Objective:To investigate the related factors of motility after total hip arthroplasty(THA).Methods:The convenience sampling method was used to include 213 patients receiving THA in our hospital from June 2020 to June ...Objective:To investigate the related factors of motility after total hip arthroplasty(THA).Methods:The convenience sampling method was used to include 213 patients receiving THA in our hospital from June 2020 to June 2023.They were divided into 2 groups according to the occurrence of kinesiophobia after THA.The demographic data of the 2 groups were analyzed by single-factor analysis.The factors with statistically significant differences were analyzed by binary logistic regression as independent variables.Finally,Spearman analysis was used to analyze the relationship between risk factors and the degree of kinesiophobia.Results:Among 213 THA patients,38 patients were diagnosed with kinetophobia,and the incidence of kinetophobia was 17.84%.visual analogue scale(VAS)and pain duration before operation were higher in patients with kinetophobia than in patients without kinetophobia.The scores of education level,self-efficacy,and social support were significantly lower than those of the non-phobia group,with statistical significance(P<0.05).Logistic regression analysis showed that VAS was a risk factor for kinetophobia after THA.Education level and self-efficacy were protective factors to reduce the occurrence of kinetophobia after THA(P<0.05).Spearman correlation analysis showed that the degree of pain(r=0.697,P<0.001)was positively correlated with the degree of kinetophobia,while the degree of education(r=-0.647,P<0.001)and self-efficacy(r=-0.756,P<0.001)were negatively correlated with the degree of kinetophobia.Conclusions:The degree of pain is a risk factor of kinesiophobia after THA,and it is positively correlated with the degree.Educational level and self-efficacy were protective factors to reduce the incidence of kinesiophobia and were negatively correlated with the degree of kinesiophobia.展开更多
BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favo...BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favoured,reverse TSA(RTSA)is increasingly utilized.AIM To systematically compare the outcomes of RTSA and TSA in this specific patient population.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.Retrospective comparative studies evaluating RTSA and TSA in patients with GHOA and intact rotator cuff were included.Key outcomes assessed included complication and reoperation rates,patient-reported outcome measures(PROMs),and range of motion.Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.RESULTS Twelve studies encompassing 1608 patients(580 RTSA,1028 TSA)met inclusion criteria.RTSA was associated with a lower reoperation rate compared to TSA[odds ratio=0.37;95%confidence interval(CI):0.14-0.94;P value=0.04],while no significant difference in overall complication rates was observed(odds ratio=0.47;95%CI:0.19-1.16;P value=0.10).RTSA patients showed superior outcomes in University of California Los Angeles,Simple Shoulder Test,and Shoulder Pain and Disability Index scores;however,the differences did not exceed the minimal clinically important difference.TSA patients had significantly better external rotation(mean difference=-9.0°;95%CI:-13.21 to-5.02;P value<0.0001).No significant differences were found in other range of motion measures or satisfaction scores.The overall methodological quality of included studies was moderate to serious.CONCLUSION In patients with GHOA and an intact rotator cuff,RTSA may offer comparable or improved outcomes to TSA with lower reoperation rates and similar complication profiles.Functional outcomes favour RTSA in certain patientreported outcome measures,while TSA retains an advantage in external rotation.Surgical decision-making should remain individualized based on patient characteristics and functional demands.展开更多
Appreciation of soft-tissue thickness(STT)at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes.Recent research has focused on the pre...Appreciation of soft-tissue thickness(STT)at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes.Recent research has focused on the predictive value of preoperative STT measurements for complications following various forms of arthroplasty,particularly infections,across procedures such as total knee,hip,shoulder,and ankle replacements.Several studies have indicated that increased STT is associated with a higher risk of complications,including infection and wound healing issues.The assessment of STT before surgery could play a crucial role in identifying patients at a higher risk of complications and may be instru-mental in guiding preoperative planning to optimize outcomes in arthroplasty procedures.Standardized measurement techniques and further research are essential to enhance the reliability and clinical utility of STT assessment for arthro-plasty surgery.展开更多
BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar k...BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar kinematics and function to a native knee.AIM To evaluate the clinical results and patient-reported outcomes after CR TKA procedures utilizing a kinematically designed medial dish system.METHODS A multicenter,retrospective cohort review of 139 primary elective TKAs utilizing a kinematically designed CR Knee System(JOURNEY™II CR MD;Smith and Nephew,Memphis,TN,United States)at three different institutions with a minimum of two years of follow-up.Demographic information,clinical outcomes,and patient-reported outcome measures were collected and analyzed.RESULTS With up to 3.7 years from surgery,overall implant survivorship was 98.6%.There were significant postoperative increases in the average Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores(17.4 at 6 months,26.1 points at two years or more,P<0.001).CONCLUSION The combination of high implant survivorship and substantial improvements in patient-reported outcome measures suggests that the medial dish tibial insert represents a safe and effective option within TKA.Additional investigation is necessary to evaluate the long-term survivorship of this design.展开更多
BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different ...BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.展开更多
Objective:To systematically summarize and evaluate the evidence on discharge preparation services for patients undergoing total knee arthroplasty,providing an evidence-based foundation for developing scientific and st...Objective:To systematically summarize and evaluate the evidence on discharge preparation services for patients undergoing total knee arthroplasty,providing an evidence-based foundation for developing scientific and standardized discharge preparation intervention programs in clinical practice.Methods:Following the“5S”evidence model,literature such as guidelines,expert consensuses,evidence summaries and randomized controlled trials related to discharge preparation services for total knee arthroplasty patients were retrieved from relevant websites and databases,both domestic and international,from database inception to August 31,2025.Two researchers independently screened the literature,conducted quality appraisals,and extracted and synthesized the evidence.Results:A total of 15 articles were included,comprising 3 guidelines,4 expert consensuses,3 evidence summaries,3 systematic reviews and 2 randomized controlled trials.Ultimately,23 pieces of evidence were summarized across five aspects.Conclusion:This study synthesizes the evidence on discharge preparation services for patients undergoing total knee arthroplasty.It is recommended that healthcare professionals apply this evidence in clinical practice,considering specific circumstances and patient needs.展开更多
Leg-length discrepancy(LLD)in individuals experiencing total hip arthroplasty(THA)is related to a substantially higher fall risk,length of post-operative hospital in-patient stay,elevated implant-related adverse event...Leg-length discrepancy(LLD)in individuals experiencing total hip arthroplasty(THA)is related to a substantially higher fall risk,length of post-operative hospital in-patient stay,elevated implant-related adverse events,and earlier revision.Therefore,it is essential to try to avoid LLD when implanting a THA.Several studies focus on this issue,including the following:Accelerometer-based portable navigation system,preoperative digital templating,robot-assisted surgery,the anatomical marker positioning method(shoulder-to-shoulder)and the artificial intelligence-based three-dimensional planning software system.The aforementioned methods should be familiar to surgeons who perform THA procedures,as a fundamental objective of this surgical intervention is to avoid LLD.展开更多
BACKGROUND Although opioids and non-steroidal anti-inflammatory drugs are commonly used as preemptive analgesics in total knee arthroplasty(TKA),their side effects are a major concern.Tapentadol,a synthetic opioid ana...BACKGROUND Although opioids and non-steroidal anti-inflammatory drugs are commonly used as preemptive analgesics in total knee arthroplasty(TKA),their side effects are a major concern.Tapentadol,a synthetic opioid analgesic,is noted for its higher potency,lower abuse potential,and better gastrointestinal tolerability compared to traditional opioids.However,its efficacy and safety as preemptive analgesia in TKA have not been evaluated.AIM To hypothesize that preemptive use of tapentadol significantly reduces postoperative pain and rescue analgesic consumption in TKA patients.Clinically,this may reduce opioid burden and improve recovery protocols.METHODS Ninety patients undergoing unilateral TKA were randomized to receive either tapentadol(single dose of 100 mg sustained-release,n=45)or a matched placebo 1 hour before surgery.Postoperative pain was assessed using the visual analog scale(VAS),and total pain reduction scores were recorded.Total rescue analgesic consumption and side effects were monitored for 24 hours.Blood samples were collected 6 hours postoperatively to measure plasma levels of cholecystokinin(CCK)(a potential biomarker of pain)and tapentadol using enzyme-linked immunosorbent assay and high-performance liquid chromatography,respectively.RESULTS The baseline characteristics of both groups were comparable.The 24-hour VAS scores,the primary outcome,were significantly lower in the tapentadol group median[interquartile range(IQR)][1.0(1.0-3.0)]compared to the placebo group[3.5(2.0-5.0)].Significant differences in VAS scores were observed at 4 hours,6 hours,and 12 hours postoperatively(P<0.05).Requests for rescue analgesia were significantly delayed in the tapentadol group(P=0.01),and the total dose of analgesics used was significantly lower[median(IQR):3(2-4)]compared to the placebo group[4.5(3-5),P=0.001].No major adverse events were observed in either group.Plasma tapentadol concentrations correlated well with pain intensity,whereas no correlation was found between CCK levels and pain intensity.CONCLUSION A preemptive single dose of 100 mg oral tapentadol is safe,effective,and significantly reduces postoperative pain and rescue analgesic requirements in TKA patients.This approach may reduce opioid dependence and support enhanced recovery protocols.展开更多
Due to the increasing ageing population,femoral neck fracture(FNF)is a common and significant public health issue in the elderly,as it significantly impacts patients’quality of life,frequently leading to severe disab...Due to the increasing ageing population,femoral neck fracture(FNF)is a common and significant public health issue in the elderly,as it significantly impacts patients’quality of life,frequently leading to severe disability.Undoubtedly,hip replacement is the standard current of care for displaced FNF in this population,as it can provide pain relief and allow immediate return to mobility.However,hip arthroplasty may present severe specific complications,such as implant dislocation and infection,which may increase mortality and morbidity,especially in more frail patients.Therefore,in this particular population,alternative treatments should be considered.Girdlestone resection arthroplasty,which includes excision of the femoral head,is a salvage procedure which was first described for the management of chronic tuberculous coxitis,and then widely used in uncontrolled infected hip replacements.This article provides an updated outcome analysis of hip resection arthroplasty as a primary definitive treatment for FNF in frail non-ambulatory patients.展开更多
BACKGROUND Patellar resurfacing in knee arthroplasty remains a contentious issue,with various strategies including routine,selective,and non-resurfacing approaches.This review and meta-analysis aim to assess the incid...BACKGROUND Patellar resurfacing in knee arthroplasty remains a contentious issue,with various strategies including routine,selective,and non-resurfacing approaches.This review and meta-analysis aim to assess the incidence of patellar resurfacing,revision rates,patient satisfaction,and relevant knee scores associated with each method.AIM To determine the comparative effectiveness of routine,selective,and nonresurfacing strategies in patellar resurfacing within knee arthroplasty by evaluating incidence rates,revision rates,patient satisfaction,and knee function scores.METHODS A systematic review spanning from 1990 to 2024 was conducted using PubMed,Embase,and Cochrane Library databases.Studies reporting on the incidence of patellar resurfacing,revision rates,patient satisfaction,and relevant knee scores were included.Data from esteemed world registries such as the Australian Orthopaedic Association National Joint Replacement Registry,the National Joint Registry for England,Wales,Northern Ireland,and the Isle of Man and Danish Knee Arthroplasty Registry among others,were meticulously examined.Metaanalysis was employed to derive pooled estimates and 95%confidence intervals.RESULTS Analysis of data sourced from diverse world registries and literature sources unveiled significant disparities in the incidence of patellar resurfacing across different geographic regions and healthcare institutions.For instance,the incidence of routine patellar resurfacing ranged from 60%to 90%in some regions,while in others,it was as low as 30%to 50%.The meta-analysis indicated that routine resurfacing was associated with a lower revision rate of 3.5%(95%CI:2.8%-4.2%)compared to non-resurfacing approaches,which exhibited a higher revision rate of 6.8%(95%CI:5.5%-8.1%).Patient satisfaction outcomes showed variability,with routine resurfacing demonstrating higher mean satisfaction scores in functionality,pain relief,and stability categories.CONCLUSION The findings underscore the complexity of patellar resurfacing in knee arthroplasty and highlight the need for continued research to refine clinical practice.Future studies should prioritize prospective randomized controlled trials comparing different patellar resurfacing techniques using standardized outcome measures.Longitudinal studies with extended follow-up periods are necessary to evaluate the long-term outcomes and durability of various patellar resurfacing strategies.Collaborative efforts among multidisciplinary teams will be essential to conduct high-quality research that can provide actionable insights and improve patient outcomes.展开更多
BACKGROUND Among the various complications associated with total hip arthroplasty(THA)periprosthetic osteolysis and wear phenomena due to the release of metal particles,are two of the most common and have been reporte...BACKGROUND Among the various complications associated with total hip arthroplasty(THA)periprosthetic osteolysis and wear phenomena due to the release of metal particles,are two of the most common and have been reported to be correlated because of inflammatory responses directed towards released particles that generally activate macrophagic osteolytic effects.Therein,new masses known as pseudotumors can appear in soft tissues around a prosthetic implant.To date,there is paucity of reliable data from studies investigating for any association between the above mentioned adverse events.AIM To investigate for the existence of any association between serum and urine concentrations of metal-ions released in THA and periprosthetic osteolysis for modular neck and monolithic implants.METHODS Overall,76 patients were divided into three groups according to the type of hip prosthesis implants:Monoblock,modular with metal head and modular with ceramic head.With an average f-up of 4 years,we conducted a radiological evaluation in order to detect any area of osteolysis around the prosthesis of both the femur and the acetabulum.Moreover,serum and urinary tests were performed to assess the values of Chromium and Cobalt released.Statistical analysis was performed to determine any association between the ion release and osteolysis.RESULTS For the 3 study groups,the monolithic,modular ceramic-headed and modular metal-headed implants had different incidences of osteolysis events,which were higher for the modular implants.Furthermore,the most serious of these(grade 3)were detected almost exclusively for the modular implants with metal heads.A mapping of the affected areas was performed revealing that the highest incidences of osteolysis were evidenced in the pertrochanteric region at the femur level,and in the supero-external region at the acetabular level.Regarding the evaluation of the release of metals-ions from wear processes,serum and urinary chromium and cobalt values were found to be higher in cases of modularity,and even more so for those with metal head.Statistical linear correlation test results suggested positive correlations between increasing metal concentrations and incidences areas of osteolysis.However,no cases of pseudo-tumor were detected.CONCLUSION Future studies are needed to identify risk factors that increase peri-prosthetic metal ion levels and whether these factors might be implicated in the triggering of local events,including osteolysis and aseptic loosening.展开更多
Total hip arthroplasty for adults with sequelae from childhood hip disorders poses significant challenges due to altered anatomy.The paper published by Oommen et al reviews the essential management strategies for thes...Total hip arthroplasty for adults with sequelae from childhood hip disorders poses significant challenges due to altered anatomy.The paper published by Oommen et al reviews the essential management strategies for these complex cases.This article explores the integration of finite element analysis(FEA)to enhance surgical precision and outcomes.FEA provides detailed biomechanical insights,aiding in preoperative planning,implant design,and surgical technique optimization.By simulating implant configurations and assessing bone quality,FEA helps in customizing implants and evaluating surgical techniques like subtrochanteric shortening osteotomy.Advanced imaging techniques,such as 3D printing,virtual reality,and augmented reality,further enhance total hip arthroplasty precision.Future research should focus on validating FEA models,developing patient-specific simulations,and promoting multidisciplinary collaboration.Integrating FEA and advanced technologies in total hip arthroplasty can improve functional outcomes,reduce complications,and enhance quality of life for patients with childhood hip disorder sequelae.展开更多
BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many p...BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many patients undergo multiple proce-dures.AIM To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second procedure.METHODS The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were excluded.Patient demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery.Outcome metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)visits.RESULTS A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were analyzed.There was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 d.For THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(P<0.001).THA patients had significantly decreased operative time only when the same sized implant was utilized(P=0.025).The vast majority(93.3%)of patients were discharged to the same type of location following their second surgery.However,when a change in disposition was present from the first surgery,patients were significantly more likely to be discharged to home after the second procedure(P=0.033).There was no difference between procedures for post-operative readmissions(P=0.438)or ED visits(P=0.915).CONCLUSION After gaining valuable experience recovering from the initial surgery,a patient’s perioperative outcomes are improved for their second TJA.This may be the result of increased confidence and decreased anxiety,and it supports the theory that enhanced patient education pre-operatively may improve outcomes.For the surgical team,the second procedure of a staged THA is more efficient,although this finding did not hold for TKA.展开更多
BACKGROUND Total hip arthroplasty is a safe and effective procedure.To improve survivorship,ultrahigh molecular weight polyethylene hip liners with antioxidants have been developed.Additive antioxidant was deployed to...BACKGROUND Total hip arthroplasty is a safe and effective procedure.To improve survivorship,ultrahigh molecular weight polyethylene hip liners with antioxidants have been developed.Additive antioxidant was deployed to reduce oxidation and consequential wear,loosening,or osteolysis.A unique manufacturing process was utilized for two such hip liners,the Novation®and Alteon®XLE hip liners and this research represents the first large series on this specific material.The study hypothesis was that Novation and Alteon XLE hip liners have similar short-term survivorship as other manufacturers’antioxidant liners according to procedure and outcome data from the American Joint Replacement Registry(AJRR).AIM To demonstrate similar short-term survivorship of XLE antioxidant hip liners compared to all antioxidant hip liners in AJRR.METHODS Utilizing total hip arthroplasty data from the AJRR,a retrospective review was performed for subjects who underwent implantation of Novation XLE(n=461),Alteon XLE(n=989),or any other antioxidant hip liner(termed the aggregate antioxidant group;n=39964)as of March 31,2022.Survivorship at three years and revision rates were compared statistically between the Novation group and the aggregate antioxidant group as well as the Alteon group and the aggregate antioxidant group.RESULTS Survivorship at three years post-surgery was 99.09%for Novation,97.73%for Alteon,and 97.69%for the aggregate antioxidant group.There were no reports of failure due to wear in either the Novation or Alteon groups.Among the revision categories(fracture,infection,aseptic loosening,instability,mechanical complications,wear,pain,hematoma/wound complications,or other),there were no significant differences identified in either comparison.There were also no significant differences in cumulative percent revision rates up to three years post-surgery for the Novation vs aggregate antioxidant group or the Alteon vs aggregate antioxidant group.CONCLUSION Novation and Alteon XLE hip liner revision rate and survivorship are equivalent to other antioxidant hip liners in the short term.展开更多
Retrieval analysis in total knee arthroplasty(TKA)has been little studied in the literature.A narrative review of the literature to understand the current importance of retrieval analysis in TKA has been conducted.On ...Retrieval analysis in total knee arthroplasty(TKA)has been little studied in the literature.A narrative review of the literature to understand the current importance of retrieval analysis in TKA has been conducted.On August 27,2024,a literature search was performed in PubMed using“TKA retrieval analysis”as keywords.A total of 160 articles were found,of which only 19 were analyzed because they were directly related to the subject of this article.Rotating-platform(mobile-bearing)TKA has no surface damage advantage over fixed-bearing TKA.TKAs with central locking mechanisms are more prone to debond from the cement mantle.No major wear of the polyethylene(PE)component in TKA using oxidized zirconium components occurs.Femoral components of cobalt-chromium roughen more than oxidized zirconium femoral components.The use of a polished tibial tray over an unpolished design is advised.At short-run assessment(15 months on average),antioxidant-stabilized highly crosslinked PE components are not clinically different in surface damage,density of crosslinking,or oxidation compared to standard remelted highly crosslinked PE components.A correlation between implant position and PE component surface damage has been reported.It shows the importance of optimizing component position to reduce PE component damage.Contemporary knee tumor megaendoprostheses show notable volumetric metal wear originated at the rotating hinge.Retrieval analysis in TKA renders relevant data on how different prosthetic designs described in the literature perform.Such information can help to improve future prosthetic designs to increase prosthetic survival.展开更多
Radial head(RH)arthroplasty(RHA)has emerged as a critical intervention in the management of complex elbow fractures,particularly Mason type III and IV injuries where the native RH is irreparable.Beyond its role in pai...Radial head(RH)arthroplasty(RHA)has emerged as a critical intervention in the management of complex elbow fractures,particularly Mason type III and IV injuries where the native RH is irreparable.Beyond its role in pain relief and joint congruity,RHA serves as a biomechanical cornerstone for restoring the lateral column and ensuring elbow stability,especially in the presence of associated ligamentous injuries or fracture-dislocations.This editorial synthesizes current evidence on RHA in Mason type III and IV RH fractures,with attention to biomechanical rationale,implant design,and complication trends.Aiming to reaffirm RHA’s position as a vital tool in contemporary elbow trauma care,a simplified treatment algorithm is presented to support individualized surgical decisionmaking.展开更多
BACKGROUND Total knee arthroplasty(TKA)is a widely used treatment for advanced knee osteoarthritis;however,the incidence of failures requiring revision surgery is increasing.Identifying the causes of TKA failure and a...BACKGROUND Total knee arthroplasty(TKA)is a widely used treatment for advanced knee osteoarthritis;however,the incidence of failures requiring revision surgery is increasing.Identifying the causes of TKA failure and assessing the outcomes of revision procedures are essential for improving patient care.We hypothesized that infection and aseptic loosening are the primary causes of TKA failure and that revision TKA(rTKA)significantly enhances functional outcomes.AIM To examine the primary causes of TKA failure and evaluate the functional outcomes following rTKA.METHODS This descriptive study was conducted at the Department of Orthopedic Surgery,Civil Hospital,Bahawalpur,from April to September 2024.A total of 118 patients undergoing rTKA for failed primary TKA were included.Data on demographics,causes of failure,and surgical details were collected.Functional outcomes were evaluated using the Knee Society Score and Visual Analog Scale before and six months after surgery.Statistical analysis was performed using SPSS version 25.0,with statistical significance set at P<0.05.RESULTS The leading causes of TKA failure were infection(45.8%),aseptic loosening(44.1%),and periprosthetic fractures(10.2%).The rTKA significantly improved knee function,with the mean Knee Society Score increasing from 39.43±6.18 to 78.91±6.17(P<0.001).Pain levels decreased substantially,with the mean Visual Analog Scale scores reducing from 7.99±1.37 to 1.42±1.17(P<0.001).No significant differences in outcomes were observed between single-stage and two-stage revision procedures.CONCLUSION Infection and aseptic loosening are the predominant causes of TKA failure.The rTKA effectively enhances knee function and alleviates pain,offering significant benefits to patients.展开更多
BACKGROUND The prevalence of depressive symptoms in patients undergoing total knee arthroplasty(TKA)ranges from 22%to 26%.The impact of depression on functional status post-TKA remains controversial.AIM To be the firs...BACKGROUND The prevalence of depressive symptoms in patients undergoing total knee arthroplasty(TKA)ranges from 22%to 26%.The impact of depression on functional status post-TKA remains controversial.AIM To be the first study in Latin American population to evaluate the association between depression and functional status one year after TKA,hypothesizing that elderly patients with depression will demonstrate lower rates of functional improvement.METHODS We conducted an observational,descriptive and analytic,retrospective cohort study involving patients over 65 years old who were indicated for TKA.Assessments were made via the Program for Determination and Management of Risks for Practices and Procedures of the Division of Geriatric Medicine at the Italian Hospital of Buenos Aires,between June 2015 and July 2019.Depression screening was conducted using Yesavage’s abbreviated score and Patient Health Questionnaire-9,while functional ability was evaluated using the Knee Society Score(KSS).RESULTS Of the 100 patients analyzed,22(22%)screened positive for depression.The mean age was 80 years±6.3 years,with an average of 77.6 years±6 years in the depressed group and 80.6 years±6.3 years in the non-depressed group(P=0.05).Depressed patients showed significantly greater cognitive impairment[clock-face drawing test median:5(3-6)vs 6(5-7),P=0.06]and more risk factors for confusional syndrome(mean:8±2 vs 6.5±2.2,P=0.006).Frailty was also more prevalent in depressed patients[Edmonton:15(68%)vs 33(42%),P=0.05;Fried:17(77%)vs 42(54%),P=0.05].Postoperative Functional KSS were similar between groups(depressed:65±22.1 vs non-depressed:66.3±20.3,P=0.8).Linear regression analysis revealed no association between depression and changes in KSS.Spearman’s rank correlation coefficients were-0.0304(P=0.8)for Functional KSS variation and-0.1(P=0.3)for KSS variation.CONCLUSION Depression in patients with osteoarthritis should not hinder surgical planning.Identifying and treating depression preoperatively may enhance outcomes such as pain relief and reduce risks of acute confusional syndrome,cognitive impairment,and frailty.展开更多
BACKGROUND Total knee arthroplasty(TKA)aims to restore motion and alleviate pain,enabling patients to return to daily activities.Despite advances in implants,surgery,and perioperative care,patient dissatisfaction rate...BACKGROUND Total knee arthroplasty(TKA)aims to restore motion and alleviate pain,enabling patients to return to daily activities.Despite advances in implants,surgery,and perioperative care,patient dissatisfaction rates remain significant.AIM To determine whether ankle symptoms are associated with inferior results of functional recovery of the knee following TKA.METHODS This prospective study included all patients with advanced knee osteoarthritis who underwent a primary unilateral TKA between August 2019 and December 2019 with data documented by the treating surgeon and outpatient physical therapists.Patients were categorized based on ankle symptoms using the Ame-rican Orthopaedic Foot and Ankle Society(AOFAS)score:(1)Group 1(AOFAS≤85,n=30);and(2)Group 2(AOFAS>85,n=49).Active range of motion(ROM),the Knee Injury and Osteoarthritis Outcome Score(KOOS),and the visual ana-logue scale(VAS)were compared between two groups.RESULTS Postoperative KOOS,ROM,and VAS significantly improved in both groups(P<0.001).However,at three months,KOOS(P=0.02)and extension motion(P=0.01)improvements were significantly greater in group 2.CONCLUSION These findings suggest that preoperative ankle symptoms may negatively impact early knee functional recovery,particularly in KOOS scores and extension motion.展开更多
BACKGROUND Sagittal spinopelvic alignment(SSA)is essential for preserving a stable and effective upright posture and locomotion.Although alterations in the SSA are recognised to induce compensatory modifications in th...BACKGROUND Sagittal spinopelvic alignment(SSA)is essential for preserving a stable and effective upright posture and locomotion.Although alterations in the SSA are recognised to induce compensatory modifications in the pelvis,hips,and knees,the inverse relationship concerning knee pathology undergoing total knee arthroplasty(TKA)has been examined by a limited number of studies,yielding inconclusive results.AIM To generate evidence of the effect of TKA on the SSA from existing literature.METHODS Databases like PubMed,EMBASE,and Scopus were used to identify articles related to the“knee spine syndrome”phenomenon using a combination of subject terms and keywords such as“spinopelvic parameters”,“sagittal spinal balance”,and“total knee arthroplasty”were used with appropriate Boolean operators.Studies measuring the SSA following TKA were included,and research was conducted as per preferred reporting items for systematic review and metaanalysis guidelines.RESULTS A total of 475 participants had undergone TKA,and six studies measuring SSA were analysed.Following TKA,pelvic tilt was the only parameter that showed significant changes,while lumbar lordosis(LL),pelvic incidence,and sacral slope were non-significant,as evident from the forest plots.CONCLUSION The body's sagittal alignment is a complex balance between pelvic,spine,and lower extremity parameters.TKA,while having the potential to correct the flexion contracture,can also correct it.Still,the primary SSA for spinal pathology,i.e.,LL,may not be corrected in patients with co-existent spinal degenerative disease.展开更多
基金supported by the Henan Provincial Medical Science and Technology Research Program,grant funded by the Henan Provincial Health Commission(No.LHGJ 20200888)。
文摘Objective:To investigate the related factors of motility after total hip arthroplasty(THA).Methods:The convenience sampling method was used to include 213 patients receiving THA in our hospital from June 2020 to June 2023.They were divided into 2 groups according to the occurrence of kinesiophobia after THA.The demographic data of the 2 groups were analyzed by single-factor analysis.The factors with statistically significant differences were analyzed by binary logistic regression as independent variables.Finally,Spearman analysis was used to analyze the relationship between risk factors and the degree of kinesiophobia.Results:Among 213 THA patients,38 patients were diagnosed with kinetophobia,and the incidence of kinetophobia was 17.84%.visual analogue scale(VAS)and pain duration before operation were higher in patients with kinetophobia than in patients without kinetophobia.The scores of education level,self-efficacy,and social support were significantly lower than those of the non-phobia group,with statistical significance(P<0.05).Logistic regression analysis showed that VAS was a risk factor for kinetophobia after THA.Education level and self-efficacy were protective factors to reduce the occurrence of kinetophobia after THA(P<0.05).Spearman correlation analysis showed that the degree of pain(r=0.697,P<0.001)was positively correlated with the degree of kinetophobia,while the degree of education(r=-0.647,P<0.001)and self-efficacy(r=-0.756,P<0.001)were negatively correlated with the degree of kinetophobia.Conclusions:The degree of pain is a risk factor of kinesiophobia after THA,and it is positively correlated with the degree.Educational level and self-efficacy were protective factors to reduce the incidence of kinesiophobia and were negatively correlated with the degree of kinesiophobia.
文摘BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favoured,reverse TSA(RTSA)is increasingly utilized.AIM To systematically compare the outcomes of RTSA and TSA in this specific patient population.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.Retrospective comparative studies evaluating RTSA and TSA in patients with GHOA and intact rotator cuff were included.Key outcomes assessed included complication and reoperation rates,patient-reported outcome measures(PROMs),and range of motion.Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.RESULTS Twelve studies encompassing 1608 patients(580 RTSA,1028 TSA)met inclusion criteria.RTSA was associated with a lower reoperation rate compared to TSA[odds ratio=0.37;95%confidence interval(CI):0.14-0.94;P value=0.04],while no significant difference in overall complication rates was observed(odds ratio=0.47;95%CI:0.19-1.16;P value=0.10).RTSA patients showed superior outcomes in University of California Los Angeles,Simple Shoulder Test,and Shoulder Pain and Disability Index scores;however,the differences did not exceed the minimal clinically important difference.TSA patients had significantly better external rotation(mean difference=-9.0°;95%CI:-13.21 to-5.02;P value<0.0001).No significant differences were found in other range of motion measures or satisfaction scores.The overall methodological quality of included studies was moderate to serious.CONCLUSION In patients with GHOA and an intact rotator cuff,RTSA may offer comparable or improved outcomes to TSA with lower reoperation rates and similar complication profiles.Functional outcomes favour RTSA in certain patientreported outcome measures,while TSA retains an advantage in external rotation.Surgical decision-making should remain individualized based on patient characteristics and functional demands.
文摘Appreciation of soft-tissue thickness(STT)at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes.Recent research has focused on the predictive value of preoperative STT measurements for complications following various forms of arthroplasty,particularly infections,across procedures such as total knee,hip,shoulder,and ankle replacements.Several studies have indicated that increased STT is associated with a higher risk of complications,including infection and wound healing issues.The assessment of STT before surgery could play a crucial role in identifying patients at a higher risk of complications and may be instru-mental in guiding preoperative planning to optimize outcomes in arthroplasty procedures.Standardized measurement techniques and further research are essential to enhance the reliability and clinical utility of STT assessment for arthro-plasty surgery.
文摘BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar kinematics and function to a native knee.AIM To evaluate the clinical results and patient-reported outcomes after CR TKA procedures utilizing a kinematically designed medial dish system.METHODS A multicenter,retrospective cohort review of 139 primary elective TKAs utilizing a kinematically designed CR Knee System(JOURNEY™II CR MD;Smith and Nephew,Memphis,TN,United States)at three different institutions with a minimum of two years of follow-up.Demographic information,clinical outcomes,and patient-reported outcome measures were collected and analyzed.RESULTS With up to 3.7 years from surgery,overall implant survivorship was 98.6%.There were significant postoperative increases in the average Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores(17.4 at 6 months,26.1 points at two years or more,P<0.001).CONCLUSION The combination of high implant survivorship and substantial improvements in patient-reported outcome measures suggests that the medial dish tibial insert represents a safe and effective option within TKA.Additional investigation is necessary to evaluate the long-term survivorship of this design.
基金Supported by the National Natural Science Foundation of China,No.82402789Beijing Jishuitan Hospital Youcai Plan,No.KYYC202402+1 种基金Beijing Jishuitan Research Funding,No.HL202402and Beijing Natural Science Foundation,No.L232062,No.L222063.
文摘BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.
文摘Objective:To systematically summarize and evaluate the evidence on discharge preparation services for patients undergoing total knee arthroplasty,providing an evidence-based foundation for developing scientific and standardized discharge preparation intervention programs in clinical practice.Methods:Following the“5S”evidence model,literature such as guidelines,expert consensuses,evidence summaries and randomized controlled trials related to discharge preparation services for total knee arthroplasty patients were retrieved from relevant websites and databases,both domestic and international,from database inception to August 31,2025.Two researchers independently screened the literature,conducted quality appraisals,and extracted and synthesized the evidence.Results:A total of 15 articles were included,comprising 3 guidelines,4 expert consensuses,3 evidence summaries,3 systematic reviews and 2 randomized controlled trials.Ultimately,23 pieces of evidence were summarized across five aspects.Conclusion:This study synthesizes the evidence on discharge preparation services for patients undergoing total knee arthroplasty.It is recommended that healthcare professionals apply this evidence in clinical practice,considering specific circumstances and patient needs.
文摘Leg-length discrepancy(LLD)in individuals experiencing total hip arthroplasty(THA)is related to a substantially higher fall risk,length of post-operative hospital in-patient stay,elevated implant-related adverse events,and earlier revision.Therefore,it is essential to try to avoid LLD when implanting a THA.Several studies focus on this issue,including the following:Accelerometer-based portable navigation system,preoperative digital templating,robot-assisted surgery,the anatomical marker positioning method(shoulder-to-shoulder)and the artificial intelligence-based three-dimensional planning software system.The aforementioned methods should be familiar to surgeons who perform THA procedures,as a fundamental objective of this surgical intervention is to avoid LLD.
文摘BACKGROUND Although opioids and non-steroidal anti-inflammatory drugs are commonly used as preemptive analgesics in total knee arthroplasty(TKA),their side effects are a major concern.Tapentadol,a synthetic opioid analgesic,is noted for its higher potency,lower abuse potential,and better gastrointestinal tolerability compared to traditional opioids.However,its efficacy and safety as preemptive analgesia in TKA have not been evaluated.AIM To hypothesize that preemptive use of tapentadol significantly reduces postoperative pain and rescue analgesic consumption in TKA patients.Clinically,this may reduce opioid burden and improve recovery protocols.METHODS Ninety patients undergoing unilateral TKA were randomized to receive either tapentadol(single dose of 100 mg sustained-release,n=45)or a matched placebo 1 hour before surgery.Postoperative pain was assessed using the visual analog scale(VAS),and total pain reduction scores were recorded.Total rescue analgesic consumption and side effects were monitored for 24 hours.Blood samples were collected 6 hours postoperatively to measure plasma levels of cholecystokinin(CCK)(a potential biomarker of pain)and tapentadol using enzyme-linked immunosorbent assay and high-performance liquid chromatography,respectively.RESULTS The baseline characteristics of both groups were comparable.The 24-hour VAS scores,the primary outcome,were significantly lower in the tapentadol group median[interquartile range(IQR)][1.0(1.0-3.0)]compared to the placebo group[3.5(2.0-5.0)].Significant differences in VAS scores were observed at 4 hours,6 hours,and 12 hours postoperatively(P<0.05).Requests for rescue analgesia were significantly delayed in the tapentadol group(P=0.01),and the total dose of analgesics used was significantly lower[median(IQR):3(2-4)]compared to the placebo group[4.5(3-5),P=0.001].No major adverse events were observed in either group.Plasma tapentadol concentrations correlated well with pain intensity,whereas no correlation was found between CCK levels and pain intensity.CONCLUSION A preemptive single dose of 100 mg oral tapentadol is safe,effective,and significantly reduces postoperative pain and rescue analgesic requirements in TKA patients.This approach may reduce opioid dependence and support enhanced recovery protocols.
文摘Due to the increasing ageing population,femoral neck fracture(FNF)is a common and significant public health issue in the elderly,as it significantly impacts patients’quality of life,frequently leading to severe disability.Undoubtedly,hip replacement is the standard current of care for displaced FNF in this population,as it can provide pain relief and allow immediate return to mobility.However,hip arthroplasty may present severe specific complications,such as implant dislocation and infection,which may increase mortality and morbidity,especially in more frail patients.Therefore,in this particular population,alternative treatments should be considered.Girdlestone resection arthroplasty,which includes excision of the femoral head,is a salvage procedure which was first described for the management of chronic tuberculous coxitis,and then widely used in uncontrolled infected hip replacements.This article provides an updated outcome analysis of hip resection arthroplasty as a primary definitive treatment for FNF in frail non-ambulatory patients.
文摘BACKGROUND Patellar resurfacing in knee arthroplasty remains a contentious issue,with various strategies including routine,selective,and non-resurfacing approaches.This review and meta-analysis aim to assess the incidence of patellar resurfacing,revision rates,patient satisfaction,and relevant knee scores associated with each method.AIM To determine the comparative effectiveness of routine,selective,and nonresurfacing strategies in patellar resurfacing within knee arthroplasty by evaluating incidence rates,revision rates,patient satisfaction,and knee function scores.METHODS A systematic review spanning from 1990 to 2024 was conducted using PubMed,Embase,and Cochrane Library databases.Studies reporting on the incidence of patellar resurfacing,revision rates,patient satisfaction,and relevant knee scores were included.Data from esteemed world registries such as the Australian Orthopaedic Association National Joint Replacement Registry,the National Joint Registry for England,Wales,Northern Ireland,and the Isle of Man and Danish Knee Arthroplasty Registry among others,were meticulously examined.Metaanalysis was employed to derive pooled estimates and 95%confidence intervals.RESULTS Analysis of data sourced from diverse world registries and literature sources unveiled significant disparities in the incidence of patellar resurfacing across different geographic regions and healthcare institutions.For instance,the incidence of routine patellar resurfacing ranged from 60%to 90%in some regions,while in others,it was as low as 30%to 50%.The meta-analysis indicated that routine resurfacing was associated with a lower revision rate of 3.5%(95%CI:2.8%-4.2%)compared to non-resurfacing approaches,which exhibited a higher revision rate of 6.8%(95%CI:5.5%-8.1%).Patient satisfaction outcomes showed variability,with routine resurfacing demonstrating higher mean satisfaction scores in functionality,pain relief,and stability categories.CONCLUSION The findings underscore the complexity of patellar resurfacing in knee arthroplasty and highlight the need for continued research to refine clinical practice.Future studies should prioritize prospective randomized controlled trials comparing different patellar resurfacing techniques using standardized outcome measures.Longitudinal studies with extended follow-up periods are necessary to evaluate the long-term outcomes and durability of various patellar resurfacing strategies.Collaborative efforts among multidisciplinary teams will be essential to conduct high-quality research that can provide actionable insights and improve patient outcomes.
文摘BACKGROUND Among the various complications associated with total hip arthroplasty(THA)periprosthetic osteolysis and wear phenomena due to the release of metal particles,are two of the most common and have been reported to be correlated because of inflammatory responses directed towards released particles that generally activate macrophagic osteolytic effects.Therein,new masses known as pseudotumors can appear in soft tissues around a prosthetic implant.To date,there is paucity of reliable data from studies investigating for any association between the above mentioned adverse events.AIM To investigate for the existence of any association between serum and urine concentrations of metal-ions released in THA and periprosthetic osteolysis for modular neck and monolithic implants.METHODS Overall,76 patients were divided into three groups according to the type of hip prosthesis implants:Monoblock,modular with metal head and modular with ceramic head.With an average f-up of 4 years,we conducted a radiological evaluation in order to detect any area of osteolysis around the prosthesis of both the femur and the acetabulum.Moreover,serum and urinary tests were performed to assess the values of Chromium and Cobalt released.Statistical analysis was performed to determine any association between the ion release and osteolysis.RESULTS For the 3 study groups,the monolithic,modular ceramic-headed and modular metal-headed implants had different incidences of osteolysis events,which were higher for the modular implants.Furthermore,the most serious of these(grade 3)were detected almost exclusively for the modular implants with metal heads.A mapping of the affected areas was performed revealing that the highest incidences of osteolysis were evidenced in the pertrochanteric region at the femur level,and in the supero-external region at the acetabular level.Regarding the evaluation of the release of metals-ions from wear processes,serum and urinary chromium and cobalt values were found to be higher in cases of modularity,and even more so for those with metal head.Statistical linear correlation test results suggested positive correlations between increasing metal concentrations and incidences areas of osteolysis.However,no cases of pseudo-tumor were detected.CONCLUSION Future studies are needed to identify risk factors that increase peri-prosthetic metal ion levels and whether these factors might be implicated in the triggering of local events,including osteolysis and aseptic loosening.
文摘Total hip arthroplasty for adults with sequelae from childhood hip disorders poses significant challenges due to altered anatomy.The paper published by Oommen et al reviews the essential management strategies for these complex cases.This article explores the integration of finite element analysis(FEA)to enhance surgical precision and outcomes.FEA provides detailed biomechanical insights,aiding in preoperative planning,implant design,and surgical technique optimization.By simulating implant configurations and assessing bone quality,FEA helps in customizing implants and evaluating surgical techniques like subtrochanteric shortening osteotomy.Advanced imaging techniques,such as 3D printing,virtual reality,and augmented reality,further enhance total hip arthroplasty precision.Future research should focus on validating FEA models,developing patient-specific simulations,and promoting multidisciplinary collaboration.Integrating FEA and advanced technologies in total hip arthroplasty can improve functional outcomes,reduce complications,and enhance quality of life for patients with childhood hip disorder sequelae.
文摘BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many patients undergo multiple proce-dures.AIM To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second procedure.METHODS The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were excluded.Patient demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery.Outcome metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)visits.RESULTS A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were analyzed.There was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 d.For THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(P<0.001).THA patients had significantly decreased operative time only when the same sized implant was utilized(P=0.025).The vast majority(93.3%)of patients were discharged to the same type of location following their second surgery.However,when a change in disposition was present from the first surgery,patients were significantly more likely to be discharged to home after the second procedure(P=0.033).There was no difference between procedures for post-operative readmissions(P=0.438)or ED visits(P=0.915).CONCLUSION After gaining valuable experience recovering from the initial surgery,a patient’s perioperative outcomes are improved for their second TJA.This may be the result of increased confidence and decreased anxiety,and it supports the theory that enhanced patient education pre-operatively may improve outcomes.For the surgical team,the second procedure of a staged THA is more efficient,although this finding did not hold for TKA.
文摘BACKGROUND Total hip arthroplasty is a safe and effective procedure.To improve survivorship,ultrahigh molecular weight polyethylene hip liners with antioxidants have been developed.Additive antioxidant was deployed to reduce oxidation and consequential wear,loosening,or osteolysis.A unique manufacturing process was utilized for two such hip liners,the Novation®and Alteon®XLE hip liners and this research represents the first large series on this specific material.The study hypothesis was that Novation and Alteon XLE hip liners have similar short-term survivorship as other manufacturers’antioxidant liners according to procedure and outcome data from the American Joint Replacement Registry(AJRR).AIM To demonstrate similar short-term survivorship of XLE antioxidant hip liners compared to all antioxidant hip liners in AJRR.METHODS Utilizing total hip arthroplasty data from the AJRR,a retrospective review was performed for subjects who underwent implantation of Novation XLE(n=461),Alteon XLE(n=989),or any other antioxidant hip liner(termed the aggregate antioxidant group;n=39964)as of March 31,2022.Survivorship at three years and revision rates were compared statistically between the Novation group and the aggregate antioxidant group as well as the Alteon group and the aggregate antioxidant group.RESULTS Survivorship at three years post-surgery was 99.09%for Novation,97.73%for Alteon,and 97.69%for the aggregate antioxidant group.There were no reports of failure due to wear in either the Novation or Alteon groups.Among the revision categories(fracture,infection,aseptic loosening,instability,mechanical complications,wear,pain,hematoma/wound complications,or other),there were no significant differences identified in either comparison.There were also no significant differences in cumulative percent revision rates up to three years post-surgery for the Novation vs aggregate antioxidant group or the Alteon vs aggregate antioxidant group.CONCLUSION Novation and Alteon XLE hip liner revision rate and survivorship are equivalent to other antioxidant hip liners in the short term.
文摘Retrieval analysis in total knee arthroplasty(TKA)has been little studied in the literature.A narrative review of the literature to understand the current importance of retrieval analysis in TKA has been conducted.On August 27,2024,a literature search was performed in PubMed using“TKA retrieval analysis”as keywords.A total of 160 articles were found,of which only 19 were analyzed because they were directly related to the subject of this article.Rotating-platform(mobile-bearing)TKA has no surface damage advantage over fixed-bearing TKA.TKAs with central locking mechanisms are more prone to debond from the cement mantle.No major wear of the polyethylene(PE)component in TKA using oxidized zirconium components occurs.Femoral components of cobalt-chromium roughen more than oxidized zirconium femoral components.The use of a polished tibial tray over an unpolished design is advised.At short-run assessment(15 months on average),antioxidant-stabilized highly crosslinked PE components are not clinically different in surface damage,density of crosslinking,or oxidation compared to standard remelted highly crosslinked PE components.A correlation between implant position and PE component surface damage has been reported.It shows the importance of optimizing component position to reduce PE component damage.Contemporary knee tumor megaendoprostheses show notable volumetric metal wear originated at the rotating hinge.Retrieval analysis in TKA renders relevant data on how different prosthetic designs described in the literature perform.Such information can help to improve future prosthetic designs to increase prosthetic survival.
文摘Radial head(RH)arthroplasty(RHA)has emerged as a critical intervention in the management of complex elbow fractures,particularly Mason type III and IV injuries where the native RH is irreparable.Beyond its role in pain relief and joint congruity,RHA serves as a biomechanical cornerstone for restoring the lateral column and ensuring elbow stability,especially in the presence of associated ligamentous injuries or fracture-dislocations.This editorial synthesizes current evidence on RHA in Mason type III and IV RH fractures,with attention to biomechanical rationale,implant design,and complication trends.Aiming to reaffirm RHA’s position as a vital tool in contemporary elbow trauma care,a simplified treatment algorithm is presented to support individualized surgical decisionmaking.
文摘BACKGROUND Total knee arthroplasty(TKA)is a widely used treatment for advanced knee osteoarthritis;however,the incidence of failures requiring revision surgery is increasing.Identifying the causes of TKA failure and assessing the outcomes of revision procedures are essential for improving patient care.We hypothesized that infection and aseptic loosening are the primary causes of TKA failure and that revision TKA(rTKA)significantly enhances functional outcomes.AIM To examine the primary causes of TKA failure and evaluate the functional outcomes following rTKA.METHODS This descriptive study was conducted at the Department of Orthopedic Surgery,Civil Hospital,Bahawalpur,from April to September 2024.A total of 118 patients undergoing rTKA for failed primary TKA were included.Data on demographics,causes of failure,and surgical details were collected.Functional outcomes were evaluated using the Knee Society Score and Visual Analog Scale before and six months after surgery.Statistical analysis was performed using SPSS version 25.0,with statistical significance set at P<0.05.RESULTS The leading causes of TKA failure were infection(45.8%),aseptic loosening(44.1%),and periprosthetic fractures(10.2%).The rTKA significantly improved knee function,with the mean Knee Society Score increasing from 39.43±6.18 to 78.91±6.17(P<0.001).Pain levels decreased substantially,with the mean Visual Analog Scale scores reducing from 7.99±1.37 to 1.42±1.17(P<0.001).No significant differences in outcomes were observed between single-stage and two-stage revision procedures.CONCLUSION Infection and aseptic loosening are the predominant causes of TKA failure.The rTKA effectively enhances knee function and alleviates pain,offering significant benefits to patients.
文摘BACKGROUND The prevalence of depressive symptoms in patients undergoing total knee arthroplasty(TKA)ranges from 22%to 26%.The impact of depression on functional status post-TKA remains controversial.AIM To be the first study in Latin American population to evaluate the association between depression and functional status one year after TKA,hypothesizing that elderly patients with depression will demonstrate lower rates of functional improvement.METHODS We conducted an observational,descriptive and analytic,retrospective cohort study involving patients over 65 years old who were indicated for TKA.Assessments were made via the Program for Determination and Management of Risks for Practices and Procedures of the Division of Geriatric Medicine at the Italian Hospital of Buenos Aires,between June 2015 and July 2019.Depression screening was conducted using Yesavage’s abbreviated score and Patient Health Questionnaire-9,while functional ability was evaluated using the Knee Society Score(KSS).RESULTS Of the 100 patients analyzed,22(22%)screened positive for depression.The mean age was 80 years±6.3 years,with an average of 77.6 years±6 years in the depressed group and 80.6 years±6.3 years in the non-depressed group(P=0.05).Depressed patients showed significantly greater cognitive impairment[clock-face drawing test median:5(3-6)vs 6(5-7),P=0.06]and more risk factors for confusional syndrome(mean:8±2 vs 6.5±2.2,P=0.006).Frailty was also more prevalent in depressed patients[Edmonton:15(68%)vs 33(42%),P=0.05;Fried:17(77%)vs 42(54%),P=0.05].Postoperative Functional KSS were similar between groups(depressed:65±22.1 vs non-depressed:66.3±20.3,P=0.8).Linear regression analysis revealed no association between depression and changes in KSS.Spearman’s rank correlation coefficients were-0.0304(P=0.8)for Functional KSS variation and-0.1(P=0.3)for KSS variation.CONCLUSION Depression in patients with osteoarthritis should not hinder surgical planning.Identifying and treating depression preoperatively may enhance outcomes such as pain relief and reduce risks of acute confusional syndrome,cognitive impairment,and frailty.
文摘BACKGROUND Total knee arthroplasty(TKA)aims to restore motion and alleviate pain,enabling patients to return to daily activities.Despite advances in implants,surgery,and perioperative care,patient dissatisfaction rates remain significant.AIM To determine whether ankle symptoms are associated with inferior results of functional recovery of the knee following TKA.METHODS This prospective study included all patients with advanced knee osteoarthritis who underwent a primary unilateral TKA between August 2019 and December 2019 with data documented by the treating surgeon and outpatient physical therapists.Patients were categorized based on ankle symptoms using the Ame-rican Orthopaedic Foot and Ankle Society(AOFAS)score:(1)Group 1(AOFAS≤85,n=30);and(2)Group 2(AOFAS>85,n=49).Active range of motion(ROM),the Knee Injury and Osteoarthritis Outcome Score(KOOS),and the visual ana-logue scale(VAS)were compared between two groups.RESULTS Postoperative KOOS,ROM,and VAS significantly improved in both groups(P<0.001).However,at three months,KOOS(P=0.02)and extension motion(P=0.01)improvements were significantly greater in group 2.CONCLUSION These findings suggest that preoperative ankle symptoms may negatively impact early knee functional recovery,particularly in KOOS scores and extension motion.
文摘BACKGROUND Sagittal spinopelvic alignment(SSA)is essential for preserving a stable and effective upright posture and locomotion.Although alterations in the SSA are recognised to induce compensatory modifications in the pelvis,hips,and knees,the inverse relationship concerning knee pathology undergoing total knee arthroplasty(TKA)has been examined by a limited number of studies,yielding inconclusive results.AIM To generate evidence of the effect of TKA on the SSA from existing literature.METHODS Databases like PubMed,EMBASE,and Scopus were used to identify articles related to the“knee spine syndrome”phenomenon using a combination of subject terms and keywords such as“spinopelvic parameters”,“sagittal spinal balance”,and“total knee arthroplasty”were used with appropriate Boolean operators.Studies measuring the SSA following TKA were included,and research was conducted as per preferred reporting items for systematic review and metaanalysis guidelines.RESULTS A total of 475 participants had undergone TKA,and six studies measuring SSA were analysed.Following TKA,pelvic tilt was the only parameter that showed significant changes,while lumbar lordosis(LL),pelvic incidence,and sacral slope were non-significant,as evident from the forest plots.CONCLUSION The body's sagittal alignment is a complex balance between pelvic,spine,and lower extremity parameters.TKA,while having the potential to correct the flexion contracture,can also correct it.Still,the primary SSA for spinal pathology,i.e.,LL,may not be corrected in patients with co-existent spinal degenerative disease.
