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 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 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
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
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
Osteoarthritis(OA)is an extremely prevalent degenerative joint disease which commonly occurs in the knee.In severe cases of knee OA,total knee arthroplasty(TKA)is often indicated to relieve pain and restore limb align...Osteoarthritis(OA)is an extremely prevalent degenerative joint disease which commonly occurs in the knee.In severe cases of knee OA,total knee arthroplasty(TKA)is often indicated to relieve pain and restore limb alignment.While studies have shown how TKA improves knee symptoms,the relationship between the operated knee with the hip and ankle remains understudied.A prospective study by Buterin et al showed a significant relationship between reduced ankle symptoms and better TKA recovery.The objective of this paper is to explore ways to expand the completed study to make it more widely applicable.These include sampling patients from multiple surgical centers in different cultural backgrounds,including different etiologies of OA,extending the study time points,and evaluating the contralateral limb.Together,the study by Buterin et al combined with future work can elucidate new TKA rehabilitation techniques which focus on the entire lower extremity.展开更多
BACKGROUND In the management of postoperative pain following total joint arthroplasty(TJA),the use of nonsteroidal anti-inflammatory drugs,including acetaminophen,plays a key role in alleviating pain.However,the compa...BACKGROUND In the management of postoperative pain following total joint arthroplasty(TJA),the use of nonsteroidal anti-inflammatory drugs,including acetaminophen,plays a key role in alleviating pain.However,the comparison between intravenous and oral acetaminophen administration in patients undergoing full joint replacement surgery remains controversial.AIM To assess the effectiveness of intravenous and oral acetaminophen in alleviating pain and supporting rehabilitation following TJA.METHODS PubMed,Embase and the Cochrane Library were comprehensively searched to identify cohort studies.The effects of intravenous and oral acetaminophen for managing pain and supporting rehabilitation following TJA were analysed using randomized controlled trials.PRISMA guidelines were followed.The effectiveness of the administration routes was compared based on visual analogue scale(VAS)scores at 24 and 48 h,total morphine usage within 24 h,and total duration of hospital stay.RESULTS The meta-analysis included seven studies comparing intravenous acetaminophen groups and oral acetaminophen groups.The results demonstrated that oral acetaminophen was comparable to intravenous acetaminophen with regard to VAS scores at 24 h and 48 h(P=0.76 and 0.08,respectively).The difference in total morphine use between the two groups was not significant(P=0.22).However,the total hospital stay duration of the intravenous acetaminophen groups was significantly reduced compared to the oral acetaminophen groups(P=0.0005),showing significant advantages in optimizing postoperative recovery and shortening hospitalisation time.CONCLUSION After TJA surgery,intravenous injection of acetaminophen can shorten hospitalisation time and is suitable for rapid analgesia,Oral administration has become the preferred choice for mild cases due to its convenience and economy,providing a basis for clinical drug selection.展开更多
Augmented reality(AR)is a technology that superimposes digital information onto real-world objects via head-mounted display devices to improve surgical finesse through visually enhanced medical information.With the ra...Augmented reality(AR)is a technology that superimposes digital information onto real-world objects via head-mounted display devices to improve surgical finesse through visually enhanced medical information.With the rapid development of digital technology,AR has been increasingly adopted in orthopedic surgeries across the globe,especially in total knee arthroplasty procedures which demand high precision.By overlaying digital information onto the surgeon's field of view,AR systems enhance precision,improve alignment accuracy,and reduce the risk of complications associated with malalignment.Some concerns have been raised despite accuracy,including the learning curve,long-term outcomes,and technical limitations.Furthermore,it is essential for health practitioners to gain trust in the utilisation of AR.展开更多
BACKGROUND Return to work(RTW)and resumption of driving(ROD)are critical factors that influence postoperative quality of life in patients undergoing total hip arthroplasty(THA).However,few studies have focused on the ...BACKGROUND Return to work(RTW)and resumption of driving(ROD)are critical factors that influence postoperative quality of life in patients undergoing total hip arthroplasty(THA).However,few studies have focused on the minimally invasive(MIS)approach and its effect on these outcomes.AIM To investigate RTW and ROD's timelines and influencing factors following anterior MIS-THA.METHODS A retrospective analysis was conducted on 124 patients who underwent anterior MIS-THA.Data on the demographics,occupational physical demands,and RTW/ROD timelines were also collected.Clinical outcomes were measured using standardised scoring systems.Statistical analyses were performed to evaluate the differences between the groups based on employment status and physical workload.RESULTS Among employed patients,the RTW rate was 94.7%,with an average return time of five weeks.The average ROD time was 3.5 weeks across all patients.Despite similar postoperative clinical scores,RTW time was significantly influenced by occupations'physical workload,with heavier physical demands associated with delayed RTW.CONCLUSION Anterior MIS-THA facilitates early RTW and ROD,particularly in occupations with lower physical demands.These findings highlight the importance of considering occupational and physical workload in postoperative care planning to optimize recovery outcomes.展开更多
BACKGROUND Periprosthetic fractures of the tibia are uncommon complications after total knee arthroplasty(TKA).Therefore,there is still clinical debate regarding the appropriate treatment method.This study presents th...BACKGROUND Periprosthetic fractures of the tibia are uncommon complications after total knee arthroplasty(TKA).Therefore,there is still clinical debate regarding the appropriate treatment method.This study presents the case of a patient with two successive periprosthetic fractures of the tibial shaft treated with revision TKA(rTKA)and intramedullary fixation.CASE SUMMARY A 65-year-old woman was treated for tibial shaft pseudarthrosis after a periprosthetic fracture.The patient underwent rTKA with a tibial component exchange to a long-stemmed implant.At her 1.5-year follow-up visit,partial asymptomatic bone union was noted with no prosthesis loosening.The patient achieved 0°to 120°range of motion and a stable knee,and reported high satisfaction.Improvements were observed in the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)from 74 to 17,and in the knee society scores(KSS)from 56 to 91(clinical)and 10 to 80(functional).After 2.5 years,the patient sustained a second fracture below the original site due to low-energy trauma.The rTKA with intramedullary stabilization was performed.One year later,WOMAC and clinical and functional KSS were 15,81,and 80,respectively.Despite tibial shortening and lower limb inequality,the patient remains very satisfied and does not experience any issues with daily activities nor weight-bearing.CONCLUSION There is little consensus in the literature on the management of tibial shaft periprosthetic fractures.Intramedullary stabilization may yield excellent outcomes,but individual case discussion is necessary for rTKA indications.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 Certain implant combinations change leg length and offset in primary total hip arthroplasty(THA).Poor restoration of leg biomechanics is a frequently cited reason for patient dissatisfaction following prima...BACKGROUND Certain implant combinations change leg length and offset in primary total hip arthroplasty(THA).Poor restoration of leg biomechanics is a frequently cited reason for patient dissatisfaction following primary THA.A pure high-offset stem should provide direct lateralization without affecting femoral length when compared to a standard stem.However,clinical experience with preoperative planning software based on computed tomography-based three-dimensionalmodels reveals that using pure high-offset stems in THA may cause a difference between expected(no change in femoral length)and actual(small increase)in postoperative femoral length.AIM To elucidate the causes of these femoral length discrepancies using preoperative planning software.METHODS Preoperative templating for 43 robotic-assisted THAs,optimizing acetabular size and orientation,center of rotation,stem size and offset,and prosthetic head diameter were obtained.The preoperative planning software was used to calculate differences between preoperative and postoperative femoral length for standard and pure high-offset stems,unique to each patient.RESULTS Whilst the increase in femoral length between standard and high-offset stems was not significant(P=0.93),35 femurs(81.4%)experienced a 1-mm increase,and 3(7.0%)experienced a 2-mm increase in femoral length while using high-offset stem compared to the standard stem.The incidence of femoral length increase was lower for patients with shorter femurs(18/22;81.8%)compared to patients with longer femurs(20/21;95.2%).CONCLUSION When pure high-offset stems were used in preoperative planning software,we demonstrated an unexpected increase in leg length between 1-2-mm in 88.4%of patients.This unexpected increase in femoral length is due to a function of the preoperative planning software’s planned stem alignment with the anatomical axis,and not an inherent fault in the stem design.With expanding accessibility of robotic-assisted THA platforms,all potential sources of postoperative leg length discrepancy should be identified during preoperative templating and necessary alterations to the surgical plan should be made to accommodate this unexpected difference when using a pure high-offset stem.展开更多
BACKGROUND Leg length discrepancy(LLD)following total hip arthroplasty(THA)is a common complaint,leading to decreased patient satisfaction.However,the effect of LLD before THA on outcomes and complications is not well...BACKGROUND Leg length discrepancy(LLD)following total hip arthroplasty(THA)is a common complaint,leading to decreased patient satisfaction.However,the effect of LLD before THA on outcomes and complications is not well defined.AIM To assess the effect of prior LLD on rates of falls,implant-related complications,stay length,readmissions,and implant survival following THA.METHODS A retrospective review of a nationwide insurance database was conducted from 2010 to 2021.All cases of THA and those with a prior diagnosis of LLD were identified.THA patients with LLD were matched to control patients 1:5 based on demographic and comorbidity profiles.Two-year fall rates and implant complications,lengths of stay,90-day readmissions,and time to revision were compared between cohorts.RESULTS A total of 2038 patients with LLD were matched to 10165 control patients.The LLD group showed significantly greater rates of falls[odds ratio(OR)=1.58;95%confidence interval(95%CI):1.24-2.01],dislocation(OR=2.61;95%CI:2.10-3.24),mechanical loosening(OR=4.58;95%CI:3.28-6.29),and periprosthetic fracture(OR=2.70;95%CI:1.96-3.72)compared to the control group(all P<0.001).Mean length of stay(LOS)was also significantly higher in the LLD group(3.1 days vs 2.8 days,P=0.034).No significant difference in 90-day readmission rates(7.75%vs 7.02%,P=0.244)was observed between the groups(P=0.244).Time to revision was significantly less in the LLD group(225 days vs 544 days,P<0.001).CONCLUSION LLD in patients having THA is related with significantly higher fall risk,rates of implant-related complications,LOS,and quicker time to revision.Identifying patients with LLD before their THA may help in identifying risks,better patient counselling,and more effective preoperative planning.However,the study have important limitations:Its design lacks information on the degree and cause of LLD,the time between diagnosis and surgery,and which leg with the discrepancy underwent the operation.Future well-designed studies should confirm the findings of this study.展开更多
This editorial critically evaluated the recent study by Ishikura et al,which examined the impact of anterior minimally invasive total hip arthroplasty(MISTHA)on postoperative quality of life,with a specific focus on t...This editorial critically evaluated the recent study by Ishikura et al,which examined the impact of anterior minimally invasive total hip arthroplasty(MISTHA)on postoperative quality of life,with a specific focus on the timeline and influencing factors for return to work and resumption of driving.Ishikura et al's research demonstrated that anterior MIS-THA could shorten recovery time,reduce postoperative pain,and significantly enhance patients'quality of life and productivity.Their findings identified occupational type and work intensity as key determinants of postoperative recovery.By synthesizing evidence from multiple studies,this analysis systematically evaluated the clinical advantages of anterior MIS-THA—including reduced soft tissue trauma and accelerated functional recovery—while acknowledging its limitations,such as a steep surgical learning curve and early postoperative complication risks.The discussion emphasized the necessity of designing personalized rehabilitation protocols that accounted for patients'occupational demands.Notably,while current findings primarily derived from retrospective analyses,the article highlighted the need for prospective cohort studies to validate these observations.The commentary also addressed ongoing debates in the field,particularly the elevated complication rates associated with the direct anterior approach compared to posterior techniques,thereby underscoring the critical role of surgeon expertise in optimizing procedural safety.Collectively,this evaluation advanced our understanding of postoperative recovery dynamics in anterior MIS-THA and provides evidencebased insights to refine clinical rehabilitation frameworks.展开更多
BACKGROUND Anxiety,depression,and postoperative pain are common in patients with hip joint disorders and are associated with compromised functional outcomes and delayed recovery.AIM To investigate the prevalence of an...BACKGROUND Anxiety,depression,and postoperative pain are common in patients with hip joint disorders and are associated with compromised functional outcomes and delayed recovery.AIM To investigate the prevalence of anxiety and depression among geriatric patients who underwent total hip arthroplasty(THA),explored their association with postoperative pain,and identified contributing risk factors.METHODS A total of 111 geriatric patients who underwent THA between January 2021 and January 2024 were included.Standardized psychological assessment tools-including the Zung Self-Rating Anxiety Scale(SAS)and the Zung Self-Rating Depression Scale(SDS)-and the Numeric Rating Scale(NRS)for pain quantification were systematically administered.Pearson correlation analysis was utilized to explore the relationships among SAS,SDS,and NRS scores.Univariate and multivariate binary logistic regression analyses were conducted to identify risk factors for anxiety and depression in these patients.RESULTS The cohort exhibited moderate anxiety(SAS:44.23±9.03),mild depression(SDS:46.98±9.15),and moderate postoperative pain(NRS:4.93±2.37).Patients with anxiety or depression reported significantly higher NRS scores than those without these conditions.Significant positive correlations were observed between SAS and SDS scores,as well as between each of these and NRS scores.Univariate analysis revealed that gender,age,disease duration,alcohol use,diabetes history,and NRS scores were significantly associated with anxiety and depression.Multivariate analysis further identified female gender,disease duration≥2 years,alcohol use,and NRS scores≥5 as independent predictors of postoperative psychological distress.CONCLUSION Anxiety and depression are closely linked with postoperative pain in geriatric patients post-THA recovery.Early psychological screening and multimodal pain management strategies are recommended-particularly for individuals with a disease duration of≥2 years,a history of alcohol consumption,or an NRS score of≥5,as well as female patients-to effectively mitigate their negative emotional states and improve postoperative recovery.展开更多
BACKGROUND Total hip arthroplasty(THA)is an increasingly common treatment for older patients with hip osteoarthritis.Psychological stress is common before THA,although its clinical effects on selected parameters such ...BACKGROUND Total hip arthroplasty(THA)is an increasingly common treatment for older patients with hip osteoarthritis.Psychological stress is common before THA,although its clinical effects on selected parameters such as joint function,quality of life,and postoperative complications remain unclear.AIM To investigate the effects of preoperative psychological stress on selected parameters in older patients who underwent THA.METHODS Ninety older patients who underwent THA between January 2023 and August 2024 were divided into two groups by their preoperative self-rated anxiety scale and self-rated depression scale scores,including high-stress(n=42)and lowstress(n=48).The postoperative joint function,short form-36 health survey(SF36)score,incidence of postoperative complications,and other indicators were compared between the two groups.Pearson’s correlation coefficient analysis of the relationship among preoperative psychological stress,quality of life,and postoperative complications was performed.RESULTS Postoperative joint function and quality of life were lower in the high-stress group than they were in the low-stress group(P<0.05).The incidence of postoperative complications was higher in the high-stress group(29.27%)than it was in the low-stress group(9.30%)(P<0.05).Cor-relation analysis revealed that psychological stress was correlated with the Harris hip and SF-36 scores.Total scores on the scale,including physical function,physical pain,general health,mental health,social function,vitality,and emotional function,were negatively correlated(P<0.05).CONCLUSION Preoperative psychological stress results in adverse effects on quality of life and complications in older patients undergoing THA.Therefore,pre-operative psychological interventions should be strengthened to improve postoperative outcomes.展开更多
Objective: The present research aims to determine if adherence to the Lewinnek safe zone, when exclusively considered, constitutes a pivotal element for ensuring stability in the context of total hip arthroplasty. Thi...Objective: The present research aims to determine if adherence to the Lewinnek safe zone, when exclusively considered, constitutes a pivotal element for ensuring stability in the context of total hip arthroplasty. This is done by examining the acetabular placement in instances of hip dislocation after total hip arthroplasty (THA). Methodology: The authors searched 2653 patient records from 2015 to 2022 looking for patients who had total hip arthroplasty at our facility. For the analysis, 23 patients were culled from 64 individuals who exhibited post-THA dislocations, employing a stringent exclusion criterion, and the resultant acetabular angulation and anteversion were quantified utilizing PEEKMED software (Peek Health S.A., Portugal) upon radiographic evidence. Results: Within the operational timeframe, from the cohort of 2653 subjects, 64 presented with at least a singular incident of displacement. Post-exclusion criterion enforcement, 23 patients were eligible for inclusion. Of these, 10 patients conformed to the safe zone demarcated by Lewinnek for both inclination and anteversion angles, while 13 exhibited deviations from the prescribed anteversion and/or inclination benchmarks. Conclusion: Analysis of the 23 patients reveals that 13 did not confirm to be in the safe zone parameters for anteversion and/or inclination, whereas 10 were within the safe zone as per Lewinnek’s guidelines. This investigative review, corroborated by extant literature, suggests that the isolated consideration of the Lewinnek safe zone does not suffice as a solitary protective factor. It further posits that additional variables are equally critical as acetabular positioning and mandate individual assessment.展开更多
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 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 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.
文摘Osteoarthritis(OA)is an extremely prevalent degenerative joint disease which commonly occurs in the knee.In severe cases of knee OA,total knee arthroplasty(TKA)is often indicated to relieve pain and restore limb alignment.While studies have shown how TKA improves knee symptoms,the relationship between the operated knee with the hip and ankle remains understudied.A prospective study by Buterin et al showed a significant relationship between reduced ankle symptoms and better TKA recovery.The objective of this paper is to explore ways to expand the completed study to make it more widely applicable.These include sampling patients from multiple surgical centers in different cultural backgrounds,including different etiologies of OA,extending the study time points,and evaluating the contralateral limb.Together,the study by Buterin et al combined with future work can elucidate new TKA rehabilitation techniques which focus on the entire lower extremity.
基金Supported by National Natural Science Foundation of China,No.11772226 and No.81572154.
文摘BACKGROUND In the management of postoperative pain following total joint arthroplasty(TJA),the use of nonsteroidal anti-inflammatory drugs,including acetaminophen,plays a key role in alleviating pain.However,the comparison between intravenous and oral acetaminophen administration in patients undergoing full joint replacement surgery remains controversial.AIM To assess the effectiveness of intravenous and oral acetaminophen in alleviating pain and supporting rehabilitation following TJA.METHODS PubMed,Embase and the Cochrane Library were comprehensively searched to identify cohort studies.The effects of intravenous and oral acetaminophen for managing pain and supporting rehabilitation following TJA were analysed using randomized controlled trials.PRISMA guidelines were followed.The effectiveness of the administration routes was compared based on visual analogue scale(VAS)scores at 24 and 48 h,total morphine usage within 24 h,and total duration of hospital stay.RESULTS The meta-analysis included seven studies comparing intravenous acetaminophen groups and oral acetaminophen groups.The results demonstrated that oral acetaminophen was comparable to intravenous acetaminophen with regard to VAS scores at 24 h and 48 h(P=0.76 and 0.08,respectively).The difference in total morphine use between the two groups was not significant(P=0.22).However,the total hospital stay duration of the intravenous acetaminophen groups was significantly reduced compared to the oral acetaminophen groups(P=0.0005),showing significant advantages in optimizing postoperative recovery and shortening hospitalisation time.CONCLUSION After TJA surgery,intravenous injection of acetaminophen can shorten hospitalisation time and is suitable for rapid analgesia,Oral administration has become the preferred choice for mild cases due to its convenience and economy,providing a basis for clinical drug selection.
基金Supported by The Hunan Provincial Natural Science Foundation of China,No.2023JJ30773,No.2025JJ60480,and No.2025JJ60552The Scientific Research Program of The Hunan Provincial Health Commission,No.202204072544+4 种基金The Science and Technology Innovation Program of Hunan Province,No.2024RC3053The CBT ECR/MCR Scheme,No.324910-0028/07National Natural Science Foundation of China,No.32300652The Scientific Research Program of Hunan Provincial Health Commission,No.W20243023The Scientific Research Launch Project for New Employees of The Second Xiangya Hospital of Central South University.
文摘Augmented reality(AR)is a technology that superimposes digital information onto real-world objects via head-mounted display devices to improve surgical finesse through visually enhanced medical information.With the rapid development of digital technology,AR has been increasingly adopted in orthopedic surgeries across the globe,especially in total knee arthroplasty procedures which demand high precision.By overlaying digital information onto the surgeon's field of view,AR systems enhance precision,improve alignment accuracy,and reduce the risk of complications associated with malalignment.Some concerns have been raised despite accuracy,including the learning curve,long-term outcomes,and technical limitations.Furthermore,it is essential for health practitioners to gain trust in the utilisation of AR.
基金approved by the Institutional Ethics Committee of Shizuoka Red Cross Hospital(No.2023-36,approval date:January 12,2024).
文摘BACKGROUND Return to work(RTW)and resumption of driving(ROD)are critical factors that influence postoperative quality of life in patients undergoing total hip arthroplasty(THA).However,few studies have focused on the minimally invasive(MIS)approach and its effect on these outcomes.AIM To investigate RTW and ROD's timelines and influencing factors following anterior MIS-THA.METHODS A retrospective analysis was conducted on 124 patients who underwent anterior MIS-THA.Data on the demographics,occupational physical demands,and RTW/ROD timelines were also collected.Clinical outcomes were measured using standardised scoring systems.Statistical analyses were performed to evaluate the differences between the groups based on employment status and physical workload.RESULTS Among employed patients,the RTW rate was 94.7%,with an average return time of five weeks.The average ROD time was 3.5 weeks across all patients.Despite similar postoperative clinical scores,RTW time was significantly influenced by occupations'physical workload,with heavier physical demands associated with delayed RTW.CONCLUSION Anterior MIS-THA facilitates early RTW and ROD,particularly in occupations with lower physical demands.These findings highlight the importance of considering occupational and physical workload in postoperative care planning to optimize recovery outcomes.
文摘BACKGROUND Periprosthetic fractures of the tibia are uncommon complications after total knee arthroplasty(TKA).Therefore,there is still clinical debate regarding the appropriate treatment method.This study presents the case of a patient with two successive periprosthetic fractures of the tibial shaft treated with revision TKA(rTKA)and intramedullary fixation.CASE SUMMARY A 65-year-old woman was treated for tibial shaft pseudarthrosis after a periprosthetic fracture.The patient underwent rTKA with a tibial component exchange to a long-stemmed implant.At her 1.5-year follow-up visit,partial asymptomatic bone union was noted with no prosthesis loosening.The patient achieved 0°to 120°range of motion and a stable knee,and reported high satisfaction.Improvements were observed in the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)from 74 to 17,and in the knee society scores(KSS)from 56 to 91(clinical)and 10 to 80(functional).After 2.5 years,the patient sustained a second fracture below the original site due to low-energy trauma.The rTKA with intramedullary stabilization was performed.One year later,WOMAC and clinical and functional KSS were 15,81,and 80,respectively.Despite tibial shortening and lower limb inequality,the patient remains very satisfied and does not experience any issues with daily activities nor weight-bearing.CONCLUSION There is little consensus in the literature on the management of tibial shaft periprosthetic fractures.Intramedullary stabilization may yield excellent outcomes,but individual case discussion is necessary for rTKA indications.
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 Certain implant combinations change leg length and offset in primary total hip arthroplasty(THA).Poor restoration of leg biomechanics is a frequently cited reason for patient dissatisfaction following primary THA.A pure high-offset stem should provide direct lateralization without affecting femoral length when compared to a standard stem.However,clinical experience with preoperative planning software based on computed tomography-based three-dimensionalmodels reveals that using pure high-offset stems in THA may cause a difference between expected(no change in femoral length)and actual(small increase)in postoperative femoral length.AIM To elucidate the causes of these femoral length discrepancies using preoperative planning software.METHODS Preoperative templating for 43 robotic-assisted THAs,optimizing acetabular size and orientation,center of rotation,stem size and offset,and prosthetic head diameter were obtained.The preoperative planning software was used to calculate differences between preoperative and postoperative femoral length for standard and pure high-offset stems,unique to each patient.RESULTS Whilst the increase in femoral length between standard and high-offset stems was not significant(P=0.93),35 femurs(81.4%)experienced a 1-mm increase,and 3(7.0%)experienced a 2-mm increase in femoral length while using high-offset stem compared to the standard stem.The incidence of femoral length increase was lower for patients with shorter femurs(18/22;81.8%)compared to patients with longer femurs(20/21;95.2%).CONCLUSION When pure high-offset stems were used in preoperative planning software,we demonstrated an unexpected increase in leg length between 1-2-mm in 88.4%of patients.This unexpected increase in femoral length is due to a function of the preoperative planning software’s planned stem alignment with the anatomical axis,and not an inherent fault in the stem design.With expanding accessibility of robotic-assisted THA platforms,all potential sources of postoperative leg length discrepancy should be identified during preoperative templating and necessary alterations to the surgical plan should be made to accommodate this unexpected difference when using a pure high-offset stem.
文摘BACKGROUND Leg length discrepancy(LLD)following total hip arthroplasty(THA)is a common complaint,leading to decreased patient satisfaction.However,the effect of LLD before THA on outcomes and complications is not well defined.AIM To assess the effect of prior LLD on rates of falls,implant-related complications,stay length,readmissions,and implant survival following THA.METHODS A retrospective review of a nationwide insurance database was conducted from 2010 to 2021.All cases of THA and those with a prior diagnosis of LLD were identified.THA patients with LLD were matched to control patients 1:5 based on demographic and comorbidity profiles.Two-year fall rates and implant complications,lengths of stay,90-day readmissions,and time to revision were compared between cohorts.RESULTS A total of 2038 patients with LLD were matched to 10165 control patients.The LLD group showed significantly greater rates of falls[odds ratio(OR)=1.58;95%confidence interval(95%CI):1.24-2.01],dislocation(OR=2.61;95%CI:2.10-3.24),mechanical loosening(OR=4.58;95%CI:3.28-6.29),and periprosthetic fracture(OR=2.70;95%CI:1.96-3.72)compared to the control group(all P<0.001).Mean length of stay(LOS)was also significantly higher in the LLD group(3.1 days vs 2.8 days,P=0.034).No significant difference in 90-day readmission rates(7.75%vs 7.02%,P=0.244)was observed between the groups(P=0.244).Time to revision was significantly less in the LLD group(225 days vs 544 days,P<0.001).CONCLUSION LLD in patients having THA is related with significantly higher fall risk,rates of implant-related complications,LOS,and quicker time to revision.Identifying patients with LLD before their THA may help in identifying risks,better patient counselling,and more effective preoperative planning.However,the study have important limitations:Its design lacks information on the degree and cause of LLD,the time between diagnosis and surgery,and which leg with the discrepancy underwent the operation.Future well-designed studies should confirm the findings of this study.
文摘This editorial critically evaluated the recent study by Ishikura et al,which examined the impact of anterior minimally invasive total hip arthroplasty(MISTHA)on postoperative quality of life,with a specific focus on the timeline and influencing factors for return to work and resumption of driving.Ishikura et al's research demonstrated that anterior MIS-THA could shorten recovery time,reduce postoperative pain,and significantly enhance patients'quality of life and productivity.Their findings identified occupational type and work intensity as key determinants of postoperative recovery.By synthesizing evidence from multiple studies,this analysis systematically evaluated the clinical advantages of anterior MIS-THA—including reduced soft tissue trauma and accelerated functional recovery—while acknowledging its limitations,such as a steep surgical learning curve and early postoperative complication risks.The discussion emphasized the necessity of designing personalized rehabilitation protocols that accounted for patients'occupational demands.Notably,while current findings primarily derived from retrospective analyses,the article highlighted the need for prospective cohort studies to validate these observations.The commentary also addressed ongoing debates in the field,particularly the elevated complication rates associated with the direct anterior approach compared to posterior techniques,thereby underscoring the critical role of surgeon expertise in optimizing procedural safety.Collectively,this evaluation advanced our understanding of postoperative recovery dynamics in anterior MIS-THA and provides evidencebased insights to refine clinical rehabilitation frameworks.
文摘BACKGROUND Anxiety,depression,and postoperative pain are common in patients with hip joint disorders and are associated with compromised functional outcomes and delayed recovery.AIM To investigate the prevalence of anxiety and depression among geriatric patients who underwent total hip arthroplasty(THA),explored their association with postoperative pain,and identified contributing risk factors.METHODS A total of 111 geriatric patients who underwent THA between January 2021 and January 2024 were included.Standardized psychological assessment tools-including the Zung Self-Rating Anxiety Scale(SAS)and the Zung Self-Rating Depression Scale(SDS)-and the Numeric Rating Scale(NRS)for pain quantification were systematically administered.Pearson correlation analysis was utilized to explore the relationships among SAS,SDS,and NRS scores.Univariate and multivariate binary logistic regression analyses were conducted to identify risk factors for anxiety and depression in these patients.RESULTS The cohort exhibited moderate anxiety(SAS:44.23±9.03),mild depression(SDS:46.98±9.15),and moderate postoperative pain(NRS:4.93±2.37).Patients with anxiety or depression reported significantly higher NRS scores than those without these conditions.Significant positive correlations were observed between SAS and SDS scores,as well as between each of these and NRS scores.Univariate analysis revealed that gender,age,disease duration,alcohol use,diabetes history,and NRS scores were significantly associated with anxiety and depression.Multivariate analysis further identified female gender,disease duration≥2 years,alcohol use,and NRS scores≥5 as independent predictors of postoperative psychological distress.CONCLUSION Anxiety and depression are closely linked with postoperative pain in geriatric patients post-THA recovery.Early psychological screening and multimodal pain management strategies are recommended-particularly for individuals with a disease duration of≥2 years,a history of alcohol consumption,or an NRS score of≥5,as well as female patients-to effectively mitigate their negative emotional states and improve postoperative recovery.
文摘BACKGROUND Total hip arthroplasty(THA)is an increasingly common treatment for older patients with hip osteoarthritis.Psychological stress is common before THA,although its clinical effects on selected parameters such as joint function,quality of life,and postoperative complications remain unclear.AIM To investigate the effects of preoperative psychological stress on selected parameters in older patients who underwent THA.METHODS Ninety older patients who underwent THA between January 2023 and August 2024 were divided into two groups by their preoperative self-rated anxiety scale and self-rated depression scale scores,including high-stress(n=42)and lowstress(n=48).The postoperative joint function,short form-36 health survey(SF36)score,incidence of postoperative complications,and other indicators were compared between the two groups.Pearson’s correlation coefficient analysis of the relationship among preoperative psychological stress,quality of life,and postoperative complications was performed.RESULTS Postoperative joint function and quality of life were lower in the high-stress group than they were in the low-stress group(P<0.05).The incidence of postoperative complications was higher in the high-stress group(29.27%)than it was in the low-stress group(9.30%)(P<0.05).Cor-relation analysis revealed that psychological stress was correlated with the Harris hip and SF-36 scores.Total scores on the scale,including physical function,physical pain,general health,mental health,social function,vitality,and emotional function,were negatively correlated(P<0.05).CONCLUSION Preoperative psychological stress results in adverse effects on quality of life and complications in older patients undergoing THA.Therefore,pre-operative psychological interventions should be strengthened to improve postoperative outcomes.
文摘Objective: The present research aims to determine if adherence to the Lewinnek safe zone, when exclusively considered, constitutes a pivotal element for ensuring stability in the context of total hip arthroplasty. This is done by examining the acetabular placement in instances of hip dislocation after total hip arthroplasty (THA). Methodology: The authors searched 2653 patient records from 2015 to 2022 looking for patients who had total hip arthroplasty at our facility. For the analysis, 23 patients were culled from 64 individuals who exhibited post-THA dislocations, employing a stringent exclusion criterion, and the resultant acetabular angulation and anteversion were quantified utilizing PEEKMED software (Peek Health S.A., Portugal) upon radiographic evidence. Results: Within the operational timeframe, from the cohort of 2653 subjects, 64 presented with at least a singular incident of displacement. Post-exclusion criterion enforcement, 23 patients were eligible for inclusion. Of these, 10 patients conformed to the safe zone demarcated by Lewinnek for both inclination and anteversion angles, while 13 exhibited deviations from the prescribed anteversion and/or inclination benchmarks. Conclusion: Analysis of the 23 patients reveals that 13 did not confirm to be in the safe zone parameters for anteversion and/or inclination, whereas 10 were within the safe zone as per Lewinnek’s guidelines. This investigative review, corroborated by extant literature, suggests that the isolated consideration of the Lewinnek safe zone does not suffice as a solitary protective factor. It further posits that additional variables are equally critical as acetabular positioning and mandate individual assessment.
