Arthroplasty最新文献

{"title":"Lewinnek zone not \"the be-all and end-all\" functional planning for acetabular component positioning in total hip arthroplasty.","authors":"Raffaele Iorio, Edoardo Viglietta, Federico Corsetti, Yuri Gugliotta, Carlo Massafra, Daniele Polverari, Andrea Redler, Nicola Maffulli","doi":"10.1186/s42836-024-00284-w","DOIUrl":"https://doi.org/10.1186/s42836-024-00284-w","url":null,"abstract":"<p><strong>Background: </strong>Proper positioning of a total hip arthroplasty (THA) plays a crucial role in the success and long-term survivorship of the implant. Cup positioning within the Lewinnek Safe Zone (LSZ) does not, however, avoid implant dislocation. Thus, the concept of a functional cup position has been introduced. The purpose of this study was to assess the discrepancy between LSZ and the acetabular cup position suggested by the patient's specific functional planning. The hypothesis was that a mismatch does exist.</p><p><strong>Methods: </strong>One hundred consecutive patients with primary hip osteoarthritis undergoing primary THA with a personalized functional preoperative planning and patient-specific cup implantation system were enrolled. Anatomical and spino-pelvic functional parameters were recorded and, for each patient, a \"safe cup orientation\" was suggested. The suggested functional safe zone was compared to the LSZ.</p><p><strong>Results: </strong>The mean suggested inclination was 39° ± 3° (range 32°-45°). The mean suggested anteversion was 21° ± 3° (range 12°-28°). The patient's functional acetabular inclination (AI) corresponded to the LSZ in one of the 100 patients, whereas the acetabular anteversion (AV) was outside the LSZ in 8 of the 100 patients. The mean pelvic tilt while standing and sitting were 0.5° ± 7° (range 21°-45°) and -6° ± 16.7° (range -63°-33°), respectively. The mean pelvic incidence was 52° ± 9.7° (range 33°-83°).</p><p><strong>Conclusion: </strong>When a functional patient's specific preoperative planning is performed, the LZS does not correspond to the patient's functional safe zone in about 8% of patients. The concept of a universal safe zone should be revisited, and a functional personalized safe zone may have to be more widely considered.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"7 1","pages":"2"},"PeriodicalIF":2.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932850","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":"Current status of bicompartmental arthroplasty.","authors":"Yingjian Gao, Bing Yue, Weiwei Xin","doi":"10.1186/s42836-024-00283-x","DOIUrl":"10.1186/s42836-024-00283-x","url":null,"abstract":"<p><strong>Background: </strong>Bicompartmental arthroplasty (BCA) serves as a less invasive alternative to total knee arthroplasty. This review aims to present the current status of BCA. BODY: Recent literature on BCA was reviewed and synthesized from the perspectives of function, radiological assessment, patient satisfaction, survival rate, patellar tracking, satisfaction survey, and revision rate.</p><p><strong>Conclusion: </strong>BCA is beneficial for patients with bicompartmental arthritis and those suffering from deterioration in other compartments after unicompartmental knee arthroplasty (UKA). Compared to total knee arthroplasty, BCA reduces trauma, accelerates recovery, and improves sports ability. While BCA is evolving towards a more exciting future, more clinical studies are warranted to exploit its potential and validate its efficacy, eventually improving outcomes and patient satisfaction.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"7 1","pages":"1"},"PeriodicalIF":2.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924095","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":"Conference Proceedings for the 10th Annual Meeting of Arthroplasty Society in Asia (ASIA), 26th Annual Meeting of the Thai Hip and Knee Society (THKS), and the 16th Annual Meeting of the ASEAN Arthroplasty Association (AAA).","authors":"","doi":"10.1186/s42836-024-00286-8","DOIUrl":"10.1186/s42836-024-00286-8","url":null,"abstract":"","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"6 Suppl 1","pages":"62"},"PeriodicalIF":2.3,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866435","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":"DAIR for periprosthetic joint infections-One week to save the joint?","authors":"Vatsal Gupta, Shafiq Shahban, Michael Petrie, Peter K Kimani, Jakub Kozdryk, Bryan Riemer, Richard King, Richard Westerman, Pedro Foguet","doi":"10.1186/s42836-024-00282-y","DOIUrl":"10.1186/s42836-024-00282-y","url":null,"abstract":"<p><strong>Background: </strong>Predicting the success of a Debridement, Antibiotics, and Implant Retention (DAIR) procedure for periprosthetic joint infection (PJI) for hip and knee joint arthroplasty remains a challenge. A failed DAIR might adversely affect the outcome of any future revision surgery for PJI. Hence, the ability to identify and optimize factors predictive of DAIR success would help target the procedure to the appropriate patient cohort and avoid unnecessary surgery for patients where a DAIR is unlikely to eradicate infection.</p><p><strong>Methods: </strong>A retrospective review of our prospective Bone Infection Group database was performed to identify all patients who underwent a DAIR of their primary or revision hip or knee arthroplasty. All patients had a confirmed PJI as per MSIS 2013 criteria and an outcome according to the MSIS working group outcome-reporting tool. DAIR surgery was then grouped into groups of \"successful\" or \"unsuccessful\" outcomes.</p><p><strong>Results: </strong>Sixty-four consecutive patients with an acute PJI underwent a DAIR procedure between 2009 and 2020, with 46 procedures performed for knees and 18 for hips. Treatment was successful in 69% (37 knees and 7 hips). The chance of a successful DAIR was significantly greater if performed at or within one week of symptom onset compared to greater than one-week duration (adjusted odds ratio (OR) 0.11; P = 0.027; 95% CI [0.02-0.78])). For DAIR performed at or within one week of symptom onset, the success rate was 93% for knees and 80% for hips. The chance of a successful DAIR however was not influenced by whether the surgeon was an arthroplasty or non-arthroplasty surgeon (OR 0.28; P = 0.13; 95% CI [0.05-1.48])). Isolated Streptococcus infection had a success rate of 100%. Next came Coagulase-negative Staphylococci (71%) and Methicillin-susceptible Staphylococcus Aureus (65%). Polymicrobial infection had the worst outcome, with a success rate of 40%.</p><p><strong>Conclusion: </strong>In our experience, DAIR surgery performed within one week of symptom onset significantly increased the chance of successful infection eradication. Collaborative work is required to ensure arthroplasty patients can access prompt appropriate surgical decision-making as soon as concerns arise, remove barriers to early assessment and minimise delays to surgery.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"6 1","pages":"61"},"PeriodicalIF":2.3,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781808","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 distribution of Coronal Plane Alignment of the Knee (CPAK) phenotypes in the Malaysian population and their correlation with demographic variables.","authors":"Wai Kit Wong, Azliana Abu Bakar Sajak, Hwa Sen Chua","doi":"10.1186/s42836-024-00281-z","DOIUrl":"10.1186/s42836-024-00281-z","url":null,"abstract":"<p><strong>Background: </strong>Only 80% of patients are satisfied with their outcomes post-TKA. Mounting attention has been paid to constitutional limb alignment and individualized alignment strategies in recent years. MacDessi et al. proposed the CPAK classification, which takes into account the patients' arithmetic hip-knee-ankle axis (aHKA) and joint line obliquity (JLO). In this study, we aimed to establish local demographic data, compare them with published data, and assess their correlations with modifiable variables.</p><p><strong>Methods: </strong>A total of 500 end-stage osteoarthritic knees subjected to TKA were radiologically analyzed. The lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were calculated from long limb radiographs before the aHKA and JLO were derived and a CPAK phenotype was assigned. Demographic data were harvested and analyzed for possible correlations.</p><p><strong>Results: </strong>There were 160 males (32%) and 340 females (68%), with a mean age of 66.42 years (range, 47-88). The mean MPTA was 85.8° (± 3.0)°, and the mean LDFA was 87.6° (± 2.4)°. The average aHKA was a varus of 1.8° (± 4.2)°, and the average JLO was 173.4° (± 3.45)°. The most common CPAK phenotype was Type 1 (43.4%). The Intraclass Correlation Coefficient demonstrated excellent reliability (> 0.9). No correlation existed between CPAK phenotypes and age, height, weight, or body mass index (BMI), but CPAK phenotype was significantly correlated with gender.</p><p><strong>Conclusion: </strong>An urban Malaysian population with osteoarthritic knees was found to be constitutionally varus, with the most common phenotype being varus aHKA with an apex-distal JLO. Constitutional alignment is not influenced by factors such as age, height, weight, or BMI.</p><p><strong>Level of evidence: </strong>Retrospective Observational Study-III.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"6 1","pages":"60"},"PeriodicalIF":2.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774768","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 clinical utility of acoustic and vibrational analyses in uncemented total hip arthroplasty?","authors":"Shlok Patel, Christian J Hecht, Yasuhiro Homma, Atul F Kamath","doi":"10.1186/s42836-024-00280-0","DOIUrl":"10.1186/s42836-024-00280-0","url":null,"abstract":"<p><strong>Background: </strong>Despite recent developments in THA, a more objective method is needed to assist orthopedic surgeons in identifying the insertion endpoint of the broaching procedure. Therefore, this systematic review evaluated the in-vivo efficacy of various acoustic and vibration analyses in detecting proper implant seating, identifying intraoperative complications, and quantifying the accuracy of predictive modeling using acoustics.</p><p><strong>Methods: </strong>Four electronic databases were searched on July 23rd, 2023, to retrieve articles evaluating the use of acoustic analysis during THA. The search identified 835 unique articles, which were subsequently screened by two independent reviewers as per our inclusion and exclusion criteria. In total, 12 studies evaluating 580 THAs were found to satisfy our criteria and were included in this review.</p><p><strong>Results: </strong>Methodologically, analyses have suggested stopping broaching when consecutive blows emit similar acoustic profiles (maximum peak frequency ± 0.5 kHz), which indicates proper implant seating in terms of stability and mitigates subsidence. Also, abrupt large deviations from the typical progression of acoustic signals while broaching are indicative of an intraoperative fracture. Since height, weight, femoral morphological parameters, and implant type have been shown to alter acoustic emissions while hammering, incorporating these factors into models to predict subsidence or intraoperative fracture yielded virtually 100% accuracy in identifying these adverse events.</p><p><strong>Conclusion: </strong>These findings support that acoustic analyses during THA show promise as an accurate, objective, and non-invasive method to predict and detect proper implant fixation as well as to identify intraoperative fractures.</p><p><strong>Trial registration: </strong>PROSPERO registration of the study protocol: CRD42023447889, 23 July 2023.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"6 1","pages":"59"},"PeriodicalIF":2.3,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774772","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":"Nanoparticle ultrasonication: a promising approach for reducing bacterial biofilm in total joint infection-an in vivo rat model investigation.","authors":"Itay Ashkenazi, Mark Longwell, Barbara Byers, Rachael Kreft, Roi Ramot, Muhammad A Haider, Yair Ramot, Ran Schwarzkopf","doi":"10.1186/s42836-024-00279-7","DOIUrl":"10.1186/s42836-024-00279-7","url":null,"abstract":"<p><strong>Background: </strong>While the benefits of sonication for improving periprosthetic joint infection (PJI) are well-documented, its potential therapeutic effect against bacterial biofilm remains unstudied. This study aimed to investigate the safety and efficacy of a novel nanoparticle ultrasonication process on methicillin-resistant Staphylococcus aureus (MRSA) bacterial biofilm formation in a PJI rat model.</p><p><strong>Methods: </strong>This novel ultrasonication process was designed to remove attached bacterial biofilm from implant and peri-articular tissues, without damaging native tissues or compromising implant integrity. Twenty-five adult Sprague-Dawley rats underwent a surgical procedure and were colonized with intra-articular MRSA, followed by the insertion of a titanium screw. Three weeks after the index surgery, the animals received a second procedure during which the screws were explanted, and soft tissue was sampled. The intraoperative use of the nanoparticle sonication treatment was employed to assess the device's safety, while ex vivo treatment on the retrieved tissue and implants was used to evaluate its efficacy.</p><p><strong>Results: </strong>Clinical and histological assessments did not indicate any macro- or micro-damage to the host tissue. Sonication of the retrieved tissues demonstrated an average bacterial removal of 2 × 10³ CFU/mL and 1 × 10⁴ CFU/gram of tissue. Compared to the standard-of-care group (n = 10), implants treated with sonication (n = 15) had significantly lower remaining bacteria, as indicated by crystal violet absorbance measurements (P = 0.012).</p><p><strong>Conclusions: </strong>This study suggests that nanoparticle sonication technology can successfully remove attached bacterial biofilms from explanted orthopedic hardware and the joint capsule, without negatively affecting native tissue. The study provides initial results supporting the potential of nanoparticle sonication as an adjuvant treatment option during a DAIR (debridement, antibiotics, and implant retention) procedure for PJI, paving the way for future clinical trials.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"6 1","pages":"57"},"PeriodicalIF":2.3,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585003","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 placement of acetabular cups differ between right and left sides for a right-handed surgeon operating through a direct lateral approach? A comparative study.","authors":"Ahmed A Khalifa, Ahmed M Abdelaal","doi":"10.1186/s42836-024-00278-8","DOIUrl":"10.1186/s42836-024-00278-8","url":null,"abstract":"<p><strong>Purpose: </strong>Although many factors were suggested to affect acetabular cup positioning during primary total hip arthroplasty, the effect of surgeon handedness was rarely evaluated. We aimed primarily to assess the difference in cup positioning (inclination and anteversion) between the right and left sides during primary THA. Secondly, to check the difference in the percentages of cups positioned in the safe zone for inclination and anteversion and if there will be a difference in cup positioning according to the type of cup fixation (cemented vs. cementless).</p><p><strong>Methods: </strong>Cup inclination and anteversion of 420 THAs were radiographically evaluated retrospectively. THAs were performed by a senior right-handed surgeon, who operated through a direct lateral approach in a lateral decubitus position using manual instruments and freehand technique for cup placement. Patients were assigned to two groups: Group A (right, or dominant side), and Group B (left, or non-dominant side), with equal cases of THAs (n = 210) in each group.</p><p><strong>Results: </strong>No difference was found in patients' basic characteristics, preoperative diagnosis, and cup fixation (54.3% cemented and 45.7% cementless) between the two groups. There was a significant difference in cup inclination between Groups A and Group B (40.1° ± 6.3° vs. 38.2° ± 6.1°) (P = 0.002). No significant difference was revealed in anteversion between the two groups (11.7° ± 4.4° vs. 11.8° ± 4.7°) (P = 0.95). The percentage of cups located within the safe zone in terms of both inclination and anteversion was 85.2% vs. 83.8% and 69% vs. 73.3% for Group A and Group B, according to Lewinnek and Callahan's safe zones, respectively. There existed a significant difference in the cemented cup inclination between Group A and Group B (40.8° ± 6.4° vs. 38.3° ± 6.3°) (P = 0.004).</p><p><strong>Conclusion: </strong>Cup inclination is affected by the surgeon's handedness when operating through a direct lateral approach and using a freehand technique, while anteversion is less affected. Furthermore, the difference is greater with cemented cups.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"6 1","pages":"58"},"PeriodicalIF":2.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577360","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":"Are asymmetric designs of tibial components superior to their symmetric counterparts for constrained condylar total knee arthroplasty using metal block augmentation?","authors":"Ryosuke Kabu, Hidetoshi Tsushima, Yukio Akasaki, Shinya Kawahara, Satoshi Hamai, Yasuharu Nakashima","doi":"10.1186/s42836-024-00277-9","DOIUrl":"10.1186/s42836-024-00277-9","url":null,"abstract":"<p><strong>Purpose: </strong>In total knee arthroplasty (TKA), asymmetric tibial components have been developed alongside symmetric tibial components to enhance bony coverage at the tibia. In primary TKA and revision TKA for patients with significant bone defects, augmentation is employed to fill the bone defect. However, there have been no reports on bony coverage of the tibial component of the revision system in the cases of bone defects. Therefore, we simulated bone defects using CT and compared the bony coverage of asymmetric and symmetric tibial components in the revision TKA system.</p><p><strong>Methods: </strong>This study included 45 patients (50 knees involved) with medial osteoarthritis. Preoperative CT scans were used to simulate placement using ZedKnee. Three models were evaluated: Persona Revision PCCK (Zimmer) for the asymmetric component, NexGen LCCK (Zimmer) for the symmetric component, and the ATTUNE revision system (Depuy-Synthes). A 130-mm stem extension was utilized. Augmentations of each thickness were placed to simulate bone defects of 5, 10, and 15 mm. The coverage, overhang, and underhang rates were measured for each slice and compared among the models.</p><p><strong>Results: </strong>In terms of coverage, the rate was greater for PCCK at 0 mm, and only ATTUNE exhibited a significantly lower coverage at 5 and 10 mm. There was no significant difference in coverage at 15 mm. At 0 mm, PCCK demonstrated less posterior underhangs. At 5 and 10 mm, PCCK showed less anterior overhang but more anterior underhang. At 15 mm, PCCK had a less anterior overhang, with an overhang in the posterior region but less underhang. When overhang and underhang were combined and compared, the asymmetric component generally yielded superior results.</p><p><strong>Conclusion: </strong>In the cases of bone defects, asymmetric components demonstrated reduced anterior overhang and decreased posterior underhang, resulting in greater bone coverage. This may contribute to improved long-term outcomes in the revision TKA system.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"6 1","pages":"54"},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570156","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":"Assessing pain management in total joint arthroplasty using the Detroit interventional pain assessment scale-A prospective cohort study.","authors":"Lauryn J Boggs, Ishan Patel, Melina Holyszko, Bryan E Little, Hussein F Darwiche, Rahul Vaidya","doi":"10.1186/s42836-024-00276-w","DOIUrl":"10.1186/s42836-024-00276-w","url":null,"abstract":"<p><strong>Background: </strong>Total joint arthroplasty (TJA) is an effective treatment for end-stage osteoarthritis, but postoperative pain has been poorly managed. The purpose of this study was to (1) assess how much narcotic medication was prescribed after TJA; (2) assess if patients were satisfied with their pain management; (3) compare these same data between total hip arthroplasty (THA)/total knee arthroplasty (TKA); (4) compare these same data between preoperative opioid users/opioid-naïve patients.</p><p><strong>Methods: </strong>An IRB-approved prospective study was conducted at a US academic joint replacement practice. Patients were evaluated by an independent observer at three weeks, three months, and six months postoperatively using the Detroit Interventional Pain Assessment (DIPA) scale. Patients verbally rated their pain with their current medication regimen as 0 (no pain), 1 (tolerable pain), or 2 (intolerable pain) on the DIPA scale. Narcotic usage was verified by the Michigan Automated Prescription System (MAPS). Patients were divided into THA, TKA, previously on opioids, and opioid-naïve groups. Provider efficiency scores reflected pain management satisfaction and were calculated as the percentage of patients reporting no pain or tolerable pain.</p><p><strong>Results: </strong>Out of 200 patients, the percentage of patients using narcotics and their daily usage (MMEs) significantly decreased from 75.5% (27.5 MMEs) at three weeks to 42.9% (5.3 MMEs) at six months (P < 0.001). In 80% of patients, narcotics taken at six months were prescribed by outside providers. Significantly fewer patients used narcotics at six months for THA (15.4%) compared to TKA (52.7%) (P < 0.021). There was a significant difference in daily narcotic usage between patients who took narcotics preoperatively (22.9 MMEs) and opioid-naïve ones (13.4 MMEs) (P < 0.001). Provider efficiency scores were best at three weeks (76.6%) and three months (70%) but declined at six months (57.2%).</p><p><strong>Conclusions: </strong>Narcotic tapering practices were observed as postoperative daily narcotic intake decreased across six months. However, outside providers prescribed 80% of narcotics at six months, necessitating a better-coordinated practice with surgeons. Patients taking preoperative narcotics experienced higher daily MME requirements than their opioid-naïve counterparts. In terms of the percentage of patients on narcotics, THA is a better procedure for tapering patients off narcotics by six months.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":"6 1","pages":"55"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559431","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}