","doi":"10.1186/s42836-025-00366-3","DOIUrl":"10.1186/s42836-025-00366-3","url":null,"abstract":"<p><strong>Background: </strong>While frailty assessment has become integral to preoperative risk stratification, the optimal measurement tool remains unclear for elderly women undergoing total shoulder arthroplasty (TSA). This study compared the predictive performance of the Risk Analysis Index (RAI) against traditional metrics, including the modified frailty index-5 (mFI-5) and Geriatric Nutritional Risk Index (GNRI) in this specific population.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of ACS NSQIP data from 2015-2021, including female patients aged 65-89 undergoing inpatient TSA. RAI incorporates age, functional status, recent weight loss, and physiological markers, including renal failure, congestive heart failure, and dyspnea. The mFI-5 assesses five comorbidities (diabetes, hypertension, COPD, heart failure, functional dependence), while the GNRI evaluates nutritional status using albumin and body weight. The discriminative ability of RAI, mFI-5, and GNRI was assessed using area under the curve (AUC) analysis for multiple 30-day outcomes. Primary outcomes were non-home discharge and extended length of stay (≥ 4 days), selected based on their clinical importance for discharge planning and quality metrics. Secondary outcomes included 30-day mortality, major and minor complications, readmission, and reoperation. Discriminative ability was assessed using area under the curve (AUC) analysis. Internal validation was performed using bootstrap resampling.</p><p><strong>Results: </strong>Among 11,965 patients analyzed, RAI demonstrated superior predictive performance for primary outcomes with AUCs of 0.784 for non-home discharge and 0.670 for extended length of stay, significantly outperforming mFI-5 (AUCs 0.601 and 0.590, respectively) and GNRI (AUCs 0.544 and 0.543). For secondary outcomes, RAI maintained competitive performance across mortality, complications, readmissions, and reoperations.</p><p><strong>Conclusion: </strong>The Risk Analysis Index provides superior discrimination for non-home discharge and extended length of stay compared to traditional frailty measures in elderly female TSA patients, with particularly strong predictive performance for discharge disposition, supporting its adoption as the preferred risk stratification tool for discharge planning in this population. Video Abstract.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12961877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356349","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":"Anatomical relationship between the intertrochanteric line and femoral neck osteotomy level in direct anterior approach total hip arthroplasty: a 3D morphometric and cadaveric validation study.","authors":"Sakkadech Limmahakhun, Suchate Runraksar, Nitchanant Kitcharanant, Warakorn Jingjit","doi":"10.1186/s42836-025-00365-4","DOIUrl":"10.1186/s42836-025-00365-4","url":null,"abstract":"<p><strong>Aims: </strong>Inaccurate femoral neck osteotomy is a recognized technical challenge in direct anterior approach total hip arthroplasty (DAA-THA), largely due to limited femoral exposure and the absence of a standardized intraoperative landmark. This study aimed to investigate whether the ITL is an alternative bony landmark for femoral neck osteotomy during the DAA.</p><p><strong>Patients and methods: </strong>Three anatomical references, the Intertrochanteric line (ITL) height (ITL-H), ITL angle (ITL-A), and femoral saddle height (SH), were measured from 3D-CT models of 60 normal hip patients (30 males and 30 females) to simulate a cutting height of 10 mm above the LT. Twenty cadaveric hip specimens were then used to evaluate the accuracy of the proposed anatomical references.</p><p><strong>Results: </strong>The mean ITL-H, ITL-A, and SH were 23 ± 4 mm, 17.4° ± 3.5°, and 26 ± 4 mm, respectively. While ITL-H showed no sex difference (23 ± 3.4 mm vs 23.1 ± 4.1 mm, P = 0.96), significant differences existed for ITL-A (15.8° ± 3.4° vs 19.9° ± 1.4°, P = 0.001) and SH (27.2 ± 3.9 mm vs 23.9 ± 3 mm, P = 0.002). ITL-H was not correlated with age (P = 0.063), femoral length (P = 0.31), or femoral neck shaft angle (P = 0.41). Femoral neck osteotomy performed 23 mm above the ITL-H could yield 80% and 100% success rates for cutting heights of 10-15 mm and > 5 mm above the LT, respectively.</p><p><strong>Conclusions: </strong>ITL-H serves as a reproducible anatomical landmark for femoral neck osteotomy during DAA-THA. An osteotomy level of approximately 23 mm above the ITL-H represents a safe lower margin to avoid excessive calcar bone resection. Nevertheless, individualized preliminary osteotomy based on preoperative templating remains necessary, with intraoperative adjustment according to patient-specific ITL-H. Video Abstract.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12954999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349803","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":"Exploring the optimal age for total knee arthroplasty to minimize risk of adverse outcomes: machine learning analysis of a statewide cohort.","authors":"Chloe Heiting, Yiyuan Wu, Susan M Goodman, Peter Sculco, Fei Wang, Said Ibrahim, Peter Cram, Rich Caruana, Bella Mehta","doi":"10.1186/s42836-026-00372-z","DOIUrl":"10.1186/s42836-026-00372-z","url":null,"abstract":"<p><strong>Background: </strong>Rates of total knee arthroplasty (TKA) in the United States have risen in patients of a wide age range. Although rates of postoperative TKA complications have decreased, they remain a significant concern. In this study, we aim to determine how the risk of adverse TKA outcomes changes dynamically with age and explore the optimal ages with the lowest risk for adverse outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study included patients who underwent elective primary TKA from 2012 to 2018 in the Pennsylvania Health Care Cost Containment Council Database. We trained (70% train:30% test) an explainable boosting machine (EBM), a modern generalized additive model, to predict risk for 90-day mortality, 90-day readmission, 1-year revision, and longer length of stay (LOS). This \"glass box\" model allowed us to measure and visualize feature importance using mean absolute scores and determine the role of age in the model. We then ran EBM models that allowed two-way interactions between age and patient-level covariates.</p><p><strong>Results: </strong>In our cohort of 227,959 patients, 90-day readmission was observed in 7.5%, 90-day mortality in 0.2%, and 1-year revision in 0.8%. The median LOS was 2 days (IQR [2, 3]). Age was among the most important factors for predicting all outcomes, and these were nonlinear relationships. The risk for 90-day mortality increased substantially at 76.5 years, and for 90-day readmission and longer LOS at 73.5 years. Risk for 1-year revision was greater before 63.5 years.</p><p><strong>Conclusions: </strong>We determined that there is a nonlinear relationship between age and risk for adverse TKA outcomes, and it changes dramatically at specific time points. Our data suggests that the optimal age for lower risk of 90-day mortality, 90-day readmission, and longer LOS is below 73.5 years, and above 63.5 years for 1-year revision. These findings can help in decision-making when trying to quantify risks related to aging.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318808","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}