Arthroplasty最新文献

{"title":"Clinical outcomes and perioperative safety of primary total knee arthroplasty for hemophilic arthropathy versus osteoarthritis: a retrospective cohort study.","authors":"Ruixiang Ma, Quan Liu, Xianli Hu, Haibo Sun, Jing Zhao, Juan Tong, Zheng Su, Chen Zhu","doi":"10.1186/s42836-026-00431-5","DOIUrl":"10.1186/s42836-026-00431-5","url":null,"abstract":"<p><strong>Background: </strong>Hemophilic arthropathy (HAr) frequently progresses to end-stage joint disease requiring total knee arthroplasty (TKA), but coagulation dysfunction raises concerns about perioperative bleeding and complications. We aim to analyze the clinical outcomes and safety associated with primary TKA in patients with HAr.</p><p><strong>Methods: </strong>This single-center retrospective cohort included 22 TKAs in 20 men with HAr and 66 TKAs in 66 male osteoarthritis (OA) controls selected by surgeon and proximity of surgery date. The procedure was the analysis unit, and standard errors were clustered by patient. Continuous outcomes were compared with Welch tests and adjusted using baseline-outcome analysis of covariance including group, age, and body mass index. Sparse binary outcomes were exploratory and analyzed with Fisher exact tests and Firth logistic regression. Calculated blood loss was evaluated using the Nadler-Gross method.</p><p><strong>Results: </strong>Patients with HAr were younger (41.86 ± 11.29 versus 68.33 ± 6.70 years). Mean improvement in the Knee Society clinical score was 49.64 ± 18.43 versus 53.24 ± 5.77 points (unadjusted between-group change-score difference, - 3.61; 95% CI - 11.88 to 4.67; p = 0.376). Adjusted 12-month group effects were 0.54 points (95% CI - 4.19 to 5.28; p = 0.820) for Knee Society clinical score and 3.02 points (95% CI - 9.73 to 15.77; p = 0.639) for Knee Society function while adjusted flexion remained lower (mean difference, - 19.64°; 95% CI - 38.29° to - 0.99°; p = 0.039). Calculated blood loss did not differ significantly (532.53 ± 355.18 versus 628.00 ± 328.38 mL; p = 0.275), while transfusion occurred in 4/22 versus 0/66 procedures (p = 0.003). Wound problems (6/22 versus 3/66) and 90-day readmissions (9/22 versus 1/66) were more frequent in crude comparisons, but adjusted estimates were highly imprecise.</p><p><strong>Conclusions: </strong>Under comprehensive blood management, TKA produced substantial within-group functional improvement in HAr. Adjusted 12-month Knee Society clinical and function scores were not detectably different, although flexion remained lower. Calculated blood loss was not increased, but transfusion and unadjusted wound or readmission signals warrant multidisciplinary care and confirmation in larger, prospectively defined cohorts.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992320","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":"Advancing preoperative planning technology in total joint arthroplasty with a real-time machine learning calculator: 1-year mortality risk in a value-based care era.","authors":"Alexander H King, Kole Joachim, Christopher D Hamad, Casey Abernethy, Aaron Cheng, Timothy Ko, Brandon Gettleman, Adrian Lin, Amanda Perrotta, Sumin Jeong, Ezekiel Dingle, Joshua M Wiener, Alexandra Stavrakis, Alexander B Christ","doi":"10.1186/s42836-026-00428-0","DOIUrl":"10.1186/s42836-026-00428-0","url":null,"abstract":"<p><strong>Background: </strong>Technological innovation in total joint arthroplasty (TJA) has largely focused on intraoperative precision through robotics, navigation, and implant design, while preoperative decision-making remains comparatively underdeveloped. Accurate estimation of patient-specific risk is central to surgical indications, yet existing tools provide limited resolution for consequential outcomes such as 1-year mortality.</p><p><strong>Methods: </strong>A machine learning model was developed using the TriNetX Research Network. Patients undergoing total knee (TKA) or hip (THA) arthroplasty with verifiable 1-year follow-up were included in the analysis. An XGBoost model incorporating 43 preoperative variables was trained using nested cross-validation with isotonic calibration. Model performance was assessed using discrimination, calibration, and decision curve analysis, and the results were used to derive thresholds for a web calculator based on machine-learning-derived inputs. Feature contributions were assessed using SHapley Additive exPlanations (SHAP).</p><p><strong>Results: </strong>The observed 1-year mortality rate was 0.574% (n = 1,344). On internal validation, the model demonstrated an Area Under the Receiver Operating Characteristic (AUROC) of 0.761 (fold-level range: 0.744-0.787, standard deviation [SD]: 0.016), a Brier score of 0.006, and an average precision of 0.037. Calibration remained stable across risk deciles, with mean absolute error below 0.15% for D1-D9 and modest overprediction confined to D10 (+ 0.16%). Mortality increased monotonically across stratified risk groups: the highest quintile had a 1.488% mortality rate (2.6-fold above baseline), the highest decile had 2.50% (4.4-fold), and the top 5% had 3.57% (6.2-fold). Feature importance analysis identified age as the dominant predictor (mean |SHAP| = 0.407), followed by male sex (0.218), serum creatinine (0.162), hemoglobin (0.153), and BMI (0.145). Threshold-based risk stratification yielded two clinically relevant operating points: a sensitivity-anchored threshold of 0.235% captured 90.1% of all deaths, while a Youden-optimal threshold of 0.767% achieved 83.9% specificity.</p><p><strong>Conclusions: </strong>One-year mortality following primary THA and TKA can be estimated with discriminative accuracy using routinely available preoperative variables, with predictive importance attributable primarily to age and markers of physiologic reserve. Supported by these findings and future external validations, machine learning-derived mortality models are amenable to prospective clinical deployment via web-based interfaces, enabling individualized preoperative risk quantification at the point of care.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914401","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":"DVIA technique for acute periprosthetic joint infection: a surgical technique and case series.","authors":"Mingzhang Li, Boyong Wang, Zifei Yin, Changming Wang, Deyi Ding, Xiaohua Chen, Hao Shen, Qiaojie Wang","doi":"10.1186/s42836-026-00430-6","DOIUrl":"10.1186/s42836-026-00430-6","url":null,"abstract":"<p><strong>Aims: </strong>Periprosthetic joint infection (PJI) remains a major challenge in orthopaedic surgery. While debridement, antibiotics, and implant retention (DAIR) are a common treatment for acute PJI, its success rate is variable. Intra-articular antibiotic administration and wound healing techniques may enhance infection control and improve clinical outcomes. This study aimed to describe a modified technique combining DAIR with vacuum sealing drainage (VSD) and intra-articular antibiotic infusion (DVIA) for treating acute PJI, and evaluate its clinical feasibility and preliminary outcomes.</p><p><strong>Methods: </strong>This retrospective, single-center case series included 31 patients who underwent DVIA (hip: 19; knee: 12) between September 2019 and December 2023. Following DAIR, a technique integrating vacuum-sealed drainage for wound management with intra-articular antibiotic infusion was applied. Inflammatory markers (CRP, ESR) and intra-articular antibiotic concentrations were monitored at multiple time points. Treatment outcomes, CRP and ESR levels, Knee Society Score (KSS), KSS functional score, Harris Hip Score (HHS), and the 36-item Short-Form (SF-36) physical function scale were evaluated over a 12-month follow-up.</p><p><strong>Results: </strong>Infection control was achieved in 90.32% (28/31) of patients. CRP and ESR levels decreased after treatment. Joint function and patient-reported physical function improved during follow-up. Intra-articular vancomycin concentrations measured in a subset of patients exceeded previously reported minimum biofilm eradication concentration (MBEC) thresholds. No catheter-related complications, retrograde infections, or systemic antibiotic-related adverse events were observed.</p><p><strong>Conclusion: </strong>The DVIA technique appears to be a feasible adjunctive strategy for the management of acute PJI, enabling effective local antibiotic delivery and favorable clinical outcomes. These findings are preliminary and warrant further validation in prospective controlled studies.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908214","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":"Quadriceps muscle status after medial-pivot versus ultracongruent total knee arthroplasty using localized bioimpedance analysis: a randomized exploratory study.","authors":"Glòria Pedemonte-Parramón, Lexa Nescolarde, Ester García-Oltra, Vicente López, Lika Dzidzishvili, José A Hernández-Hermoso","doi":"10.1186/s42836-026-00429-z","DOIUrl":"10.1186/s42836-026-00429-z","url":null,"abstract":"<p><strong>Background: </strong>Implant design in total knee arthroplasty (TKA) may influence postoperative biomechanics and muscle recovery. Ultracongruent (UC) and medial pivot (MP) designs aim to enhance anteroposterior stability and reproduce physiological knee kinematics, yet comparative data remain scarce, and muscle recovery has rarely been directly evaluated. Localized bioelectrical impedance analysis (L-BIA) provides an objective method to assess skeletal muscle status, but its application to compare muscle recovery between different TKA implant designs has not been previously investigated.</p><p><strong>Methods: </strong>A prospective, randomized, patient-blinded study was conducted between 2022 and 2024, including 40 patients undergoing primary TKA for advanced knee osteoarthritis. Patients were randomly assigned to receive either a medial-pivot (MP) or an ultracongruent (UC) prosthesis. The final analysis included 30 patients (15 per group). The primary outcome was postoperative quadriceps muscle recovery between implant groups, assessed longitudinally by reactance (Xc) of the rectus femoris, vastus medialis, and vastus lateralis using localized bioelectrical impedance analysis (L-BIA). Assessments were performed preoperatively and at 6 and 12 months postoperatively. Secondary outcomes included resistance (R), WOMAC, Knee Society Score, range of motion, and radiographic parameters. Temporal changes and between-group differences were analysed using repeated-measures and covariance-based statistical models.</p><p><strong>Results: </strong>Demographic and preoperative characteristics were comparable between groups. Resistance values remained stable across all time points with no differences between implant designs. Reactance showed a transient decrease at 6 months followed by recovery at 12 months in both groups, with no significant differences between groups. ANCOVA demonstrated that baseline reactance was associated with 12-month reactance values (all p < 0.001), whereas implant design had no significant effect. The clinical relevance of this finding remains uncertain. Radiographic parameters, postoperative range of motion, and clinical outcomes improved significantly after surgery in both groups without significant differences between MP and UC designs.</p><p><strong>Conclusion: </strong>No significant differences in quadriceps recovery were observed between MP and UC implants during the first postoperative year. Baseline muscle status was associated with postoperative L-BIA outcomes, whereas no significant differences were observed between implant designs.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901245","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":"Calprotectin identified as a key differentially expressed plasma biomarker in periprosthetic joint infection against aseptic failure: a precision health proteomics study.","authors":"Sebastian L Andree, Linnea Salbøg Morsø, Jacob Skallerup, Bo Larsen-Ledet, Mathilde V Søborg, Letizia Satriano, Anne C Bay-Jensen, Sten Rasmussen, Christian F Thudium, Allan Stensballe","doi":"10.1186/s42836-026-00414-6","DOIUrl":"10.1186/s42836-026-00414-6","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) is a debilitating and dangerous complication following joint arthroplasty procedures. With the increasing incidence of arthroplasty procedures, the burden of PJI is expected to continually grow. A correct and early diagnosis of PJI proves difficult, with the lack of a single standardized molecular test. The utilization of serology-based biomarkers would provide a non-invasive sampling method; however, these methods have not proven sufficient to satisfy the diagnostic criteria.</p><p><strong>Methods: </strong>The present study aimed to employ liquid chromatography/mass spectrometry-based (LC-MS) techniques to explore the proteomic profile of plasma samples derived from a prospective Danish PJI cohort, PRIS, to identify relevant proteins that are significantly differentially expressed in acute PJI compared to those with aseptic failure or chronic pain related to the prosthesis. Serum from patients included in the LC-MS analysis was measured for a biomarker of neutrophil activity, CPa9-HNE, measuring a neo-epitope of neutrophil elastase-cleaved calprotectin.</p><p><strong>Results: </strong>A total of 656 plasma proteins were quantified by the discovery proteomic approach, and differential abundance analysis showed increased abundance of calprotectin heterodimers, S100A8, and S100A9 in acute PJI samples compared to both aseptic failure and chronic pain. Functional enrichment of the significantly regulated proteins in acute PJI, compared to aseptic failure and chronic pain, showed an upregulation of acute immune-related pathways. Serum levels of a biomarker of neutrophil activity, an elastase-derived calprotectin neo-epitope, CPa9-HNE, showed statistically significant differences between infection and both aseptic failure and chronic pain in the same cohort, supporting the findings in LC-MS analysis.</p><p><strong>Conclusion: </strong>Plasma LC-MS proteomics and targeted measurement of CPa9-HNE neutrophil activity biomarker in matched serum samples of patients with PJI, aseptic failure, and chronic pain show significant upregulation of calprotectin heterodimers, S100A8 and S100A9, as well as CPa9-HNE in patients with PJI.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888865","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 novel classification system for anterior femoral notching in total knee arthroplasty.","authors":"Alexander Antoniadis, Jaad Mahlouly, Thibaut Royon, Julien Wegrzyn","doi":"10.1186/s42836-026-00424-4","DOIUrl":"10.1186/s42836-026-00424-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Femoral notching in Total Knee Arthroplasty (TKA) is traditionally associated with an increased risk of periprosthetic fracture in cases of excessive anterior resection. Beyond fracture risk, notching can influence implant fit, patellofemoral and tibiofemoral balance, joint stability, and overall biomechanics. Despite its clinical importance, a standardized system for describing femoral notching is lacking. We propose a novel Femoral Notch Classification, based on resection depths and trochlear geometry, intended as a common language applicable both intraoperatively and on lateral radiographs, independent of alignment philosophy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The classification was developed through clinical observation and biomechanical rationale, focusing on preserving anterior cortical integrity while permitting a controlled notch when required. Definitions relate resection depths to implant thickness, distal femoral anatomy, and trochlear geometry, with attention to balancing anterior and posterior gaps. Perpendicularity of the anterior cut relative to the cortex can be evaluated and adapted according to implant design and alignment technique. Four descriptive categories were established, providing a structured framework for assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;(1) Type 0-No Notch: Complete preservation of the anterior cortex with no visible step-off or indentation. Anterior resection may match implant thickness precisely; if not, anterior overstuffing or posterior over-resection should be controlled. (2) Type 1-On the Line: Anterior resection is flush with the femoral cortex, creating a subtle notch that remains biomechanically stable without compromising the cortex. (3) Type 2-Controlled Notch: A deeper anterior resection (ideally, &lt; 3 mm) beyond the cortical line in the presence of specific trochlear geometry or distal femoral anatomy. This configuration is acceptable when the radiographic pattern is consistent with trochlear accommodation. Posterior gaps must still be carefully controlled to avoid overstuffing. (4) Type 3-Critical Notch: Excessive anterior resection (&gt; 3 mm) characterized by significant cortical interruption and the absence of a radiographically identifiable anatomical correlate. This configuration may compromise distal femoral strength and is associated with increased risk of periprosthetic fracture when not justified by trochlear geometry. Surgeons should exercise caution and verify proper implant alignment. Inter-observer reliability was substantial (Fleiss' κ = 0.80; quadratic weighted κ = 0.87) and intra-observer reliability was almost perfect (mean Cohen's κ = 0.91). The majority of cases were classified as Type 0 and Type 1.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The Femoral Notch Classification provides a practical, reproducible framework for assessing femoral notching in TKA, suitable for intraoperative guidance and radiographic analysis. It may help surgeons avoid over- or un","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882401","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":"Custom-made acetabular implants for severe acetabular bone defects: implant evolution, mid-term clinical and radiographic outcomes, and complications in 154 consecutive patients over 18 years.","authors":"Mari Babasiz, Alberto Alfieri Zellner, Tamara Babasiz, Robert Ossendorff, Frank Sebastian Fröschen, Andreas Christian Strauss, Max Jaenisch, Dieter Christian Wirtz","doi":"10.1186/s42836-026-00425-3","DOIUrl":"10.1186/s42836-026-00425-3","url":null,"abstract":"<p><strong>Background: </strong>Custom-made acetabular components (CMAC) represent an important treatment option for complex acetabular defects where standard implants are not sufficient. Over the years, substantial advances in implant design and materials have improved stability, function, and longevity of implants. However, evidence on implant survivorship and design evolution in custom-made acetabular reconstruction remains limited.</p><p><strong>Methods: </strong>In this retrospective single-center study, 154 consecutive patients treated with a CMAC between October 2007 and June 2025 were analysed. All reconstructions were performed for severe acetabular defects classified as Paprosky type 3A (n = 85) or 3B (n = 69), corresponding to the Acetabular Defect Classification (ADC) type 3C (n = 85) and ADC type 4 (n = 69) with pelvic discontinuity (4A n = 14, 4B n = 28, 4C n = 27). Demographic data, implant design characteristics, and surgical technique were recorded. Clinical outcomes were assessed using the Oxford Hip Score (OHS), all complications were recorded, and radiographic evaluation was performed.</p><p><strong>Results: </strong>The mean follow-up was 34.82 months (± 26.2 range, 6.2-168 months). Paired preoperative and postoperative OHS improved from 21.69 ± 5.59 to 30.93 ± 5.26, corresponding to a mean improvement of 9.23 points (p < 0.0001). Kaplan-Meier estimated survivorship at 3 and 5 years was 0.85 (SE = 0.04) and 0.78 (SE = 0.05) for explantation and 0.64 (SE = 0.04) and 0.58 (SE = 0.05) for reoperation for any reason. Postoperative periprosthetic infection (11.0%) and dislocation (10.4%) were the most frequent complications. In an exploratory multivariable Cox model, flange design was the only covariate associated with explantation (HR 17.70, 95% CI 4.78-65.52; p < 0.001).</p><p><strong>Conclusions: </strong>This 18-year single-centre experience with 154 CMAC demonstrates the mid-term clinical reliability of an individualized approach to complex acetabular reconstruction. Postoperative periprosthetic infection (11.0%) and dislocation (10.4%) remained relevant complications. The design transition from multiflange to monoflange constructs represents the principal evolution of this experience and warrants dedicated comparative evaluation.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of thigh muscle status and longitudinal changes assessed by MRI with subsequent total hip arthroplasty: insights from the osteoarthritis initiative.","authors":"Xiangjie Yin, Ziquan Li, Yuanpeng Zhu, Di Liu, Terry Jianguo Zhang, Siyi Cai, Nan Wu","doi":"10.1186/s42836-026-00423-5","DOIUrl":"10.1186/s42836-026-00423-5","url":null,"abstract":"<p><strong>Background: </strong>Evidence regarding the association of longitudinal thigh muscle MRI markers with subsequent total hip arthroplasty (THA) is limited. Such markers may help characterize risk among individuals with or at risk of hip osteoarthritis.</p><p><strong>Methods: </strong>A longitudinal year-2 landmark analysis was conducted using the Osteoarthritis Initiative cohort. Hips that underwent THA after the year-2 landmark were matched to eligible control hips at a 1:4 ratio. Thigh MRI cross-sectional areas (CSAs) were automatically quantified using a validated U-Net segmentation network. The prespecified primary exposure was the 2-year change in total thigh muscle CSA. Individual muscle regions, adipose-tissue measures, baseline measurements, and alternative processing methods were evaluated as secondary or exploratory exposures. Cox proportional hazards models reported hazard ratios (HRs) per 1-standard-deviation increase. Secondary p-values were adjusted using the Benjamini-Hochberg false discovery rate procedure. This study evaluated associations and did not develop or validate a clinical prediction model.</p><p><strong>Results: </strong>A total of 495 hips (99 THA cases and 396 matched controls) were included. In the primary analysis, a greater 2-year change in total thigh muscle CSA was associated with a lower incidence of subsequent THA (HR per 1-SD increase, 0.75; 95% CI 0.63-0.90; p = 0.002). In secondary analyses, the 2-year changes in quadriceps, hamstrings, and adductors CSA showed nominal inverse associations with subsequent THA; however, none remained statistically significant after FDR correction (all q ≥ 0.05). No baseline MRI measure was significantly associated with subsequent THA.</p><p><strong>Conclusion: </strong>A greater 2-year change in total thigh muscle CSA, corresponding to greater gain or less loss, was associated with a lower incidence of subsequent THA. Conversely, lower change values or greater CSA loss were associated with higher subsequent THA incidence. Findings for individual muscle regions and alternative processing methods did not remain significant after false discovery rate correction and should be interpreted as exploratory. Longitudinal total thigh muscle CSA may warrant further study as a potential risk-stratification marker, but predictive performance and clinical utility were not evaluated.</p><p><strong>Trial registration: </strong>The parent OAI cohort is registered at ClinicalTrials.gov (NCT00080171). This secondary analysis was not separately registered.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867700","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":"Asia-Pacific expert consensus on robotic-assisted hip and knee arthroplasty.","authors":"Guoqiang Zhang, Yixin Zhou, Yunsu Chen, Nicolaas C Budhiparama, Chun Hoi Yan, Seung Jae Lim, Lincoln Ming Han Liow, Nobuhiko Sugano, Andrew Tang, Hong Cai, Dirk van Bavel, Wei Chai, Ping Keung Chan, Xinyu Fang, Eryou Feng, Henry Fu, Takafumi Hiranaka, Zongke Zhou, Kang-Il Kim, Andrew Kurmis, Huiwu Li, David Liu, Xianzhe Liu, Sébastien Lustig, Xinzhan Mao, Tomoyuki Matsumoto, Ming Ni, Michael Ong, Sang Eun Park, Wenwei Qian, Hongyi Shao, Chandeep Singh, Hao Tang, Yukihide Minoda, Haobo Wu, Jie Xie, Seng-Jin Yeo, Xiaogang Zhang, Aree Tanavalee, Li Cao, Myung Chul Yoo, Yan Wang","doi":"10.1186/s42836-026-00427-1","DOIUrl":"https://doi.org/10.1186/s42836-026-00427-1","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted total joint arthroplasty (rTJA) has witnessed rapid adoption across the Asia-Pacific region. However, practice heterogeneity and conflicting evidence regarding its clinical value necessitate standardized guidance. Therefore, this expert consensus aims to establish consensus-based recommendations to guide and standardize the clinical application of rTJA.</p><p><strong>Methods: </strong>The Arthroplasty Society in Asia (ASIA) convened a panel of 45 experts. A modified Delphi technique was employed across three rounds. A systematic literature review informed the generation of consensus statements, which were finalized through anonymous voting. Consensus was defined as ≥ 75% agreement.</p><p><strong>Results: </strong>The panel reached consensus on 18 critical clinical questions spanning general principles, total hip arthroplasty, and total knee arthroplasty. Key consensus points include: (1) rTJA demonstrates superior accuracy in implant positioning and alignment restoration compared to manual techniques (98%); (2) current evidence does not yet support a definitive superiority in long-term survivorship or PROMs (77%); (3) robotic platforms are enabling technologies that make personalized alignment philosophies technically reproducible (100%); and (4) soft-tissue balancing should take precedence over rigid mechanical alignment targets in rTKA when conflicts arise(91%).</p><p><strong>Conclusion: </strong>This consensus statement provides a comprehensive framework for the application of robotic technology in hip and knee arthroplasty, emphasizing safety, precision, and the need for rigorous training.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761377","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":"Preoperative vertebral fracture assessment reveals bone fragility missed by DXA in patients undergoing total hip arthroplasty.","authors":"Yudai Yano, Yoshinobu Uchihara, Sachiko Kawasaki, Munehito Seko, Masakazu Okamoto, Tadashi Fujii, Kenji Kawamura","doi":"10.1186/s42836-026-00419-1","DOIUrl":"10.1186/s42836-026-00419-1","url":null,"abstract":"<p><strong>Background: </strong>Bone fragility assessment prior to total hip arthroplasty (THA) is typically based on bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA). Meanwhile, prevalent vertebral fracture (VF), an important indicator of bone fragility, may be present even when BMD does not meet the diagnostic criteria for osteoporosis. Although preoperative bone health assessment has become crucial in patients undergoing THA, VFs remain insufficiently evaluated. This study aimed to investigate the prevalence and distribution of DXA-defined osteoporosis and VFs in patients undergoing THA and to evaluate how often DXA alone fails to detect clinically relevant bone fragility.</p><p><strong>Methods: </strong>This retrospective observational study included all consecutive patients aged ≥ 45 years who underwent primary THA between January 2021 and December 2025. Those undergoing THA for non-osteoarthritis etiologies were excluded. BMD was measured at the lumbar spine and femoral neck using DXA, and prevalent VFs were assessed on preoperative lateral thoracolumbar radiographs using Genant's semi-quantitative method. DXA-defined osteoporosis was defined as a T-score ≤ - 2.5 at any measured site. Clinical osteoporosis was defined as DXA-defined osteoporosis and/or VF. The prevalence and distribution of DXA-defined osteoporosis, VF, and their overlap were assessed. Multivariable logistic regression analysis adjusted for age, sex, body mass index, and contralateral hip status was performed to identify factors associated with VF without DXA-defined osteoporosis.</p><p><strong>Results: </strong>Among the 352 included patients, DXA-defined osteoporosis was identified in 84 (23.9%) and VFs in 59 (16.8%). Clinical osteoporosis was observed in 118 patients (33.5%). Of these, 34 patients (9.7% of the total cohort; 28.8% of those with clinical osteoporosis) had VFs without DXA-defined osteoporosis and would not have been identified using DXA alone. Advanced age was independently associated with VF without DXA-defined osteoporosis (adjusted odds ratio, 2.65 per 10-year increase; 95% confidence interval, 1.65-4.24). In patients aged 80 years or older, the prevalence of VF without DXA-defined osteoporosis was 30.6%, and that of clinical osteoporosis was 58.3%.</p><p><strong>Conclusions: </strong>DXA alone underestimated clinically relevant bone fragility in patients undergoing THA. Preoperative radiographic evaluation of VF may improve bone fragility assessment, particularly in older patients.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"8 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714655","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}