Acta Orthopaedica最新文献

{"title":"Antibiotic prophylaxis and incidence of infection following elbow arthroplasty: a nationwide study.","authors":"Johan E Wänström, Anne Dettmer, Hanna C Björnsson Hallgren, Björn Salomonsson, Oskar Ljungquist, Lars E Adolfsson","doi":"10.2340/17453674.2025.43288","DOIUrl":"https://doi.org/10.2340/17453674.2025.43288","url":null,"abstract":"<p><strong>Background and purpose: </strong> Periprosthetic joint infection (PJI) after elbow arthroplasty is a serious complication. Evidence of the best antibiotic prophylaxis for elbow arthroplasty is lacking. We aimed to investigate the regimens presently used in Sweden, incidence of PJI, and the bacteria most frequently found in elbow PJI.</p><p><strong>Methods: </strong> A questionnaire was sent out to all Swedish units performing elbow arthroplasty in 2019 asking about antibiotic prophylaxis routines. The Swedish Elbow Arthroplasty Register (SEAR) and national inpatient and outpatient registers (NPR) from the National Board of Health and Welfare were searched for procedures related to all primary total- or hemi-elbow arthroplasties performed during 2019-2021. Results of microbiological analyses of the suspected PJI cases were collected from the respective laboratory.</p><p><strong>Results: </strong> Most centers used only cloxacillin (44%) or cloxacillin together with benzylpenicillin (44%), as prophylaxis. 250 primary procedures were performed between 2019 and 2021, and the most used antibiotic prophylaxes were cloxacillin (61%) and cloxacillin with benzylpenicillin (23%). In the NPR, 20 patients (8%) with a diagnosis that could indicate PJI were found and 9 (3.6%) had a confirmed PJI. The most common bacteria were Staphylococcus epidermidis, Cutibacterium acnes, and Staphylococcus aureus.</p><p><strong>Conclusion: </strong> Most centers used cloxacillin antibiotic prophylaxis for elbow arthroplasty. The incidence of PJI was 3.6%. The most frequent diagnosed pathogen was Staphylococcus epidermidis.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"278-282"},"PeriodicalIF":2.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fractures sustained by slipping on ice or snow: an epidemiological study of 50,500 fractures from the Swedish Fracture Register.","authors":"Henrik Ivdal, Linnea Bergenholtz, Carl Bergdahl, Olof Wolf, Emilia Möller Rydberg","doi":"10.2340/17453674.2025.43186","DOIUrl":"https://doi.org/10.2340/17453674.2025.43186","url":null,"abstract":"<p><strong>Background and purpose: </strong> Despite numerous patients sustaining fractures annually due to slipping on ice or snow, descriptive studies are scarce, which may result in less systematic management and prevention. We aimed to analyze fractures in adults sustained by slipping on ice and snow in Sweden using data from the Swedish Fracture Register (SFR).</p><p><strong>Methods: </strong> Data on all patients ≥ 18 years registered in the SFR between January 1, 2015 and December 31, 2022, with a fracture sustained by slipping on ice or snow was extracted. Descriptive statistical analyses were performed.</p><p><strong>Results: </strong> During the study period, 50,500 fractures were registered as sustained by slipping on ice or snow, representing 9% of all registered fractures in the SFR during the same period. 60% of the fractures affected the upper extremity. The mean age at the time of fracture was 61 years (18-105) and almost 70% of fractures were seen in women. The most common fractures were to the wrist (34%), ankle (18%), proximal humerus (11%), and hip (10%).</p><p><strong>Conclusion: </strong> Almost 1 in 10 fractures is sustained by slipping on ice or snow. The most common fractures are related to the wrist and the ankle. The majority of fractures affect the upper extremity, and two-thirds are sustained by women. Protective shoe wear, and better snow and ice clearance, could potentially have a large effect on injury prevention.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"272-277"},"PeriodicalIF":2.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiostereometric measurement of implant migration in robotically assisted vs conventional bi-cruciate stabilized cemented total knee arthroplasty: secondary analysis of a randomized controlled trial.","authors":"Øystein Skåden, Ove Nord Furnes, Stein Håkon Låstad Lygre, Irene Ohlen Moldestad, Geir Hallan, Anne Marie Fenstad, Paul Johan Høl, Øystein Johannes Gøthesen","doi":"10.2340/17453674.2025.43081","DOIUrl":"https://doi.org/10.2340/17453674.2025.43081","url":null,"abstract":"<p><strong>Background and purpose: </strong>Robotically assisted computer navigation (robotic) has been developed to improve the positioning in total knee arthroplasties (TKAs), attempting to achieve better functional results and longevity of the prostheses. However, the benefit of robotics is still controversial. The aim of our study was to compare migration between robotic and conventional techniques in cemented bi-cruciate stabilized TKAs, using radiostereometric analysis (RSA) based on a secondary analysis of a randomized controlled trial (RCT).</p><p><strong>Methods: </strong> We enrolled 60 TKA patients from one hospital (2020-2021), with osteoarthritis or arthritic disease. The patients were examined up to 24 months after the surgery, to estimate the mechanical stability of the tibial component. The maximum total point motion (MTPM) representing the magnitude of migration, the largest negative (subsidence) and positive (lift-off) value for y-translation, and prosthetic rotations were measured. The migration in the 2 groups was compared and the precision evaluated.</p><p><strong>Results: </strong> 51 RSA marked TKAs were available for a comparison of tibial migration between robotically assisted (n = 26) and conventional operations (n = 25). The MTPM in the first year was 0.44 mm and 0.64 mm, and at 24 months 0.46 mm and 0.75 mm, for the conventional and the robotic groups, respectively. The robotic group migrated more than the conventional group at 2 years, 0.21 mm (95% confidence interval [CI] 0.05-0.44; P = 0.01). The overall median MTPM for the investigated implants (both groups) up to 12 months was 0.54 mm (CI 0.44-0.63), and 0.19 mm between 12 and 24 months (CI 0.16-0.22). The magnitude of migration and rotation around the 3 axes was small for both groups, but flexion/extension migration of the tibial component was slightly higher in the robotic group 0.14° (CI 0.00-0.33; P = 0.049).</p><p><strong>Conclusion: </strong> MTPM and flexion/extension migrations of the tibial component were higher for the robotic group, up to 24 months. The overall migration pattern for the bi-cruciate stabilized implant was acceptable.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"283-289"},"PeriodicalIF":2.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time trends in spine surgery in Italy: a nationwide, population-based study of 1,560,969 records of administrative health data from 2001 to 2019.","authors":"Marina Torre, Andrea Piazzolla, Enrico Ciminello, Tiziana Falcone, Eugenio Carrani, Simona Pascucci, Michela Franzò, Giuseppe Barbagallo, Vincenzo Vitiello, Gustavo Zanoli, Alessia Biondi, Letizia Sampaolo, Veronica Mari, Francesco Langella, Pedro Berjano","doi":"10.2340/17453674.2025.43188","DOIUrl":"https://doi.org/10.2340/17453674.2025.43188","url":null,"abstract":"<p><strong>Background and purpose: </strong> The use of spinal implants has increased substantially. Their widespread use raises public health concerns. We aimed to study spinal surgery trends in Italy from 2001 to 2019 and present a mapping for ICD9-CM codes potentially related to spinal diagnoses and procedures.</p><p><strong>Methods: </strong> ICD9-CM codes of interest were selected and mapped to clinically meaningful spinal diagnostic categories and procedure classes. The Italian National Hospital Discharge Records database was then browsed according to these codes. Surgical volumes and trends were described. Population incidence rates (IR) were estimated and provided with 95% confidence intervals (CI). Variations in IRs were reported in terms of incidence rate ratio. The statistical significance of counts and IR time series trends was assessed by using the Cox-Stuart test.</p><p><strong>Results: </strong> 1,560,969 spinal procedures were extracted from 209,818,966 admissions registered nationally. The annual number of spinal procedures increased significantly by 67%, from 58,369 in 2001 to 97,636 in 2019 (P < 0.002). 1,040,326 (67%) procedures did not include implants, while 590,643 (33%) used implants, 395,450 (25%) associated with fusions and 125,193 (8%) with non-fusions. Population IRs increased from 100.9 (CI 100.1-101.7) to 163.2 (CI 162.2-164.3) episodes per 100,000 inhabitants. Surgical volumes for non-implant-related procedures remained stable, while implant-related procedures increased significantly, by 420% over the 19 observed years (P = 0.002).</p><p><strong>Conclusion: </strong>Spinal surgical procedures and their population incidence rates increased significantly. Fusions and other implant-related procedures increased substantially for most diagnostic categories. An ICD9-CM mapping for spinal diagnoses and procedures as a reproducible tool for further explorations was presented.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"256-264"},"PeriodicalIF":2.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Day-case hip and knee arthroplasty does not increase healthcare system contacts: a prospective multicenter study in a public healthcare setting.","authors":"Abdullahi Abdirisak Hirsi, Oddrún Danielsen, Claus Varnum, Thomas Jakobsen, Mikkel Rathsach Andersen, Manuel Josef Bieder, Søren Overgaard, Christoffer Calov Jørgensen, Henrik Kehlet, Kirill Gromov, Martin Lindberg-Larsen","doi":"10.2340/17453674.2025.43001","DOIUrl":"https://doi.org/10.2340/17453674.2025.43001","url":null,"abstract":"<p><strong>Background and purpose: </strong> Discharge on day of surgery after hip or knee arthroplasty is increasing, but whether this leads to an increase in the overall number of post-discharge healthcare system contacts is unknown. We aimed to investigate whether day-case surgery leads to increased patient-reported healthcare system contacts compared with non-day-case surgery within the first 30 days postoperatively.</p><p><strong>Methods: </strong> We performed a prospective multicenter study at seven fast-track centers from September 2022 to August 2023. Candidates for primary total hip arthroplasty (THA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA) were evaluated for day-case eligibility using pre-defined criteria. Patients received a survey 30 days postoperatively regarding any healthcare system contacts related to surgery. Planned healthcare visits were excluded. We used day-case eligible patients not discharged on day of surgery (inpatients) as control group.</p><p><strong>Results: </strong> Of 2,278 day-case eligible patients, 2,073 (91%) completed the survey, including 1,146 day-case patients (55%) and 927 inpatients (45%). The overall rate of healthcare system contacts was 49% (95% confidence interval [CI] 45-51) in day-case patients compared with 52% (CI 49-56) in inpatients. Specific contacts included visits to a general practitioner (GP) or out-of-hours medical clinic (25% [CI 22-27] vs 32% [CI 29-35]), the emergency department (ED) (6% [CI 4-7] vs 7% [CI 5-8]), and outpatient clinics or wards (35% [CI 33-38] vs 35% [CI 32-38]). The most common reasons for all types of healthcare contacts were wound problems, prescription renewals, and pain management.</p><p><strong>Conclusion: </strong> Day-case hip and knee arthroplasties was not associated with increased healthcare system contacts within the first 30 days postoperatively.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"265-271"},"PeriodicalIF":2.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of and survival after surgery for metastatic spine disease: a nationwide register-based study between 1997 and 2020 from Finland.","authors":"Leevi A Toivonen, Ville Ponkilainen, Jussi P Repo, Ville M Mattila","doi":"10.2340/17453674.2025.43264","DOIUrl":"10.2340/17453674.2025.43264","url":null,"abstract":"<p><strong>Background and purpose: </strong> Information on metastatic spine disease (MSD) based on nationwide data on trends and postoperative survival is limited but is needed to optimize treatment in this population. We aimed to assess the incidence of and survival rates after MSD surgery.</p><p><strong>Methods: </strong> This retrospective nationwide register-based study combined data from the Finnish Cancer Registry, Finnish Care Register for Health Care, and the Finnish Cause of Death Register from 1997 to 2020. Surgeries were identified using diagnosis and procedural codes, with primary spine pathologies excluded. Incidence rates were calculated per 100,000 inhabitants and adjusted for age and sex. Survival analysis was conducted using the Kaplan-Meier estimator.</p><p><strong>Results: </strong> 1,845 patients underwent 1,992 surgeries, with a mean age of 65 years; 58% were men. The most common primary cancers were prostate cancer (15.1%), breast cancer (11.6%), and myeloma (10.6%). The incidence of MSD surgery increased by 87%, from 1.05 to 1.97 per 100,000 person-years. Surgery increased most among patients aged 70-79 years. Over the same period, the 6-month survival remained fairly stable. The overall survival probabilities were 57% (95% confidence interval [CI] 54-59) at 1 year, 44% (CI 42-46) at 2 years, 28% (CI 26-30) at 5 years, and 18% (CI 16-20) at 10 years. The 1-year survival was highest in patients with breast cancer at 75% (CI 69-81) and lowest in patients with kidney cancer at 45% (CI 38-53) and prostate cancer at 47% (CI 42-53).</p><p><strong>Conclusion: </strong> Finnish nationwide data showed an increase in MSD surgery between 1997 and 2020 with a stable postoperative survival of 57% (CI 48-69) to 76% (CI 66-89) at 6 months.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"250-255"},"PeriodicalIF":2.5,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 socioeconomic status on return to work following primary total hip arthroplasty: a Danish population-based cohort study on 9,431 patients from 2008-2018.","authors":"Peter Alsing, Julie B Pajaniaye, Martin G Stisen, Søren Overgaard, Erzsébet Horváth-Puhó, Inger Mechlenburg, Alma B Pedersen","doi":"10.2340/17453674.2025.43189","DOIUrl":"10.2340/17453674.2025.43189","url":null,"abstract":"<p><strong>Background and purpose: </strong> Return to work (RTW) following primary total hip arthroplasty (THA) is important for patients and society. We aimed to investigate the association between markers of socioeconomic status (SES) and RTW after primary THA, and whether the association is influenced by sex, age, and comorbidity.</p><p><strong>Methods: </strong> Using Danish population-based registries we included 9,431 patients aged 18 to 59 years, undergoing primary THA for osteoarthritis from 2008-2018. Exposure was individual-level data on SES markers (education, income, and cohabitation). Work status information before and after THA was obtained from the Danish Register for Evaluation of Marginalization. We computed cumulative incidence of RTW up to 24 months after THA. The association between SES and RTW was analyzed using Cox regression by hazard ratios with 95% confidence intervals (CI).</p><p><strong>Results: </strong> The median time to RTW was 54 days. Cumulative incidence of RTW was 86% by 6 months and 93% by 24 months. The adjusted hazard ratio for RTW was 1.9 (CI 1.8-2.0) for high vs low education, 2.2 (CI 2.1-2.3) for high vs low income, and 1.3 (CI 1.3-1.4) for cohabiting vs living alone. Associations were stronger in male than female patients for all SES markers.</p><p><strong>Conclusion: </strong> Most patients returned to work within 24 months, with the largest proportion within 6 months. Markers of low SES were associated with delayed RTW, highlighting the importance of enhanced focus on THA patients in socially vulnerable positions to reduce health and financial implications of delayed RTW.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"243-249"},"PeriodicalIF":2.5,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulnar shortening osteotomy for ulna impaction syndrome with positive ulnar variance: retrospective outcome analysis.","authors":"Marisa Valentini, Eva Kalcher, Silvia Zötsch, Andreas Leithner, Philipp Lanz","doi":"10.2340/17453674.2025.43086","DOIUrl":"10.2340/17453674.2025.43086","url":null,"abstract":"<p><strong>Background and purpose: </strong> We primarily aimed to report the results of ulnar shortening osteotomy (USO) in cases of ulna impaction syndrome (UIS), and secondarily to assess the influence of etiology, radiographic parameters, and comorbidities on the outcome.</p><p><strong>Methods: </strong> Patients with USO performed for UIS between 2014 and 2022 at our department were included in the study. Demographic, surgical, and postoperative data, including complications and revisions, were recorded retrospectively. An additional study-specific follow-up was performed in all available cases, including subjective outcome measures as Patient Related Wrist Evaluation (PRWE) and Quick Disability of the Arm Shoulder and Hand (Quick-DASH) scores, and standardized 90-90° wrist radiographs.</p><p><strong>Results: </strong> 47 patients were treated with USO at mean age 45.8 years (standard deviation [SD] 16.7); 28 were female; median follow-up was 37 months (interquartile range [IQR] 22-57). Isolated USO was performed in 27 cases; the rest received a combination of procedures, e.g., wrist arthroscopy. USO-specific devices were used in all cases. Reoperations were performed in 12 cases, with implant removal in 11. Postoperative complications such as chronic regional pain syndrome or pseudoarthrosis were detected in 9 patients. 29 patients were additionally examined at median 36 months (IQR 22-49) follow-up. A median PRWE score of 7 (IQR 0-19) and a median Quick-DASH score of 4.5 (IQR 0-15.9) were reported. The subjective improvement was rated as very high by 24 patients. Radiographs showed a mean ulnar shortening of 2.9 mm (SD 1.1) and bone consolidation was achieved in all osteotomies at last follow-up. Relevant comorbidities weakly correlated with worse outcome scores (ρ = 0.41, 95% confidence interval [CI] -0.05 to 0.74 for PRWE and ρ = 0.40, CI -0.06 to 0.73 for Quick-DASH). No statistically significant difference could be detected in any other variables, including UIS etiology.</p><p><strong>Conclusion: </strong> We found that USO had good subjective results measure scores, but with relatively high complication and revision rates, including implant removal.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"235-242"},"PeriodicalIF":2.5,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How many doses and what type of antibiotic should be used as systemic antibiotic prophylaxis in primary hip and knee arthroplasty? A register-based study on 301,204 primary total and hemi- hip and total knee arthroplasties in Norway 2005-2023.","authors":"Olav Lutro, Marianne Bollestad Tjørhom, Tesfaye Hordofa Leta, Jan-Erik Gjertsen, Geir Hallan, Trond Bruun, Marianne Westberg, Tina Strømdal Wik, Christian Thomas Pollmann, Stein Håkon Lygre, Ove Furnes, Lars Engesæter, Håvard Dale","doi":"10.2340/17453674.2025.43003","DOIUrl":"10.2340/17453674.2025.43003","url":null,"abstract":"<p><strong>Background and purpose: </strong> Guidelines for systemic antibiotic prophylaxis (SAP) in arthroplasty surgery vary worldwide from repeated doses to only 1 preoperatively. We aimed to investigate, primarily whether 4 doses reduced the risk of PJI compared with 1 to 3 doses, and secondarily if there was a difference between types of antibiotics.</p><p><strong>Methods: </strong> Patients reported to the Norwegian Arthroplasty Register and the Norwegian Hip Fracture Register with primary total knee (TKA), total (THA) or hemi- (HA) hip arthroplasty between 2005 and 2023 were included. Cases with 1 to 4 doses of cefalotin (half-life = 45 minutes), cefazolin (90 minutes), cefuroxime (70 minutes), cloxacillin (30 minutes), or clindamycin (180 minutes) were assessed. Primary outcome was 1-year risk of reoperation (adjusted hazard rate ratio; aHRR) for PJI and was estimated by Cox regression analyses. Secondary outcomes were reoperation for PJI and reoperation for any cause with follow-up of up to 19 years. Non-inferiority analyses and propensity score matching with subsequent Kaplan-Meier analyses were performed with a predetermined non-inferiority margin of 15% (aHRR = 1.15).</p><p><strong>Results: </strong> 301,204 cases were included. Of these, 3,388 (1.1%) were reoperated on for PJI within 1 year. The 1-year incidence of reoperation for PJI was 98/9,760 (1.0%) for 1 dose of SAP, 109/10,956 (0.9%) for 2 doses, 178/18,948 (0.9 %) for 3 doses, and 3,003/261,540 (1.0%) for 4 doses. The 1-year risk (aHRR, 95% confidence interval [CI]) of reoperation for PJI was 1.0 (CI 0.8-1.2), 0.9 (CI 0.8-1.2), and 0.9 (CI 0.9-1.1) for 1, 2, and 3 doses, respectively, compared with 4 doses. The 1-year incidence of reoperation for PJI was 2,162/183,964 (1.2%) for cefalotin, 993/91,159 (1.1%) for cefazolin, 35/4,435 (0.8%) for cefuroxime, 85/9,022 (0.9%) for cloxacillin, and 113/12,624 (0.9%) for clindamycin. Compared with cefazolin, cloxacillin (1.2, CI 1.0-1.6) and cefalotin (1.4, CI 1.2-1.5) had a higher risk of reoperation for PJI, whereas cefuroxime (1.0, CI 0.7-1.4) and clindamycin (1.1, CI 0.9-1.3) had a similar risk.</p><p><strong>Conclusion: </strong> 4 doses of SAP did not reduce the risk of PJI compared with 1 to 3 doses in primary arthroplasty as measured against PJI. Cefazolin, the 1st-generation cephalosporin with the longest half-life, showed the lowest risk of PJI.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"217-225"},"PeriodicalIF":2.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying recovery trajectories following primary total shoulder arthroplasty: a cohort study of 3,358 patients from the Dutch Arthroplasty Register.","authors":"Mirthe H W Van Veghel, Liza N Van Steenbergen, Cornelis P J Visser, B Willem Schreurs, Gerjon Hannink","doi":"10.2340/17453674.2025.43085","DOIUrl":"10.2340/17453674.2025.43085","url":null,"abstract":"<p><strong>Background and purpose: </strong>Some patients do not improve after total shoulder arthroplasty (TSA), indicating different recovery trajectories. We aimed to identify recovery trajectories after TSA based on the Oxford Shoulder Score (OSS). Second, we investigated whether recovery trajectories were associated with patient or procedure characteristics.</p><p><strong>Methods: </strong> We included primary anatomical and reversed TSAs (ATSAs/RTSAs) for osteoarthritis (OA) or cuff arthropathy/rupture with preoperative, 3-month, and/or 12-month postoperative OSS, registered between 2016 and 2022 in the Dutch Arthroplasty Register (n = 3,358). We used latent class growth modeling (LCGM) to identify recovery patterns, and multinomial logistic regression analyses to investigate associations between potential risk factors and class membership (odds ratio [OR], 95% confidence interval [CI]).</p><p><strong>Results: </strong> We identified 3 recovery patterns: \"Fast responders\" (59%), \"Steady responders\" (27%), and \"Poor responders\" (14%). Factors associated with \"Steady responders\" vs \"Fast responders\" were female vs male sex (OR 2.0, CI 1.5-2.7), ASA III-IV vs ASA I (OR 1.9, CI 1.2-3.1), Walch A1 vs B2 (OR 1.6, CI 1.1-2.5), and most vs medium socioeconomic deprivation (OR 1.4, CI 1.1-1.9). Factors associated with \"Poor responders\" vs \"Fast responders\" were ASA II vs ASA I (OR 2.0, CI 1.1-3.6), ASA III-IV vs ASA I (OR 3.0, CI 1.6-5.5), Walch A1 vs B2 (OR 2.1, CI 1.3-3.3), previous shoulder surgeries (OR 1.8, CI 1.3-2.4), most vs medium socioeconomic deprivation (OR 1.5, CI 1.2-2.0), RTSA for OA vs ATSA for OA (OR 1.8, CI 1.2-2.7), and RTSA for cuff arthropathy or rupture vs ATSA for OA (OR 2.3, CI 1.5-3.4).</p><p><strong>Conclusion: </strong> 3 recovery trajectories were identified following TSA, which we labelled as \"Fast responders,\" \"Steady responders,\" and \"Poor responders.\" \"Steady responders\" and \"Poor responders\" were more likely to have higher ASA scores, a Walch A1 vs B2 classification, and greater vs medium socioeconomic deprivation than \"Fast responders.\" Moreover, \"Steady responders\" were more likely to be female, while \"Poor responders\" were more likely to have previous shoulder surgeries and RTSA for OA or for cuff arthropathy or rupture than \"Fast responders.\"</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"226-234"},"PeriodicalIF":2.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}