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Zhao WQ, Yu KQ, Xie RZ, Liang YF, Huang JF. Risk factors for periprosthetic femoral fractures following hip arthroplasty: a systematic review and meta-analysis. Ann Med 2025; 57:2494679. [PMID: 40265296 DOI: 10.1080/07853890.2025.2494679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Revised: 02/25/2025] [Accepted: 04/04/2025] [Indexed: 04/23/2025] Open
Abstract
INTRODUCTION Periprosthetic femoral fracture (PPFF) is a serious complication following hip arthroplasty. The objective of this study was to determine the risk factors for PPFF following hip arthroplasty from existing studies. METHODS A comprehensive systematic search was performed in 4 databases: Pubmed, Embase, Web of Science, and Cochrane Library. The last search was carried out on 26th July 2024. We focused on identifying risk factors for PPFF following hip arthroplasty. Study eligibility required PPFF as an outcome and reporting of associated risk factors. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS), with evidence certainty evaluated via Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Meta-analyses employed both fixed-effect and random-effects models to pool odds ratios for identified risk factors. RESULTS Out of 1553 articles, 36 studies published between 2006 and 2024 were included. Risk factors associated with increased incidence of PPFF ranges from very Low to High. High-quality evidence supported the use of uncemented stems (Odds Ratio [OR]: 3.36, 95% Confidence Interval [95% CI]: 3.02-3.74), major teaching hospital (OR: 2.04, 95% CI: 1.37-3.05). Moderate-quality evidence: female gender (OR: 1.60, 95% CI: 1.43-1.78), morbid obesity (OR: 1.44, 95% CI: 1.01-2.16), higher Deyo-Charlson index (OR: 1.44, 95% CI: 1.18-1.77), rheumatoid arthritis (OR: 1.89, 95% CI: 1.16-3.06), femoral Dorr type C (OR: 4.23, 95% CI: 2.82-6.33). Low evidence: age > 70 years (OR: 1.67, 95% CI: 1.19-2.34), revision hip arthroplasty (OR: 2.60, 95% CI: 1.59-4.27). BMI > 30 and history of hip surgery are not the risk (very low). Diagonized as osteoarthritis before surgery is a protective factor (OR:0.51, 95%CI: 0.40-0.65, quality = High). CONCLUSION This meta-analysis provided some low-to-high evidence about the risk of PPFF following hip arthroplasty. It's recommended that clinicians consider these risk factors when evaluating patients for hip arthroplasty and take steps to mitigate their impact, like optimizing patients health preoperatively, using cemented stems, and monitoring high-risk patients closely.
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Affiliation(s)
- Wei-Qiang Zhao
- Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ke-Qin Yu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Rong-Zhen Xie
- Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yu-Feng Liang
- Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jie-Feng Huang
- Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
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Parel PM, Kuyl EV, Haft M, Silverman R, Ramesh A, Agarwal AR, Quan T, Ranson RA, Zimmer ZR, Srikumaran U. Anti-osteoporotic treatment reduces risk of revision following total shoulder arthroplasty in patients with osteoporosis. J Shoulder Elbow Surg 2025; 34:e348-e354. [PMID: 39542235 DOI: 10.1016/j.jse.2024.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 08/22/2024] [Accepted: 09/05/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND Osteoporosis, a prevalent bone density disorder, introduces a complex dynamic in the context of total shoulder arthroplasty (TSA). However, despite the well-established association between osteoporosis and an elevated risk of revision, the existing literature lacks comprehensive insights into the impact of anti-osteoporotic therapy on surgical outcomes in the setting of TSA. Thus, the purpose of this study was to investigate whether anti-osteoporotic therapy correlates with improved revision outcomes following TSA. METHODS A retrospective cohort analysis was performed using a national all payer's claims database. Patients who underwent TSA were identified using Current Procedural Terminology and International Classification of Diseases procedure codes. Patients with a preoperative diagnosis of osteoporosis were included and stratified into 2 groups: (1) patients with osteoporosis who underwent anti-osteoporotic therapy within 6 months prior to surgery (anti-OP cohort) and (2) patients with osteoporosis who never received anti-osteoporotic treatment (no anti-OP cohort). Primary outcomes included the incidence of 2-year all-cause revision, periprosthetic fracture, periprosthetic joint infection, and mechanical loosening. Univariate and multivariable regression analysis was conducted to compare outcomes between the 2 cohorts. RESULTS In total, 40,532 osteoporotic patients were included in this study, with 11,577 (28.5%) having undergone anti-osteoporotic treatment. Patients who did not receive anti-osteoporotic treatment had significantly higher odds of 2-year all-cause revision (odds ratio: 1.31; P < .001) and mechanical loosening (odds ratio: 1.25; P < .001) following TSA when compared to those treated for osteoporosis. DISCUSSION This study demonstrates a significant association between anti-osteoporotic therapy and reduced rates of 2-year revision following TSA. Orthopedic surgeons should recognize the heightened risk of early implant failure in the absence of osteoporosis therapy. This underscores the imperative for increased screening initiatives given the high prevalence of undiagnosed or untreated osteoporosis in the TSA population. These results also emphasize the importance of integrating osteoporosis management strategies into the broader context of surgical decision-making, thereby contributing to enhanced patient outcomes and quality of care in shoulder surgery.
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Affiliation(s)
- Philip M Parel
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Emile-Victor Kuyl
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Mark Haft
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel Silverman
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Abhisri Ramesh
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Amil R Agarwal
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Theodore Quan
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rachel A Ranson
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Zachary R Zimmer
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ou JT, Tawiah W, Wainwright J, Gay SS, Nguyen A, Barimani B, Wenke JC. Robotic-assistance did not reduce complications in total hip arthroplasty. J Orthop 2025; 64:147-152. [PMID: 40352779 PMCID: PMC12059589 DOI: 10.1016/j.jor.2025.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2025] [Accepted: 04/21/2025] [Indexed: 05/14/2025] Open
Abstract
Aims & objectives Robotic-assisted total hip arthroplasty (rTHA) is an increasingly common method of joint arthroplasty used to improve surgical accuracy and reduce human error. Despite not having compelling clinical data on long-term complications or outcomes to justify additional time costs, its rate of use is increasing. In this study we compare the longitudinal rates of complications between patients undergoing conventional total hip arthroplasty (cTHA) and rTHA. Materials & methods Data from the TriNetX Research Network identified subjects with at least 5 years of patient follow up data through electronic health records. The first cohort were patients undergoing cTHA, and the second cohort included patients undergoing rTHA. Propensity score matching of known factors that can affect clinical outcomes at 1:1 ratio was performed to reduce confounding variables. Records with conditions unrelated to primary THA such as pathological fracture or revision arthroplasty were excluded. Rates of complication in five outcomes were observed at 1, 3 and 5 years: prosthetic joint infection, dislocation, revision, loosening, and periprosthetic fracture. Results The database contained 95,085 THA patients. Analysis was performed with 2241 patients in each matched cohort. At 5 years, there was no difference in all-cause complications between the cTHA cohort and rTHA cohort [OR (95 % CI), 1.073 (0.772-1.491)]. Also, no differences were noted in rates of revision [OR (95 % CI), 1.1.604(0.726, 3.543)] or dislocation [OR (95 % CI), 1.775(0.976, 3.228)]. Conclusion Despite evidence for improved surgical accuracy and reduced errors, robotic assistance did not reduce the rate of complications over a 5-year period after total hip arthroplasty.
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Affiliation(s)
- Joshua T. Ou
- John Sealy School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, United States
| | - Winston Tawiah
- John Sealy School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, United States
| | - Jared Wainwright
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, United States
- Shriners Children's Texas, 815 Market St, Galveston, TX 77550, United States
| | - Samuel S. Gay
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, United States
- Shriners Children's Texas, 815 Market St, Galveston, TX 77550, United States
| | - Adam Nguyen
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, United States
- Shriners Children's Texas, 815 Market St, Galveston, TX 77550, United States
| | - Bardia Barimani
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, United States
- Division of Orthopedic Surgery, McGill University, Montreal, Canada
| | - Joseph C. Wenke
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, United States
- Shriners Children's Texas, 815 Market St, Galveston, TX 77550, United States
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Loppini M, Guazzoni E, Gambaro FM, La Camera F, Chiappetta K, Grappiolo G. Trabecular Metal Augments for the Management of Paprosky Type III Defects Without Pelvic Discontinuity: Average 11-Year Follow-Up in Cases With Previously Reported 4-Year Clinical Results. J Arthroplasty 2025; 40:1600-1605. [PMID: 39579802 DOI: 10.1016/j.arth.2024.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 11/11/2024] [Accepted: 11/12/2024] [Indexed: 11/25/2024] Open
Abstract
BACKGROUND This retrospective case series aimed to assess the clinical and radiographic outcomes of revision total hip arthroplasty with trabecular metal (TM) augments associated with cementless TM acetabular components for the management of Paprosky type IIIA and IIIB defects without pelvic discontinuity. METHODS There were 83 hips (82 patients) enrolled. There were 53 patients who completed the clinical and radiological follow-up (64% of the total) who had a mean follow-up of 11 years (range, 7 to 16.6). There were seven patients who died during the follow-up period without undergoing further revision, and 23 were lost to follow-up. A Paprosky type IIIA defect was found in 42 hips, whereas a Paprosky type IIIB defect was present in 11 hips. We previously reported short-term outcomes for 55 hips that underwent acetabular reconstruction using TM cups associated with TM augments with a mean follow-up of 53.7 months. Here, we followed the clinical and radiological outcomes of the aforementioned patients and 28 more hips. We retrospectively collected the clinical and radiological data of all the patients operated on in our tertiary referral center between 2005 and 2016. RESULTS The average Harris Hip Score increased from 36.4 (range, 24 to 53) preoperatively to 87.4 (range, 63 to 100) at the last follow-up. The cumulative survival of the acetabular construct at 7 years of follow-up was 90.6% (95% confidence interval [CI]: 78.8 to 95.9) considering revision for any reason, and at 10 years of follow-up was 86.3% (95% CI: 73.4 to 93.2). The cumulative survival of the acetabular construct at 7 years of follow-up was 94.2% (95% CI: 83.2 to 98.1) considering revision for aseptic loosening, and at 10 years of follow-up was 92.1% (95% CI: 80.4 to 97). CONCLUSIONS The use of TM cups and augments could be considered an effective management of Paprosky type III defects without pelvic discontinuity. The present technique provides an anatomical reconstruction of the defect with the restoration of the hip center of rotation associated with good clinical and radiographic outcomes in the midterm. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy; Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Savona, Italy
| | - Edoardo Guazzoni
- IRCCS Humanitas Research Hospital, Milan, Italy; Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Savona, Italy
| | | | - Francesco La Camera
- IRCCS Humanitas Research Hospital, Milan, Italy; Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Savona, Italy
| | - Katia Chiappetta
- IRCCS Humanitas Research Hospital, Milan, Italy; Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Savona, Italy
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Milan, Italy; Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Savona, Italy
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Anderson KD, Dulion B, Wong J, Patel N, DeBenedetti A, Della Valle CJ, Ross RD. Polymorphisms in rs2069845 are associated with IL-6 and soluble IL-6 receptor levels during total joint replacement. PLoS One 2025; 20:e0312985. [PMID: 40373041 PMCID: PMC12080868 DOI: 10.1371/journal.pone.0312985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 04/03/2025] [Indexed: 05/17/2025] Open
Abstract
As the number of patients undergoing total joint replacement (TJR) surgery increases, so does the number of revision surgeries. One driver of implant failure and subsequent revision surgery is peri-implant osteolysis, which is driven by inflammation-mediated bone loss. IL-6 is an inflammatory cytokine that is elevated during the peri-operative period. Early elevations in IL-6 levels have been linked to osteolysis development. The current study asked whether there is genetic contribution to the IL-6-related peri-operative inflammatory reaction to TJR surgery. Patients undergoing primary TJR (total hip or total knee) provided pre-operative and post-operative blood samples for measurement of the circulating levels of IL-6 and the soluble IL-6 receptor (sIL-6r), as well as evaluation of allele status of three single nucleotide polymorphisms (SNPs) linked to IL-6 or sIL-6r levels - rs2069845, rs2228145, and rs4537545. Circulating sIL-6r levels were associated with allele status in the rs2228145 SNP. More interestingly, allele status in the rs2069845 SNP was associated with the change in circulating IL-6 levels following TJR surgery. Specifically, patients with the A,A allele had increasing levels of IL-6, while those harboring the G,A allele had decreasing levels of IL-6. While implant survival was not assessed, the critical role of IL-6 in peri-implant osteolysis suggests that the rs2069845 allele may influence orthopedic implant success. rs2069845 polymorphisms may be a useful patient-specific marker of inflammatory response to TJR surgery.
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Affiliation(s)
- Kyle D. Anderson
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Bryan Dulion
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, Illinois, United States of America
| | - John Wong
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Niyati Patel
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Anne DeBenedetti
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Craig J. Della Valle
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Ryan D. Ross
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, Illinois, United States of America
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Dombrowsky A, Jolissaint J, Avercamp B, Rowe T, Hietpas K, Griffin W, Curtin BM. Outcomes of Primary Cementless Femoral Stems Used in Revision Hip Arthroplasty. J Arthroplasty 2025:S0883-5403(25)00518-2. [PMID: 40373833 DOI: 10.1016/j.arth.2025.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 05/06/2025] [Accepted: 05/06/2025] [Indexed: 05/17/2025] Open
Abstract
INTRODUCTION An abundance of literature exists assessing outcomes of revision THA using diaphyseal engaging stems; however, there is little research into the use of primary-style femoral stems in revision THA. Primary stems may have benefits including cost reduction, maintenance of proximal bone stock, and ease of potential future reconstructions. The purpose of this study was to evaluate the aseptic survival rate of revision THAs using primary femoral stems. METHODS A review of our registry was performed to identify patients from 2010 to 2020 who underwent all-cause revision THA utilizing a primary metaphyseal-engaging stem for femoral reconstruction. Patients who had a history of previous revision THA or those treated with cement or bone graft augmentation were excluded. There were seven patients excluded due to a lack of two-year follow-up. Implant survival, complications requiring revision surgery, and ambulatory status at final follow-up were documented. There were 78 patients who met the final inclusion criteria. The mean follow-up was 5.2 years (range, 2.0 to 10.0). RESULTS The most common indications for index revision were aseptic loosening (44%) or infection (34%). Pre-revision Paprosky classification of the femur was Type I in 41 patients (52%), Type II in 37 patients (47%), and Type 3A in one patient (1%). Overall, 13 patients (16.5%) required re-revision, five for periprosthetic fracture, six for instability, and two for recurrent infection. Of those, seven of 13 required femoral component revision. When excluding recurrent infections, the aseptic femoral-component survivorship for the cohort was 94%. There were three patients who sustained a fracture requiring stem re-revision. A Vancouver B1 fracture was sustained > two years postoperatively, and two Vancouver B2 fractures were sustained within six months postoperatively. There were no femoral re-revisions for aseptic loosening. CONCLUSION Primary metaphyseal-engaging femoral stems provide reliable fixation during revision THA in patients who have preserved proximal metaphyseal bone with similar complication rates to those previously reported in the literature for revision THA.
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Affiliation(s)
- Alex Dombrowsky
- Department of Orthopedics, Atrium Health Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Josef Jolissaint
- Department of Orthopedics, Atrium Health Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Ben Avercamp
- Department of Orthopedics, Atrium Health Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Taylor Rowe
- OrthoCarolina Research Institute, 2001 Vail Avenue, Ste 200A, Charlotte, NC, 28207, USA
| | - Kayla Hietpas
- OrthoCarolina Research Institute, 2001 Vail Avenue, Ste 200A, Charlotte, NC, 28207, USA
| | - William Griffin
- OrthoCarolina Hip and Knee Center, 2001 Vail Avenue, Ste 200A, Charlotte, NC, 28207, USA
| | - Brian M Curtin
- OrthoCarolina Hip and Knee Center, 2001 Vail Avenue, Ste 200A, Charlotte, NC, 28207, USA.
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Ondeck NT, LeBrun DG, Roy S, Faizan A, Westrich GH. The effect of acetabular shell and liner design on posterior horizontal dislocation distance in modern dual-mobility implants. Hip Int 2025; 35:258-263. [PMID: 40170409 DOI: 10.1177/11207000251329269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2025]
Abstract
BACKGROUND The posterior horizontal dislocation distance (PHDD) is a 3-dimensional jump distance measurement that is relevant to the risk of dislocation. There are a number of dual-mobility (DM) constructs with varying designs available. The present study identifies design factors associated with increased PHDD and evaluates the PHDD of 3 DM implants. METHODS 3 different computer-aided implant designs were virtually implanted within a 3-dimensional CT-derived pelvic model. Each design represented an analogue of a DM system (MDM, OR3O, and G7) according to specific variations in acetabular liner rim build-up and femoral head centre location. The effective head diameters and PHDD values were calculated for each size acetabular shell and DM design. RESULTS The positive rim build-up design (MDM) showed higher PHDD values as compared to the other 2 hemispherical rim designs with no build-up, across all studied shell sizes. Specifically, the MDM design analogue had 16.4-29.0% greater PHDD values than the OR3O design analog and 15.2-30.5% greater PHDD values than the G7 design analogue The effect of a sfemoral head centre location relative to the liner head centre (OR3O) was negated by a larger effective head diameter to shell diameter ratio of the G7 design, resulting in similar PHDD values. CONCLUSIONS Design parameters affect the PHDD values of DM cups. The use of an elevated rim was associated with greater PHDD values. A medialised femoral head centre should also improve PHDD values, but the effect was nullified due to consecutive lower effective head diameters.
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Affiliation(s)
- Nathaniel T Ondeck
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Drake G LeBrun
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Shammodip Roy
- Advanced Technology and Research Division, Stryker Orthopedics, Mahwah, NJ, USA
| | - Ahmad Faizan
- Advanced Technology and Research Division, Stryker Orthopedics, Mahwah, NJ, USA
| | - Geoffrey H Westrich
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Leal J, Wu CJ, Seyler TM, Jiranek WA, Wellman SS, Bolognesi MP, Ryan SP. Unsuspected Positive Intra-Operative Cultures in Aseptic Revision Hip Arthroplasty: Prevalence, Management, and Infection-Free Survivorship. J Arthroplasty 2025; 40:1326-1334.e3. [PMID: 39481617 DOI: 10.1016/j.arth.2024.10.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 10/14/2024] [Accepted: 10/20/2024] [Indexed: 11/02/2024] Open
Abstract
BACKGROUND This study aimed to describe the management and outcomes of aseptic revision total hip arthroplasty (arTHA) with unsuspected intraoperative positive cultures (UPCs) compared to those with sterile cultures. METHODS A single tertiary center's institutional database was retrospectively reviewed for arTHA from January 2013 to October 2023. Preoperative Musculoskeletal Infection Society scores were assigned to patients based on available infectious workup, and those who met the criteria for periprosthetic joint infection (PJI), received antibiotic spacers, or had less than 1-year follow-up were excluded. Patients were grouped and compared according to intraoperative culture results as follows: sterile cultures, one unexpected positive culture with a new organism, one UPC with the same organism as prior PJI, ≥ two UPCs with different organisms, and ≥ 2 UPCs with the same organism. RESULTS There was a total of 604 arTHAs included in this study, of which 0.8% [5 of 604] had ≥ two UPCs with different organisms, 1.5% [9 of 604] had ≥ two UPCs with the same organism, 9.8% [59 of 604] had one UPC with a new organism, 0.2% [one of 604] had one UPC with an organism from prior PJI, and 87.7% [530 of 604] of patients had sterile cultures. When comparing 5-year infection-free survival between patients who had one UPC with a new organism and sterile cultures, there was no difference (P = 0.40); however, patients who had ≥ two UPCs with different organisms (P < 0.001), patients who had ≥ two UPCs with the same organism (P = 0.001), and patients who had one UPC of an organism from prior PJI (P < 0.001) had statistically worse infection-free survival compared to patients with sterile cultures. CONCLUSIONS Infection-free survival at five years was similar between patients who had one UPC with a new organism and those who had sterile cultures; however, ≥ two UPCs and a history of PJI are both significant risk factors for rerevision for infection after arTHA.
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Affiliation(s)
- Justin Leal
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Christine J Wu
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - William A Jiranek
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | | | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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Cipolla A, Vella-Baldacchino M, Le Baron M, Argenson JN, Flecher X. Using Porous Tantalum Uncemented Components to Manage Acetabular Defects and to Restore the Hip Center of Rotation in Revision Total Hip Arthroplasty: A Minimum Ten-Year Clinical and Radiological Study. J Arthroplasty 2025; 40:1284-1292. [PMID: 39481618 DOI: 10.1016/j.arth.2024.10.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 10/14/2024] [Accepted: 10/20/2024] [Indexed: 11/02/2024] Open
Abstract
BACKGROUND Managing acetabular defects and restoring the hip center of rotation (COR) in revision hip arthroplasty is considered a complex and challenging surgery. Among many existing options, porous tantalum components have shown favorable short-term (less than ten years) follow-up results. The present study aimed to describe clinical and radiographic outcomes in longer-term follow-up. METHODS Between 2006 and 2013, 98 patients who underwent this surgical technique in our institute were clinically and radiographically reviewed. Rerevisions for aseptic loosening of the acetabular component were examined to consider the survivorship of the implant as the primary endpoint. The clinical outcome was measured using the Harris Hip Score. Radiological signs of osseointegration, radiolucency lines, acetabular stability, and position of the hip COR were evaluated at the immediate postoperative and last follow-up radiographs. RESULTS The cup survivorship was 96% at a mean follow-up of 14 years (range, 10 to 17). Global survivorship was 83.6% if any reason for rerevisions was considered an endpoint. The most frequent complications were dislocation (13.7%) and infections (12%). Overall, 13 patients died, and 17 patients were lost to follow-up. There were 73 patients available for clinical and radiographic evaluation. The mean Harris Hip Score was 81 (range, 39 to 100). More than 80% of hips showed radiological evidence of osseointegration, and no change was found in COR position at last follow-up radiographs. CONCLUSIONS The use of porous tantalum uncemented components to manage revision hip arthroplasty can be considered a favorable solution for managing acetabular defects and restoring the hip COR with satisfactory clinical and radiological results in a long-term follow-up.
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Affiliation(s)
- Alessandra Cipolla
- University of Turin, CTO Hospital (C.T.O. Centro Traumatologico Ortopedico), Torino, Italy; Aix-Marseille University, AP-HM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Martinique Vella-Baldacchino
- Aix-Marseille University, AP-HM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France; MSk Lab - Imperial College London, Department of Surgery & Cancer, Sir Michael Uren Hub, London, UK
| | - Marie Le Baron
- Aix-Marseille University, AP-HM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France; Service de Chirurgie Orthopédique, Hôpital Nord, Pôle Locomoteur, Institut du Mouvement et de L'appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Jean-Noel Argenson
- Aix-Marseille University, AP-HM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Xavier Flecher
- Aix-Marseille University, AP-HM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France; Service de Chirurgie Orthopédique, Hôpital Nord, Pôle Locomoteur, Institut du Mouvement et de L'appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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10
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Heckmann ND, Palmer RC, Otero JE, Jaffri H, Mullen KJ, Springer BD, Lieberman JR. Dual-Mobility Articulations in Primary Total Hip Arthroplasty: Mid-Term Outcomes From the American Joint Replacement Registry. J Arthroplasty 2025; 40:1252-1257.e3. [PMID: 39515398 DOI: 10.1016/j.arth.2024.10.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 10/26/2024] [Accepted: 10/30/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND In recent years, there has been an increased utilization of dual-mobility (DM) implants in primary total hip arthroplasty (THA) to mitigate the risk of postoperative hip instability. This study aimed to present mid-term outcomes of DM bearings in primary THA using data from the American Joint Replacement Registry. METHODS Screening was conducted on patients aged ≥ 65 years who underwent primary THA between 2012 and 2018. Patients were categorized into three groups: (1) DM articulation, (2) ≤ 32-mm femoral head, and (3) ≥ 36-mm femoral head. Multivariable statistical modeling was employed to analyze patient and hospital characteristics, minimizing potential confounding variables and identifying independent associations with revision. Cox proportional hazards regression analyses were used to assess all-cause revision and revision specifically for instability. A total of 207,526 primary THAs were identified. Among them, 13,896 (6.7%) utilized DM articulation, 60,358 (29.1%) had a femoral head size of ≤ 32 mm, and 133,272 (64.2%) had a femoral head size of ≥ 36 mm. RESULTS At the 8-year follow-up, the all-cause revision rate was higher in the DM group (3.5%, 95% confidence interval [CI] 3.1 to 4.1) compared to the ≤ 32-mm (2.6%, 95% CI 2.5 to 2.8) and ≥ 36-mm (2.7%, 95% CI 2.5 to 2.9) groups. However, the revision rate for instability was comparable among the DM (0.4%, 95% CI 0.2 to 0.5), ≤ 32 mm (0.5%, 95% CI 0.4 to 0.5), and ≥ 36 mm (0.3%, 95% CI 0.3 to 0.4) groups at 8-year follow-up. CONCLUSIONS The utilization of DM was associated with higher overall revision rates. However, no significant differences in rates of revision for instability were observed among any of the bearing surface groups. These findings may be attributed to surgeons selectively utilizing DM articulations in higher-risk patients.
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Affiliation(s)
- Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Ryan C Palmer
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jesse E Otero
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina
| | - Heena Jaffri
- American Academy of Orthopaedic Surgeons, Combined Analytics Team, Rosemont, Illinois
| | - Kyle J Mullen
- American Academy of Orthopaedic Surgeons, Combined Analytics Team, Rosemont, Illinois
| | | | - Jay R Lieberman
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
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11
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Peuchot H, Haynes Simmons E, Fabre-Aubrespy M, Flecher X, Jacquet C, Argenson JN. The use of both conventional and dual-mobility components in primary total hip arthroplasty is safe in a university hospital practice. Bone Joint J 2025; 107-B:76-81. [PMID: 40306721 DOI: 10.1302/0301-620x.107b5.bjj-2024-1096.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2025]
Abstract
Aims Dislocation after total hip arthroplasty (THA) is a frequent cause of revision. Patients with intrinsic risk factors have been identified. The use of a dual-mobility (DM) acetabular component has shown great effectiveness in preventing dislocation, with questions regarding selective or absolute use. The aim of this study was to compare the outcome of conventional THA (C-THA) and DM-THA, when used for selected patients. Methods This retrospective continuous cohort study evaluated 531 patients, of whom 313 received C-THA and 218 DM-THA. There were 354 primary osteoarthritis (67%), 121 femoral neck fractures (FNFs) (23%), and 56 other indications (10%). The surgical approach was anterior (AA) in 75% cases (398) and posterior (PA) in 25% of cases (133). In the DM-THA group, 189 patients (87%) presented at least one dislocation risk factor compared to 151 patients (48%) in the C-THA group (p < 0.001). The primary outcome was major surgical complications within two years (including deep infection requiring surgery, dislocation requiring closed or open reduction, or revision surgery). Secondary outcomes included length of hospital stay and component positioning. Results There were no differences in major complications at two years' follow-up, with six patients (2.7%) in the DM-THA group and eight in the C-THA group (2.6%) (p = 0.301). There were four dislocations in the DM-THA group (three PA and one AA) and three in the C-THA group (three AA) (p = 0.402). The length of stay was significantly longer in the DM-THA group, with seven days (2 to 12) compared to four days (1 to 7) in the C-THA group (p = 0.001). Conclusion C-THA and DM-THA are complementary devices in the management of patients requiring primary THA. C-THA associated with AA is a safe option for patients with or without dislocation risk factors, excluding FNF. The selective implantation of the DM component was associated with a low rate of dislocation when THA was undertaken for FNF. The identification of dislocation risk factors is important to select patients requiring DM-THA and provide reproducible outcomes in a university hospital practice with various levels of surgeon experience.
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Affiliation(s)
- Henri Peuchot
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, Sainte Marguerite Hospital, Marseille, France
| | - Emily Haynes Simmons
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, Sainte Marguerite Hospital, Marseille, France
| | - Maxime Fabre-Aubrespy
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, Sainte Marguerite Hospital, Marseille, France
| | - Xavier Flecher
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, Sainte Marguerite Hospital, Marseille, France
| | - Christophe Jacquet
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, Sainte Marguerite Hospital, Marseille, France
| | - Jean-Noel Argenson
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, Sainte Marguerite Hospital, Marseille, France
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12
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Wasilczyk C, Wasilczyk B. Nanosurgery and Bioengineered Regenerative Protocols for the Treatment of Hip Osteoarthritis: A Double-Blind Randomized Controlled Trial as an Alternative to Surgical Hip Replacement. Biomedicines 2025; 13:987. [PMID: 40299644 PMCID: PMC12024760 DOI: 10.3390/biomedicines13040987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2025] [Revised: 04/14/2025] [Accepted: 04/16/2025] [Indexed: 05/01/2025] Open
Abstract
Introduction: Hip osteoarthritis (HOA) significantly affects mobility and quality of life, with total hip arthroplasty (THA) being a common treatment. However, complications and increasing revision rates highlight the need for alternative approaches. This study evaluates the efficacy of ultrasound-guided nanosurgery and bioengineering treatment (NSBT) compared to non-standardized platelet-rich plasma (PRP) treatment for patients with symptomatic HOA. Methods: A double-blind, randomized trial included 38 patients referred for THA, divided into two groups. The study group received NSBT with modified PRP enriched with somatotropin and Strophanthus kombe, while the control group received PRP and hyaluronic acid injections without a standardized protocol. Treatments were guided by ultrasound, and outcomes were assessed using the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Harris Hip Score (HHS), and range of motion (RoM) evaluations over 12 months. Results: The study group showed significant improvements in all clinical outcomes, including reductions in VAS scores from 7.8 to 0.2 (p < 0.0001) and WOMAC scores from 76.2 to 10.5 (p < 0.0001). The HHS improved from 56.4 to 93.0, and RoM showed substantial gains in flexion, external rotation, and internal rotation (all p < 0.001). The control group demonstrated less pronounced improvements. Conclusions: NSBT offers a safe and effective alternative for managing HOA, significantly reducing pain and improving joint function while potentially delaying or avoiding the need for THA. Further long-term studies are warranted to confirm these findings.
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Affiliation(s)
- Cezary Wasilczyk
- Medical Department, Wasilczyk Medical Clinic, ul. Kosiarzy 37/80, 02-953 Warszawa, Poland;
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13
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Listopadzki TR, Boyle KK, Nodzo SR. Computed Tomography With Implant Movement Analysis in the Work-Up of Painful Total Hip Prostheses. J Arthroplasty 2025:S0883-5403(25)00339-0. [PMID: 40216278 DOI: 10.1016/j.arth.2025.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Revised: 04/01/2025] [Accepted: 04/02/2025] [Indexed: 05/09/2025] Open
Abstract
BACKGROUND Diagnosing aseptic loosening following total hip arthroplasty is challenging. Computed tomography (CT)-guided implant movement analysis (CT-IMA) overlays two CT scans of a stressed total hip prosthesis to evaluate for micromotion. The purpose of this study was to evaluate this technology in identifying clinically stable and unstable total hip prostheses. METHODS Plain radiographs and CT-IMA scans of 80 patients with painful total hip prostheses were evaluated. Standard radiographs demonstrating 1- to 2-mm circumferential radiolucent lines within the modified Gruen, or Delee and Charnley zones, or subsidence were considered loose. A CT-IMA scan demonstrating implant motion > 0.5 mm was generally considered loose. Patients were categorized by implant stability based on plain radiographs and CT-IMA scans. Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) scores were calculated for each group from the initial to the final follow-up. Statistical analysis was performed with two-tailed paired t-tests. RESULTS There were 66 patients who were categorized into the radiographically Stable-IMA Stable group (Group 1), six into the radiographically Loose-IMA Stable group (Group 2), and eight into the radiographically Loose-IMA Loose group (Group 3). Within Group 1, HOOS, JR scores improved from 49.5 ± 18.4 to 64.2 ± 18.9 (P = 0.004). The 14 patients who underwent revision surgery had well-fixed components. Within Group 2, HOOS, JR scores improved from 57.7 ± 19.7 to 69.1 ± 21.5 (P = 0.01). The two patients who underwent revision surgery had well-fixed components. Within Group 3, HOOS, JR scores improved from 45.5 ± 18.1 to 71.8 ± 15.4 (P = 0.04). The seven patients who underwent revision surgery had loose components and one patient was lost to follow-up. CONCLUSIONS A CT-IMA better identified patients who had stable total hip prostheses than standard radiographs, demonstrating its value in the workup of a painful total hip prosthesis.
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Affiliation(s)
- Thomas R Listopadzki
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, Buffalo, New York
| | - K Keely Boyle
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Scott R Nodzo
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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14
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Adik K, Adams NA, Srivastava AK, Hughes RE, Zheng TH, Hallstrom BR, Markel DC. Increasing Use of Cemented Stems Is Associated With Reduced Early Fracture After Total Hip Arthroplasty: A Michigan Arthroplasty Registry Collaborative Quality Initiative Study. J Arthroplasty 2025:S0883-5403(25)00324-9. [PMID: 40209825 DOI: 10.1016/j.arth.2025.03.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 03/27/2025] [Accepted: 03/28/2025] [Indexed: 04/12/2025] Open
Abstract
BACKGROUND The Michigan Arthroplasty Registry Quality Collaborative Initiative (MARCQI) identified periprosthetic fracture as the most common reason for early total hip arthroplasty (THA) revision of uncemented hips. This analysis described a state-wide quality improvement project to reduce fracture and early revision. METHODS The MARCQI reports data to participants through reports and in-person meetings and incorporated postoperative hip fracture into pay-for-performance incentives as part of a quality improvement project in 2018. The percent of cemented stems and incidence of fracture within 90 days of surgery were analyzed by age, sex, and year of surgery. RESULTS The overall use of cemented stems in THA rose from 2.7% in 2017 to 6.8% in 2022. Only 0.7% of men and 1.8% of women under 75 years were cemented in 2017 while 4.7 and 10.4% of patients 75 years and older were cemented, respectively. By 2022, 10.8% of men and 26.8% of women 75 years and older were cemented. In elderly women, the incidence of fracture after THA has dropped to 1.7% in 2022 from a peak of 3.5% in 2018 as the use of cement has increased. CONCLUSIONS Early fracture often leads to revision and may be preventable. This analysis demonstrated a direct correlation between the use of cemented stems and decreased postoperative fracture rates in elderly women. State-wide fractures increased from 2012 to 2018 (peak at 1.3%). Since the beginning of the MARCQI fracture reduction quality initiative, there has been a steady decline to 0.96% in 2022. Stratifying by age and sex, cementing in older women increased by 16%, and fracture rates decreased by nearly 2%. With this MARCQI initiative, there were an estimated 280 fewer revisions secondary to fractures in Michigan. Surgeons should consider using cemented femoral stems for THA in elderly women.
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Affiliation(s)
- Kevin Adik
- McLaren-Flint Department of Orthopaedic Surgery, Flint, Michigan
| | | | | | - Richard E Hughes
- Michigan Arthroplasty Registry Collaborative Quality Initiative Coordinating Center, Ann Arbor, Michigan; Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Thomas H Zheng
- Michigan Arthroplasty Registry Collaborative Quality Initiative Coordinating Center, Ann Arbor, Michigan
| | - Brian R Hallstrom
- Michigan Arthroplasty Registry Collaborative Quality Initiative Coordinating Center, Ann Arbor, Michigan; Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - David C Markel
- Ascension-Providence Section of Orthopaedic Surgery and The CORE Institute, Novi, Michigan
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15
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Axenhus M, Bodén H, Kelly-Pettersson P, Sköldenberg O. Denosumab for treating periprosthetic osteolysis: a feasibility study. BMC Res Notes 2025; 18:151. [PMID: 40200363 PMCID: PMC11980280 DOI: 10.1186/s13104-025-07216-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 03/31/2025] [Indexed: 04/10/2025] Open
Abstract
OBJECTIVE Wear-induced osteolysis is a leading cause of late failure in total hip arthroplasty (THA). Denosumab, a RANKL inhibitor, suppresses osteoclast activity and may slow osteolytic progression. This feasibility study aimed to assess the practicality of conducting a randomized, double-blind, placebo-controlled trial evaluating Denosumab's effect on periprosthetic osteolysis in asymptomatic THA patients. RESULTS Twelve patients were enrolled; ten completed follow-up. No significant difference in lesion volume change was observed between groups (Denosumab: +1.53 cm³; Placebo: +0.49 cm³). Secondary clinical outcomes also showed no notable differences. The trial protocol, recruitment, treatment, and follow-up were feasible, though slow enrollment limited statistical power. This study demonstrates the feasibility of a larger trial investigating Denosumab for osteolysis prevention. TRIAL REGISTRATION Clinicaltrails.gov, NCT02299817. Registered 20 November 2014. https://www. CLINICALTRIALS gov/study/NCT02299817?term=Denosumab%20for%20Treating%20Periprosthetic%20Osteolysis.%26;rank=1.
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Affiliation(s)
- Michael Axenhus
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
- Department of Orthopaedics, Danderyd University Hospital, Entrévägen 2 182 68, Danderyd, Stockholm, Sweden.
| | - Henrik Bodén
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Entrévägen 2 182 68, Danderyd, Stockholm, Sweden
| | - Paula Kelly-Pettersson
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Entrévägen 2 182 68, Danderyd, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Entrévägen 2 182 68, Danderyd, Stockholm, Sweden
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16
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Masciulli F, Corti A, Lindemann A, Chiappetta K, Loppini M, Corino VDA. Hip prosthesis failure prediction through radiological deep sequence learning. Int J Med Inform 2025; 196:105802. [PMID: 39884035 DOI: 10.1016/j.ijmedinf.2025.105802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 12/20/2024] [Accepted: 01/21/2025] [Indexed: 02/01/2025]
Abstract
BACKGROUND Existing deep learning studies for the automated detection of hip prosthesis failure only consider the last available radiographic image. However, using longitudinal data is thought to improve the prediction, by combining temporal and spatial components. The aim of this study is to develop artificial intelligence models for predicting hip implant failure from multiple subsequent plain radiographs. METHODS A cohort of 224 patients was considered for model development and a balanced cohort of 14 patients was used for external validation. A sequence of two or three anteroposterior radiographic images per patient was considered to track the prosthesis over time. A combination of a convolutional neural network (CNN) and a recurrent section was used. For the CNN, a pretrained autoencoder, a pretrained RadImageNet DenseNet and a pretrained custom DenseNet were considered. The recurrent section was implemented using either a single Gated Recurrent Unit (GRU) layer or a Long Short-Term Memory block. RESULTS Considering 3 images as input provided a positive predictive value (PPV) of 0.966 and an f1 score of 0.933 on the validation set. Regarding the 2-image models, using the postoperative and the last image resulted in PPV of 0.933 and f1 score of 0.918, whereas using the second-to-last image with the post-operative one reached a PPV of 0.882 and f1 score of 0.923. On the external validation set, the 3-image model reached an accuracy of 0.786. CONCLUSION This study demonstrated the potential of the developed models, based on a series of plain radiographs, to predict hip prosthesis failure.
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Affiliation(s)
- Francesco Masciulli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20131 Milan, MI, Italy
| | - Anna Corti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20131 Milan, MI, Italy
| | - Alessia Lindemann
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20131 Milan, MI, Italy
| | - Katia Chiappetta
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, MI, Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy; Fondazione Livio Sciutto Ricerca Biomedica in Ortopedia-ONLUS, Via A. Magliotto 2, 17100 Savona, SV, Italy
| | - Valentina D A Corino
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20131 Milan, MI, Italy; Cardio Tech-Lab, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy.
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17
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Clapp IM, Braathen DL, Blackburn BE, Pelt CE, Anderson LA, Gililland JM, Archibeck MJ. Increasing Limb Length During Stage 1 Revision Leads to Higher Rates of Instability Following Stage 2 Revision Total Hip Arthroplasty. J Arthroplasty 2025:S0883-5403(25)00308-0. [PMID: 40174682 DOI: 10.1016/j.arth.2025.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 03/20/2025] [Accepted: 03/24/2025] [Indexed: 04/04/2025] Open
Abstract
BACKGROUND Currently, two-stage revision total hip arthroplasty is the gold standard in managing periprosthetic joint infection (PJI) of the hip; however, complications are common, including instability. The purpose of this study was to determine how alterations in limb length during a stage 1 articulating spacer affect dislocation rates of the stage 2 revision. METHODS A retrospective study of consecutive patients who underwent two-stage revision total hip arthroplasty for PJI between December 2013 and December 2022 was performed. We measured limb length as the perpendicular distance from the trans-teardrop line to the apex of the lesser trochanter after stage 1 articulating spacer implantation. Independent t-tests and logistic regression were used to compare limb lengths following stage 1 spacers between patients who did and did not dislocate after stage 2 implantation. Overall, 147 patients who underwent staged revisions for the treatment of PJI were identified. The cohort was 59% women who had a mean age of 60 years (range, 25 to 84 years) and an average follow-up time of 2.7 years (range, 1.0 to 9.1 years). RESULTS The dislocation rates after stage 1 and stage 2 were 3.0 and 11.7%, respectively. Limb length did not impact dislocation rates of the articulating stage 1 spacers (P = 0.71), but patients who sustained a dislocation following stage 2 were lengthened significantly more at stage 1 implantation (8.5 ± 15.9 versus 0.8 ± 11.8 mm, P = 0.033). Additionally, the odds of dislocation after stage 2 increased by 7% with each mm lengthened during stage 1 (odds ratio = 1.07, 95% confidence interval: 1.01 to 1.13). CONCLUSIONS During a stage 1 articulating spacer of the hip, limb length restoration is often disregarded, which can result in overlengthening that may necessitate subsequent shortening during stage 2 reconstruction. This study demonstrates that overlengthening of an articulating stage 1 hip spacer can place the patient at an increased risk of dislocation following stage 2 reconstruction.
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Affiliation(s)
- Ian M Clapp
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Dalton L Braathen
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Brenna E Blackburn
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Christopher E Pelt
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Lucas A Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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18
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Porter G, Balian J, Ng AP, Mannings H, Jeffcoat D, Benharash P. Cost-Volume Analysis of Primary Total Knee and Hip Arthroplasty in the United States. J Arthroplasty 2025:S0883-5403(25)00252-9. [PMID: 40147780 DOI: 10.1016/j.arth.2025.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 03/10/2025] [Accepted: 03/13/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Utilization of total knee (TKA) and total hip (THA) arthroplasty is increasing along with associated hospitalization costs. A contemporary analysis of the impact of hospital case volume on the costs of TKA and THA is lacking. METHODS Adults undergoing primary elective TKA or THA who had a diagnosis of osteoarthritis were identified from an inpatient all-payer database from 2012 to 2019. Operative volume was ascertained with restrictive cubic spline analysis. The volume corresponding to the inflection point of the spline was used to stratify hospitals as high volume (HVH) or low volume (LVH). Multivariable regression models were developed to examine the association of volume with hospitalization costs, adverse events, lengths of stay, and non-home discharges. RESULTS Of the 7,781,233 patients undergoing TKA or THA over the study period, 73.1% of primary TKA and 77.1% of primary THA were managed at HVH. Upon adjustment for patient and hospital covariates, treatment at high-volume TKA or THA hospitals was associated with a cost decrement of $2,200 (95% CI [confidence interval], 2,900 to 2,400, P < 0.001, Ref: LVH) and $1,900 (95% CI, 2,100 to 1,600), respectively. Notably, the disparity in hospitalization costs between HVH and LVH significantly increased during the study period (P < 0.001). CONCLUSIONS Greater TKA and THA volume was associated with reduced hospitalization costs. These findings suggest that regionalization of care to experienced hospitals may improve the value of orthopaedic surgical care.
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Affiliation(s)
- Giselle Porter
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jeffrey Balian
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Ayesha P Ng
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Hugo Mannings
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Devon Jeffcoat
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Peyman Benharash
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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19
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Steelman KR, Cheslik TG, Green CC, Haidukewych GJ. Constrained Liners During Acetabular Revision: Clinical Results of an Impingement Avoidance Strategy. J Arthroplasty 2025:S0883-5403(25)00265-7. [PMID: 40139478 DOI: 10.1016/j.arth.2025.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 03/15/2025] [Accepted: 03/17/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Instability after total hip arthroplasty (THA) remains a challenging problem. Component revision or bearing exchange can be successful; however, constraints may be necessary. This study evaluated the results of revision THA for instability that required constrained liners (CLs) to determine whether revising or retaining the acetabular component is preferred. METHODS This single-surgeon retrospective study included 50 consecutive patients who required a CL during acetabular revision for instability. Indications for constraint included the absence of functioning abductors and failed previous CL or dual mobility liner. A CL was used in existing cups if the cup position was deemed acceptable with a reasonable impingement-free arc of motion. If unacceptable, it was revised, or, if the internal diameter allowed, a CL was cemented into the existing cup in a "face changing" position to minimize impingement. All patients had a minimum 2-year follow-up. Recurrent instability occurred in 15 of 50 patients overall (30%). Results were analyzed, and patients were separated into the following two groups based on whether the cup/liner position was changed: group 1, cup revision or cemented CL with "face change" (FC) (n = 28), and group 2, CL implanted into existing cup without FC (n = 22). RESULTS Group 1 had recurrent instability in four of 28 cases (14%), whereas group 2 had instability in 11 of 22 (50%) cases (P = 0.012). Cemented liners with FC failed in four of 16 cases. Cup revision had the lowest rate of recurrent instability (zero of 12) versus 15 of 38 (39%) when the cup was retained (P = 0.01). CONCLUSIONS This study demonstrated significantly lower rates of recurrent instability when CLs can be positioned to minimize impingement, either by revising the cup or cementing the liner independent of the existing cup: a so-called "FC." Cup revision demonstrated the lowest rate of recurrent instability with predictable osteointegration at the mean 4-year follow-up.
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Affiliation(s)
- Kevin R Steelman
- Department of Orthopaedics, Orlando Health-Orlando Regional Medical Center, Orlando, Florida
| | - Thomas G Cheslik
- Department of Orthopaedics, Orlando Health-Orlando Regional Medical Center, Orlando, Florida
| | - Cody C Green
- Department of Orthopaedics, Orlando Health-Orlando Regional Medical Center, Orlando, Florida
| | - George J Haidukewych
- Department of Orthopaedics, Orlando Health-Orlando Regional Medical Center, Orlando, Florida
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20
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Bruna J, Prochazkova J, Podzimek S, Himmlova L, Janatova T, Vinsu A. Metal Hypersensitivity in Patients With Failure of Joint Prosthesis Treatment. J Immunol Res 2025; 2025:4319686. [PMID: 40225948 PMCID: PMC11991841 DOI: 10.1155/jimr/4319686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 01/20/2025] [Accepted: 01/29/2025] [Indexed: 04/15/2025] Open
Abstract
The objective of this study is to measure lymphocyte responses to metal antigens using MELISA (memory lymphocyte immunostimulation assay) test-modified lymphocyte transformation test (mLTT) and to evaluate metal sensitization in patients with and without the need of prosthetic surgery. This study is a case-control retrospective survey. We retrospectively analyzed all patients from 2013 to 2018 who were referred to the Institute of Dental Medicine, General University Hospital in Prague, and First Faculty of Medicine, Charles University, Prague, either following joint prosthesis-related complications or as a preoperative evaluation concerning metal hypersensitivity. For the control group, we selected healthy adults from our database. A group of 127 patients aged 25-81 years was chosen, 92 of which were female and 35 were male. The patients completed a special questionnaire aimed at information regarding their health status and history of metal exposure. After clinical examination, their peripheral blood samples were taken to perform mLTT. mLTT provided quantitative lymphocyte proliferation measurement, where a stimulation index of >2 indicated metal sensitivity. For statistical analysis, the Fisher's exact test, χ2 test, McNemar's exact test Student's paired t-test were used. By comparison of the study group and control group mLTT results, it can be stated that patients of the study group showed a higher level of lymphocyte reactivity to most of the tested metal antigens (Ag [silver], Cu [copper], Fe [iron], Mo [molybdenum], Pd [palladium], Pt [platinum], Ti [titanium], and Zn [zinc]) and an elevated incidence of metal hypersensitivity to Hg (mercury), Al (aluminum), Au (gold), Co (cobalt), Cr (chromium), Ni (nickel), and Sn (tin). The evaluation of the data obtained from patients in this study confirmed a significant clinical benefit of mLTT in diagnostics of metal hypersensitivity. Our study has revealed that the patients with the need of prosthetic surgery exhibited an elevated lymphocyte response to metal antigens. This result supports a metal-specific adaptive immune response and suggests involvement of metal exposure as a trigger for their health problems. This knowledge could be helpful in effectively enhancing the treatment of patients with need of orthopedic joint prosthesis.
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Affiliation(s)
- Jana Bruna
- Institute of Dental Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Jarmila Prochazkova
- Institute of Dental Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
- Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Stepan Podzimek
- Institute of Dental Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Lucie Himmlova
- Institute of Dental Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Tatjana Janatova
- Institute of Dental Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Alex Vinsu
- Institute of Dental Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
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21
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Feng T, Tang H, Zhang X, Zhang Y, Zhou Y, Jin Z. A novel preoperative prosthetic position planning algorithm for total hip arthroplasty based on the no-impingement principle: A case study. Proc Inst Mech Eng H 2025; 239:321-331. [PMID: 40079481 DOI: 10.1177/09544119251319960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2025]
Abstract
Most preoperative planning calculations of impingement-free range of motion (IFROM) and impingement-free safe zone (IFSZ) rarely consider non-standard shaped prostheses and bony impingement (BI) for total hip arthroplasty (THA). This research developed a novel algorithm that considers BI, prosthetic impingement, pelvic tilt angle (PT) in the sagittal plane, and non-standard-shaped hip prostheses. This research aimed to investigate the effect of BI and PT on hip IFROM, IFSZ, and the BI rate. Using this algorithm to calculate a case, we found that when considering BI, (1) the upper limit of the hip IFROM was decreased, and the different PT affected the upper limit of the hip IFROM of various movements; (2) the BI rate of the flat-rim liner in standing and sitting postures were 54.6% and 67%; and (3) the maximum IFSZ size of the flat-rim liner was reduced by 12%, the reduction rate of the combined pelvic position with a non-zero IFSZ size was 83.2% for the flat-rim liner. Consideration of BI further reduces the IFROM, the IFSZ size, and the number of the combined position of the pelvis with a non-zero IFSZ size of the hip joint. Importantly, this algorithm provides a reliable tool for personalized prosthesis positioning for THA. This algorithm has excellent applications in personalized surgical planning and surgical robotics.
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Affiliation(s)
- Tao Feng
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Hao Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xiaogang Zhang
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Yali Zhang
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Zhongmin Jin
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China
- School of Mechanical Engineering, University of Leeds, Leeds, UK
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22
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Hannon CP, Salmons HI, Trousdale RT, Lewallen DG, Berry DJ, Abdel MP. Why Are Contemporary Primary Ceramic-on-Highly Crosslinked Polyethylene Total Hip Arthroplasties Failing? An Analysis of Over 5,500 Cases. J Arthroplasty 2025; 40:711-717. [PMID: 39265814 DOI: 10.1016/j.arth.2024.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 08/28/2024] [Accepted: 08/30/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Ceramic-on-highly crosslinked polyethylene (HXLPE) has become the most common bearing surface utilized in primary total hip arthroplasty (THA). The purpose of this study was to determine the implant survivorship and clinical outcomes of THAs with ceramic-on-HXLPE in a large single-institutional series. METHODS We identified 5,536 primary THAs performed from 2007 to 2017 using a ceramic-on-HXLPE bearing through our total joint registry. The mean age was 60 years, 51% were women, and the mean body mass index was 30. A cementless femoral component was used in 98% of cases, and a head size of ≥ 36 was used in 75%. Kaplan-Meier survivorship analyses were completed to assess survivorship free of any revision or reoperation. Clinical outcomes were assessed via Harris Hip Score. The mean follow-up was four years. RESULTS The 5-year survivorship free of any revision was 97%. The most common indications for revision were dislocation (41 hips), periprosthetic joint infection (39 hips), and periprosthetic femur fracture (18 hips). The 5-year survivorship free of any reoperation was 96%. There were an additional 70 reoperations, with the most common indications being wound dehiscence (32 hips), iliopsoas impingement (11 hips), and periprosthetic femur fracture (11 hips). There were only two bearing surface failures: one HXLPE liner fractured and one dissociated. There were no ceramic head fractures or failures. The mean Harris Hip Score increased from 57 to 92 (P < 0.0001). CONCLUSIONS In over 5,500 THAs completed with modern ceramic-on-HXLPE bearings, failures of the bearing surface were nearly eliminated at midterm follow-up, and overall 5-year survivorship free of revision was excellent. Dislocation, periprosthetic joint infection, and periprosthetic femur fracture were the most common causes of failure. As bearing surfaces have evolved, traditional failure mechanisms such as polyethylene wear, corrosion and metal reactions, and ceramic fractures have become nearly extinct. LEVEL OF EVIDENCE III (Case-Control Study), Therapeutic.
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Affiliation(s)
- Charles P Hannon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Harold I Salmons
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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23
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Bender JM, Yang J, Sterling ON, Collett GA, Fernando ND, Chen AF, Hernandez NM. Does Femoral Head Size Matter? A Comparison of 32-, 36-, and 40-Millimeter Heads in Primary Total Hip Arthroplasty: An American Joint Replacement Registry Analysis. J Arthroplasty 2025:S0883-5403(25)00188-3. [PMID: 40015384 DOI: 10.1016/j.arth.2025.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 02/16/2025] [Accepted: 02/18/2025] [Indexed: 03/01/2025] Open
Abstract
BACKGROUND Studies have shown that increased femoral head size reduces the risk of dislocation in primary total hip arthroplasty (THA), but there has been limited research on femoral head sizes greater than 36 mm. METHODS The American Joint Replacement Registry was utilized to evaluate all primary THA cases in Medicare patients aged 65 years and older who had a femoral head size of 32, 36, or ≥ 40 mm between 2012 and 2020. Patients who received a ≥ 40-mm head were more likely to be men and had a higher Charlson comorbidity index (CCI, P < 0.001). Multivariate analyses were performed to adjust for age, sex, race, femoral head composition, and CCI. Cox's proportional hazards models were used to compare differences in revision between groups. RESULTS Of 319,531 total THA cases, 84,524 (26.4%) used a 32 mm, 211,814 (66.3%) used a 36 mm, and 23,193 (7.3%) used ≥ 40-mm femoral head. When compared to 32-mm heads, 36-mm heads had significantly lower rates of revision for dislocation (32 mm: 0.68%, 36 mm: 0.46%, P < 0.001). Femoral heads ≥ 40 mm were not associated with a decreased rate of revision for dislocation (0.51%) when compared to 32 and 36 mm heads. However, femoral heads ≥ 40 mm were associated with an increased risk of all-cause revision (32 mm: 2.55%, 36 mm: 2.37%, 40 mm: 2.78%, P < 0.001) and revision for infection (32 mm: 0.43%, 36 mm: 0.53%, 40 mm: 0.82%, P < 0.001) compared to 32 and 36 mm heads. CONCLUSIONS Large femoral heads (≥ 40 mm) do not decrease revision for dislocation in primary THA but were associated with an increased risk of all-cause revision and revision for infection. Although demographic and comorbidity variables were controlled in our multivariate analysis, more men and higher CCI in ≥ 40-mm head patients may represent a population with a greater presurgical risk for complications. More research on ≥ 40-mm heads is warranted before widespread adoption.
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Affiliation(s)
- Joshua M Bender
- Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, Washington
| | - JaeWon Yang
- Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, Washington
| | | | - Garen A Collett
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Navin D Fernando
- Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, Washington
| | - Antonia F Chen
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Nicholas M Hernandez
- Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, Washington
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24
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Leal J, DiLallo M, Seyler TM, Jiranek WA, Wellman SS, Bolognesi MP, Ryan SP. Periprosthetic Joint Infection: Are Patients Still Better off Than if Primary Arthroplasty Had Not Been Performed? J Arthroplasty 2025:S0883-5403(25)00139-1. [PMID: 39978651 DOI: 10.1016/j.arth.2025.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 02/04/2025] [Accepted: 02/06/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND This study sought to evaluate patient-reported outcome measures (PROMs) before primary total joint arthroplasty (TJA) and after successful treatment for periprosthetic joint infection (PJI), with the hypothesis that patients still demonstrate clinical improvement despite the occurrence of PJI. METHODS A single tertiary academic center's institutional database was retrospectively reviewed for patients who underwent primary TJA, developed PJI, and were managed for PJI from January 2019 to December 2023. Patients who did not have PROMs recorded were excluded from the study. Preoperative and postoperative generic and joint-specific PROMs were collected. Patient preprimary and postfinal revision surgery for PJI PROMs were subsequently compared. The minimum follow-up after PJI treatment was 6 months. A total of 55 patients (31 total knee arthroplasty and 24 total hip arthroplasty) were included with a mean follow-up of 1.8 years (range, 6 months to 4.5 years). All PJIs were managed via debridement, antibiotics, and implant retention, 1-stage, 1.5-stage, 2-stage revision, or resection arthroplasty. RESULTS After final revision surgery for PJI in total knee arthroplasty, patients had lower median patient-reported outcome measure information system (PROMIS) pain interference scores than before their primary surgery (62.0 [55.0, 67.0] versus 67.0 [65.0, 70.5]; P < 0.01). However, median PROMIS physical function postfinal revision for PJI and preprimary scores were similar (38.0 [33.0, 42.0] versus 34.0 [29.5, 40.0]; P = 0.08). After final revision surgery for PJI in total hip arthroplasty, patients had lower median PROMIS pain interference scores than before their primary surgery (57.5 [53.8, 64.0] versus 68.0 [66.5, 74.0]; P < 0.01). After final revision surgery for PJI, patients also had higher median PROMIS physical function scores than before their primary surgery (39.5 [33.5, 48.2] versus 29.5 [28.8, 34.2]; P < 0.01). CONCLUSIONS Patients who have been successfully managed for PJI show improvement in generic and joint-specific PROMs compared to their preprimary TJA PROMs.
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Affiliation(s)
- Justin Leal
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Marcus DiLallo
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - William A Jiranek
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | | | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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25
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Owen AR, Dilger OB, Bedard NA, Hannon CP, Mabry TM, Berry DJ, Abdel MP. Repeat Two-Stage Exchange Arthroplasty for Recurrent Periprosthetic Joint Infection of the Hip: Sobering Results. J Arthroplasty 2025:S0883-5403(25)00134-2. [PMID: 39956489 DOI: 10.1016/j.arth.2025.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 02/05/2025] [Accepted: 02/06/2025] [Indexed: 02/18/2025] Open
Abstract
BACKGROUND A two-stage exchange arthroplasty is the standard management method of chronic periprosthetic joint infections (PJIs) of the hip in North America. However, a subset of patients become reinfected and may require a repeat two-stage exchange arthroplasty. The purpose of the present study was to assess revisions, reoperations, and risk factors for failure associated with repeat two-stage exchange arthroplasties for recurrent PJIs after total hip arthroplasty (THA). METHODS We identified 52 repeat two-stage exchange THAs completed from 2000 to 2021 at a single, high-volume academic medical center. The mean age was 61 years, 39% were women, and the mean body mass index was 33. At the time of the repeat two-stage exchange, high-dose antibiotic spacers were used in 90% of patients (28 articulating, 19 nonarticulating), and 10% had a resection arthroplasty in the interim between stages. The mean time from repeat first stage to reimplantation was 33 weeks. At the final follow-up, 54% of patients were on chronic antibiotic therapy. The mean follow-up was 6 years. RESULTS The 7-year survivorships free of re-revision for reinfection, any re-revision, and any reoperation were 85, 57, and 50%, respectively. The leading indications for re-revision were dislocation (45%) and PJI (35%). McPherson host grade C was a significant risk factor for re-revision for infection (HR [hazard ratio] 5, P = 0.04). Additionally, increased operative time at reimplantation was a risk for any reoperation (HR 1.06, P < 0.01) and reoperation for infection (HR 1.07, P < 0.01). At the final follow-up, 98% of patients had a revision THA in situ (one hip disarticulation). CONCLUSIONS Repeat two-stage exchange arthroplasty of the hip had a 7-year survivorship free of re-revision for infection that was 85%, but only 57% were free of any re-revision (most due to revision for dislocation). McPherson C hosts had a 5-fold increased risk of reinfection. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Aaron R Owen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Oliver B Dilger
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Charles P Hannon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Tad M Mabry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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26
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Park KT, Lee DH, An JH, Won JH, Koo KH, Park JW, Lee YK. Causes of Reoperations After Primary Total Hip Arthroplasty: A Retrospective Cohort Study Over 20 Years. J Arthroplasty 2025:S0883-5403(25)00160-3. [PMID: 39956497 DOI: 10.1016/j.arth.2025.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 02/08/2025] [Accepted: 02/10/2025] [Indexed: 02/18/2025] Open
Abstract
BACKGROUND Reoperations following total hip arthroplasty (THA) remain a major clinical challenge, with their incidence and socioeconomic burden rising despite advances in surgical techniques and prosthesis design. This study aimed to evaluate the predominant causes of reoperations following THA over two decades at a tertiary referral hospital, comparing trends between 2004 to 2013 and 2014 to 2023. METHODS We analyzed all reoperations performed at a tertiary referral hospital between January 2004 and December 2023. A total of 515 hips (483 patients) were included after excluding multiple reoperations on the same hip. The causes of reoperation were stratified into two time periods (2004 to 2013 and 2014 to 2023) to analyze trends. The time interval from primary THA to reoperations was also evaluated. RESULTS The main cause of reoperation after primary THA was aseptic loosening, accounting for 52.4% of cases, followed by infection (13.2%), periprosthetic fracture (PPF) (10.7%), wear/osteolysis (8.5%), ceramic fracture (5.8%), and instability/dislocation (5.6%). The proportion of aseptic loosening decreased significantly from 62.5 to 40.4%, while the proportions of infection, PPF, ceramic fracture, and instability/dislocation increased (P < 0.001). The causes of reoperation varied according to the time interval. Instability, PPF, and infection were early causes, and wear/osteolysis and aseptic loosening were relatively later causes of reoperations. CONCLUSIONS Aseptic loosening was the most common cause of reoperation following primary THA. However, the proportion of infection and PPF increased as a cause of reoperations, while the proportion of aseptic loosening decreased with time. Surgeons should consider that the main cause of reoperations differed according to the time interval from primary THA to reoperation.
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Affiliation(s)
- Ki-Tae Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong-Hoon Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joon-Hwan An
- Department of Orthopaedic Surgery, Chamjoeun Hospital, Gwangju, Gyeonggi-do, Republic of Korea
| | - Jong-Hwa Won
- Department of Orthopaedic Surgery, Chamjoeun Hospital, Gwangju, Gyeonggi-do, Republic of Korea
| | - Kyung-Hoi Koo
- Kay Joint Center, Cheil Orthopaedic Hospital, Seoul, Republic of Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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27
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Zhu J, Zheng S, Sun J, Ma B, Zhang C, Zhang C, Shen J, Xia T. Efficacy of an artificial intelligence preoperative planning system for assisting in revision surgery after artificial total hip arthroplasty. BMC Surg 2025; 25:58. [PMID: 39920717 PMCID: PMC11804043 DOI: 10.1186/s12893-024-02752-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 12/30/2024] [Indexed: 02/09/2025] Open
Abstract
OBJECTIVE To explore the early efficacy of an artificial intelligence preoperative planning system (AIHIP system) for assisting in hip revision surgery. METHODS The clinical data of 25 patients (26 hips) who underwent hip revision between June 2019 and December 2023 and who met the selection criteria were retrospectively analyzed. There were 13 males and 12 females; the ages ranged from 44 to 90 years, with a mean of 69.1 years. The patients' replacement of prosthesis model, operation time, hospitalization time, postoperative time out of bed, etc., as well as the occurrence of adverse events such as postoperative infection, fracture, and loosening of the prosthesis were recorded. The Harris Hip score (HHS) was used to evaluate the function of the affected limbs preoperatively, and 1 week and 6 months postoperatively, and hip mobility was compared preoperatively and 6 months postoperatively. RESULTS All 25 patients were followed up for 6 to 59 months, with an average of 25.3 months. Except for one patient who developed a thigh hematoma (treated with incision and drainage and decompression) and hip dislocation in one hip (repaired), the remaining patients experienced no adverse events such as loosening of the prosthesis or infection. The postoperative acetabular cup type matching degree completely matched 25 hips, not matching 1 hip (+ 2 number), for a matching rate of 96.15%; the femoral stem type matching degree completely matched 25 hips, generally matching 1 hip (-1 number), for a matching rate of 100%. The Harris scores were 54.7 ± 9.6 and 89.6 ± 7.0 at 1 week and 6 months after surgery, respectively, which were significantly improved (P < 0.05) compared with the preoperative scores of 33.5 ± 8.3, and further improved at 6 months after surgery compared with the 1-week period (P < 0.05). The patients' hip function was evaluated according to the Harris score at 6 months after surgery, and they were assigned to 23 good hips and 3 medium hips, which could satisfy daily life needs. Hip mobility at 6 months after surgery was 111.15 ± 9.72°, and the difference was statistically significant compared with the preoperative value of 79.42 ± 17.51° (t = -8.077, P < 0.001). CONCLUSION AIHIP system-assisted treatment of THA postoperative revision patients can improve the precision of revision surgery, and reduce the difficulty of surgery, in patients with good postoperative recovery and satisfactory early outcomes.
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Affiliation(s)
- Jiaqing Zhu
- Department of Orthopedics and Traumatology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, 210029, China.
| | - Shanbin Zheng
- Department of Orthopedics and Traumatology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, 210029, China
| | - Jiahao Sun
- Department of Orthopedics and Traumatology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, 210029, China
| | - Bowen Ma
- Department of Orthopedics and Traumatology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, 210029, China
| | - Chiyu Zhang
- Department of Orthopedics and Traumatology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, 210029, China
| | - Chao Zhang
- Department of Orthopedics and Traumatology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, 210029, China
| | - Jirong Shen
- Department of Orthopedics and Traumatology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, 210029, China.
| | - Tianwei Xia
- Department of Orthopedics and Traumatology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, 210029, China.
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28
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Leal J, Kugelman DN, Seyler TM, Jiranek WA, Wellman SS, Bolognesi MP, Ryan SP. Same-Day Discharge Total Knee Arthroplasty: Hospital Demonstrates Similar Outcomes to Ambulatory Surgery Center in a More Complex Patient Population. J Arthroplasty 2025; 40:392-399. [PMID: 39089395 DOI: 10.1016/j.arth.2024.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The purpose of this study was to compare outcomes between patients undergoing same-day discharge (SDD) total knee arthroplasty (TKA) at an ambulatory surgery center (ASC) versus a tertiary care university hospital setting. METHODS A single tertiary academic center's institutional database was reviewed for patients who underwent primary TKA and were discharged the same day from August 2021 to January 2024. Patients who did not have at least 1 year of follow-up were excluded. Patient demographics, comorbidities, patient-reported outcome measures, emergency department visits, admissions, reoperations, and revisions were collected. Patients were stratified by the location of their surgery: ASC versus hospital. Specific criteria had to be met prior to surgery at the ASC, and the final decision regarding the location of surgery was made via shared decision-making between the patient and their surgeon. Patients who did not meet ASC criteria underwent TKA at the main hospital. Univariable analyses were used to compare groups, and multivariable logistic regression was used to determine if surgical location was a significant factor. Of the 449 TKAs meeting inclusion criteria, 63.3% (284) were performed at the ASC and 36.7% (165) at the university hospital at a mean follow-up of 1.51 years (range, 1.00 to 2.40). Of those 165 whose surgery was done at the hospital, 93.9% met at least one ASC exclusion criteria. RESULTS Patients whose TKA was done at the hospital had significantly higher weight (P = 0.003), body mass index (P < 0.001), Elixhauser comorbidity index (P < 0.001), proportion of patients who had an American Society of Anesthesiologists classification of 3 (P = 0.023), and proportion of patients who required general anesthesia (P < 0.001). Additionally, patients whose TKA was done at the hospital had higher preoperative patient-reported outcome measurement information system (PROMIS) pain interference (PI) (62.0 [59.0, 66.0] versus 63.0 [61.8, 67.0]; P = 0.006), and lower physical function (PF) (39.0 [36.0, 43.0] versus 38.0 [34.0, 41.0]; P = 0.001). At 1 year, however, patients in both groups had similar PROMIS PI (53.0 [49.0, 59.0] versus 54.0 [44.0, 59.0]; P = 0.785) and PROMIS PF (47.0 [42.0, 51.0] versus 47.0 [41.0, 50.0]; P = 0.422) scores as well as similar rates of achieving minimum clinically important difference for PROMIS PI (64.4 versus 71.4%; P = 0.336) and PROMIS PF (60.5 versus 71.4%; P = 0.124). They also had a similar number of emergency department visits and admissions at 30 and 90 days, as well as similar reoperation-free (92.0 versus 93.3%; P = 0.79) and revision-free (95.5 versus 99.4%; P = 0.59) survival at 2 years CONCLUSIONS: Although ASCs have strict patient criteria for SDD TKA, complex patients at a tertiary university hospital can be sent home the same day with equivalent outcomes. Therefore, unhealthier patients can safely achieve SDD without compromising outcomes if done in the appropriate setting.
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Affiliation(s)
- Justin Leal
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - David N Kugelman
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - William A Jiranek
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | | | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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Bulzacki Bogucki BD, Digennaro V, Cecchin D, Panciera A, Ferri R, Benvenuti L, Bordini B, Faldini C. Reliability and utility of the new Belt et al. classification for revision of infected total knee arthroplasty. Arch Orthop Trauma Surg 2025; 145:155. [PMID: 39891734 DOI: 10.1007/s00402-025-05769-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Accepted: 01/15/2025] [Indexed: 02/03/2025]
Abstract
INTRODUCTION The frequency of revisions in total knee arthroplasty (TKA) is rising. Various classifications of bone defects exist, each with its own limitations. Recently, Belt et al. have proposed a new classification for TKA revisions based on X-ray imaging. We evaluated the Belt et al. classification and verified if this new classification is reliable, and if it correlates with the implant used during revision surgery for periprosthetic joint infection. METHODS This is a retrospective study. We reproduced the paper proposed by Belt et al. with the radiological data of all patients who underwent two stage revision for infected TKA in our institution between January 2017 and December 2022. Five different operators classified the bone defect for each patient at two time points. Subsequently, we assessed intra- and inter-operator reproducibility. We also collect the surgery data from our registry to verify if there is a correlation between augment use and epiphyseal bone defect. RESULTS The classification proposed by Belt is reliable, and have a good reproducibility inter and intraoperator. There is no correlation between the bone defect. And the use of augment, and so this classification is usless in the prediction of the material needed in the operating room. CONCLUSION The Belt at al. classification is reliable, but a classification which can predict the implant neded have to be developed.
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Affiliation(s)
| | - V Digennaro
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
| | - Davide Cecchin
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy.
| | - A Panciera
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
| | - R Ferri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
| | - L Benvenuti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
| | - B Bordini
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy
| | - C Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
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Sephton BM, Havenhand T, Mace JWA. Outcomes of Dual Mobility Versus Fixed-Bearing Components in Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2025; 40:516-529. [PMID: 39128780 DOI: 10.1016/j.arth.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 07/30/2024] [Accepted: 08/05/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Dual mobility (DM) implants have received increasing interest in revision surgery due to their increased stability. The aim of this systematic review was to compare outcomes of DM versus conventional fixed-bearing (FB) implants in revision total hip arthroplasty (rTHA). METHODS A comprehensive search was performed using the PubMed, Embase, and MEDLINE databases between January 2000 and 2023. Outcome measures included rerevision due to dislocation, rerevision for other causes, all-cause rerevision, total complication rate, and functional outcome measures. The Methodological Index for Nonrandomized Studies assessment tool was used to evaluate methodological quality and the risk of bias. A pooled meta-analysis was conducted, with an assessment of heterogeneity using the Chi-square and Higgins I2 tests. A further subgroup analysis was performed between DM implants and larger femoral head (> 36 mm) FB implants. RESULTS A total of 13 studies met the final inclusion criteria, with an overall number of 5,004 rTHA hips included (2,108 DM and 2,896 FB). The DM implants had significantly lower odds of rerevision due to dislocation (odds ratio [OR] 0.38, P < 0.001), aseptic loosening (OR 0.54, P = 0.004), and all-cause rerevision (OR 0.55, P < 0.001) compared to FB implants. No statistically significant difference was seen in the odds of rerevision due to periprosthetic joint infection (OR 0.99, P = 0.94) or periprosthetic fracture (OR 0.59, P = 0.13) between the 2 groups. The total number of complications showed an odds benefit in favor of DM implants (OR 0.43, P < 0.001). In the subgroup analysis, there was no significant difference in the odds of rerevision due to dislocation (OR 0.69, P = 0.11) between DM and larger femoral head FB implants. CONCLUSIONS Based on current literature, it appears DM implants are an effective modality for reducing dislocation following rTHA with lower complication rates compared to FB implants. However, further prospective randomized controlled trials with longer term follow-up are required.
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Affiliation(s)
- Benjamin M Sephton
- Trauma & Orthopaedic Department, Royal Blackburn Hospital, Blackburn, Lancashire, UK
| | - Tom Havenhand
- Trauma & Orthopaedic Department, Royal Preston Hospital, Preston, Lancashire, UK
| | - James W A Mace
- Trauma & Orthopaedic Department, Royal Bolton Hospital, Bolton, Greater Manchester, UK
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Giraldo-Osorno PM, Turner AB, Barros SM, Büscher R, Guttau S, Asa'ad F, Trobos M, Palmquist A. Anodized Ti6Al4V-ELI, electroplated with copper is bactericidal against Staphylococcus aureus and enhances macrophage phagocytosis. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2025; 36:14. [PMID: 39853447 PMCID: PMC11761993 DOI: 10.1007/s10856-024-06853-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 12/10/2024] [Indexed: 01/26/2025]
Abstract
Implants aim to restore skeletal dysfunction associated with ageing and trauma, yet infection and ineffective immune responses can lead to failure. This project characterized the microbiological and host cell responses to titanium alloy with or without electroplated metallic copper. Bacterial viability counting and scanning electron microscopy quantified and visualized the direct and indirect bactericidal effects of the Cu-electroplated titanium (Cu-Ep-Ti) against two different Staphylococcus aureus strains. Human THP-1 macrophage adhesion and viability was analyzed, along with phagocytosis. Results showed potent antimicrobial activity alongside promising host-immunomodulatory properties. Direct and indirect exposure to Cu-Ep-Ti produced potent bactericidal effects resulting in 94-100% reductions in bacterial viability at 24 h, with complete eradication in some cases. As expected, cytotoxicity was observed in THP-1 macrophages without media exchange, though when media was exchanged at 8, 24 and 48 h cell viability was equivalent to Control-Ti. Interestingly macrophages adhered to the copper material or grown in the presence of copper ions showed 7-fold increase in phagocytosis of S. aureus bioparticles compared to Control-Ti, suggesting a dual bactericidal and host immunomodulatory mechanism. In conclusion, this Cu-electroplated Ti biomaterial can limit bacterial contamination on the implant surface, whilst simultaneously promoting a beneficial antimicrobial immune response.
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Affiliation(s)
- Paula Milena Giraldo-Osorno
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Adam Benedict Turner
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Sebastião Mollet Barros
- Stryker Trauma Gmbh, Schönkirchen, Germany
- Faculty of Medicine, Centre for Translational Bone, Joint and Soft Tissue Research, Technische Universität Dresden, Dresden, Germany
| | | | | | - Farah Asa'ad
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oral Biochemistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margarita Trobos
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden.
| | - Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Tanaka H, Tarasawa K, Mori Y, Kuriyama Y, Kawamata H, Fushimi K, Fujimori K, Aizawa T. Does Osteonecrosis of the Femoral Head Increase Early Complication Rates After Total Hip Arthroplasty? A Japanese Nationwide Medical Claims Database Study. J Arthroplasty 2025:S0883-5403(25)00044-0. [PMID: 39855403 DOI: 10.1016/j.arth.2025.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 01/15/2025] [Accepted: 01/17/2025] [Indexed: 01/27/2025] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) and osteoarthritis (OA) are two common diagnoses for patients undergoing total hip arthroplasty (THA). The early surgical complications in THA for ONFH compared to OA are inconsistently reported. Therefore, this study aimed to evaluate whether THA for ONFH was associated with early postoperative complications in comparison to THA for OA using a large database of Japanese patients. METHODS In this cohort study, using a Japanese national medical claims database on ONFH and OA patients undergoing THA from December 2011 to March 2023, we assessed the surgical-related complications, medical complications, and mortality during hospitalization after propensity score matching by age, sex, body mass index, and comorbidities. A total of 24,326 pairs of THAs for ONFH and OA were included. RESULTS In the THA for ONFH group, the odds ratios for various complications were as follows: dislocation (1.3, 95% CI [confidence interval]: 1.1 to 1.6, P < 0.01), infection (1.0, 95% CI: 0.8 to 1.2, P = 0.94), periprosthetic fracture (1.0, 95% CI: 0.8 to 1.4, P = 0.86), nerve palsy during hospitalization (0.4, 95% CI: 0.2 to 0.9, P = 0.034), pneumonia (1.7, 95% CI: 1.1 to 2.5, P < 0.01), deep vein thrombosis (0.9, 95% CI: 0.8 to 1.0, P = 0.018), pulmonary embolism (1.5, 95% CI: 0.9 to 2.5, P = 0.14), cardiac events (0.7, 95% CI: 0.3 to 2.1, P = 0.55), cerebrovascular events (0.7, 95% CI: 0.5 to 1.0, P = 0.084), acute renal failure (1.4, 95% CI: 0.4 to 4.4, P = 0.56), and mortality during hospitalization (1.8, 95% CI: 1.3 to 2.4, P < 0.01). CONCLUSIONS These findings contribute to identifying postoperative risks for ONFH patients and suggest that more attention should be paid to preoperative planning and postoperative care for ONFH patients.
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Affiliation(s)
- Hidetatsu Tanaka
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yasuaki Kuriyama
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hiroki Kawamata
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine and Dental Sciences, Bunkyo-Ku, Tokyo, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Darden AP, Deckard ER, Meneghini RM. The Association of Jumbo Femoral Heads and Acetabular Cup Position on Patient Outcomes After Modern Posterior Approach Total Hip Arthroplasty. J Arthroplasty 2025:S0883-5403(25)00035-X. [PMID: 39832640 DOI: 10.1016/j.arth.2025.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 01/13/2025] [Accepted: 01/14/2025] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND Use of jumbo femoral heads (≥ 40 mm) in total hip arthroplasty decreases postoperative dislocation; however, may leave patients more susceptible to groin pain. Limited data exist for the effect of jumbo femoral heads and acetabular cup position on modern patient-reported outcome measures (PROMs). This study evaluated the effect of jumbo femoral heads and acetabular cup position on PROMs after primary total hip arthroplasty. METHODS A total of 328 consecutive primary THAs of a single implant system with various femoral head sizes (36% ≥ 40 mm) were retrospectively reviewed. Acetabular cup inclination and anteversion were radiographically measured. Demographics, comorbidities, and implant sizes were documented. Prospectively collected University of California Los Angeles Activity Level, Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), and satisfaction were evaluated. The mean follow-up was 1.2 years (range, one to five). A P-value of 0.05 was considered statistically significant. RESULTS Femoral head size was not associated with University of California Los AngelesActivity Level scores at any time point (P ≥ 0.209). Independent of patient sex, the mean HOOS JR score was significantly higher in the ≥ 40 mm femoral head group compared to the < 40 mm head group at 4 months although not reaching a clinically significant threshold (mean difference 4.4, 95% CI [confidence interval]: 0.5 to 8.3, P = 0.027); however, mean scores at the latest follow-up were not different (P = 0.956). The HOOS JR scores ≥ 90 and being "very satisfied or satisfied" were associated with a wide range and several combinations of acetabular cup inclination and anteversion. A total of 88.9% of patients reported being "very satisfied or satisfied" at the latest follow-up. CONCLUSIONS Patients achieved comparable PROMs regardless of femoral head size, suggesting large femoral heads may not leave patients susceptible to groin pain in addition to reducing the risk of postoperative dislocation. Excellent patient outcomes correlated with wide ranges of acetabular cup positions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Austin P Darden
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana Joint Replacement Institute, Indianapolis, Indiana
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Salimy MS, Buddhiraju A, Chen TLW, Mittal A, Xiao P, Kwon YM. Machine learning to predict periprosthetic joint infections following primary total hip arthroplasty using a national database. Arch Orthop Trauma Surg 2025; 145:131. [PMID: 39820648 DOI: 10.1007/s00402-025-05757-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 01/07/2025] [Indexed: 01/19/2025]
Abstract
INTRODUCTION Periprosthetic joint infection (PJI) following total hip arthroplasty (THA) remains a devastating complication for patients and surgeons. Given the implications of these infections and the current paucity of risk calculators utilizing machine learning (ML), this study aimed to develop an ML algorithm that could accurately identify risk factors for developing a PJI following primary THA using a national database. MATERIALS AND METHODS A total of 51,053 patients who underwent primary THA between 2013 and 2020 were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Demographic, preoperative, intraoperative, and immediate postoperative outcomes were collected. Five ML models were created. The receiver operating characteristic curves, the area under the curve (AUC), calibration plots, slopes, intercepts, and Brier scores were evaluated. RESULTS The histogram-based gradient boosting (HGB) model demonstrated good PJI discriminatory ability with an AUC of 0.88. The test-specific metrics supported the model's performance and validation in predicting PJI (calibration curve slope: 0.79; intercept: 0.32; Brier score: 0.007). The top five predictors of PJI were the length of stay (> 3 days), patient weight at the time of surgery (> 94.3 kg), an American Society of Anesthesiologists (ASA) class of 4 or higher, preoperative platelet count (< 249,890/mm3), and preoperative sodium (< 139.5 mEq/L). CONCLUSION This study developed a highly specific ML model that could predict patient-specific PJI development following primary THA. Considering the feature importance of the top predictors of infection, surgeons should counsel at-risk patients to optimize resource utilization and potentially improve surgical outcomes.
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Affiliation(s)
- Mehdi S Salimy
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Anirudh Buddhiraju
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Tony L-W Chen
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ashish Mittal
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Pengwei Xiao
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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Ertan MB, Ayduğan MY, Evren E, İnanç İ, Erdemli E, Erdemli B. Differences of microbial growth and biofilm formation among periprosthetic joint infection-causing species: an animal study. Int Microbiol 2025:10.1007/s10123-024-00629-0. [PMID: 39820867 DOI: 10.1007/s10123-024-00629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 12/08/2024] [Accepted: 12/19/2024] [Indexed: 01/19/2025]
Abstract
PURPOSE The most frequently used surgical procedures for periprosthetic joint infections (PJIs) are debridement, antibiotics, and implant retention (DAIR), as well as single- or two-stage revision arthroplasty. The choice of surgery is made depending on the full maturation of the biofilm layer. The purpose of this study was to evaluate the biofilm formation and microbial growth using common PJI-causing agents and compare its development on the implant surface. METHODS The in vivo study was performed using 40 Sprague-Dawley rats divided into five groups (n = 8/group): Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Candida albicans, and control. Six standard titanium alloy discs were placed into the subcutaneous air pouches of the interscapular areas of the rats. After the inoculation of microorganisms, disc and soft tissue cultures were collected at 2-week intervals for 6 weeks, and the microbial load and the microscopic appearance of the biofilm were compared. RESULTS The disc samples from the S. aureus group had the highest infection load at all time points; however, in soft tissue samples, this was only observed at week 4 and 6. Electron microscopic images showed no distinctive differences in the biofilm structures between the groups. CONCLUSION S. aureus microbial burden was significantly higher in implant cultures at week 2 compared to other PJI-causing agents examined. These results may explain the higher failure rate seen if the DAIR procedure was performed at < 3-4 weeks after the PJI symptom onset and support the observation that DAIR may not be effective against PJIs caused by S. aureus.
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Affiliation(s)
- Mehmet Batu Ertan
- Department of Orthopedics and Traumatology, Atılım Unıversity School of Medicine, Ankara, Turkey.
| | - Mehmet Yağız Ayduğan
- Department of Orthopedics and Traumatology, Ministry of Health Haymana State Hospital, Ankara, Turkey
| | - Ebru Evren
- Department of Medical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - İrem İnanç
- Department of Histology and Embryology, Ankara University School of Medicine, Ankara, Turkey
| | - Esra Erdemli
- Department of Histology and Embryology, Ankara University School of Medicine, Ankara, Turkey
| | - Bülent Erdemli
- Department of Orthopedics and Traumatology, Ankara University School of Medicine, Ankara, Turkey
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Li FL, Qi XY, Chen JL, Zeng YR. From disease management to prevention, hip prosthesis joint infections in the past 20 years: a global research trends and top 10 cited articles analysis. Front Surg 2025; 11:1448049. [PMID: 39845026 PMCID: PMC11752910 DOI: 10.3389/fsurg.2024.1448049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 12/10/2024] [Indexed: 01/24/2025] Open
Abstract
Background There are few literatures comprehensively analyzed the global research in hip prosthesis joint infections (HPJI). We aim to clarify the global research trends and analysis the top 10 cited articles in the HPJI field. Methods We identified the core collection of articles/reviews in the HPJI field from 2001 to 2021 through the Web of Science Core Collection (WOSCC). VOSviewer and online bibliometric tool were used to conduct the visualized and knowledge maps. Annual trends of publications, research hotspots and the top 10 cited articles were analyzed. Results A total of 5,477 publications were finally included. Generally, an increasing trend was observed in the number of publications from 2001 to 2021. The authors, journals and institutions with largest number of publications all belong to the USA. Co-occurrence analysis of keywords showed that surgical techniques, risk factors, revision surgery strategy, epidemiology, diagnoses and prevention were the 6 major research directions. Total hip arthroplasty, replacement, outcomes, risk factors and diagnosis were the keywords that occurred most frequently. The top 10 cited articles were all published in Journal Citation Reports (JCR) Q1 journals, providing valuable reference value from the perspectives of clinical guidelines, perioperative management, causes and diagnostic methods of infection, epidemiological investigation, risk factors and prognostic analysis. Conclusions The number of publications in HPJI field had been on the rise over the past 20 years, from disease management to prevention. An intensive reading of the top 10 cited articles is beneficial to understand the focus of HPJI research comprehensively.
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Affiliation(s)
- Fei-Long Li
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Baiyun, China
- Department of Orthopaedics (Joint Center), The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Liwan, China
| | - Xing-Yu Qi
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jin-Lun Chen
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yi-Rong Zeng
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Baiyun, China
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Yu JS, Tripathi V, Magahis P, Ast M, Sculco P, Premkumar A. Characterization and Potential Relevance of Randomized Controlled Trial Patient Populations in Revision Total Joint Arthroplasty: A Systematic Review. J Knee Surg 2025; 38:79-88. [PMID: 39353620 DOI: 10.1055/a-2428-1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
Randomized controlled trial (RCT) studies in revision total joint arthroplasty (rTJA) are essential to investigate the effectiveness of interventions. However, there has been limited research investigating how patient cohorts comprising rTJA RCT samples resemble the U.S. patient population undergoing rTJA in terms of demographic and clinical characteristics. Thus, the purpose of this systematic review was to compare the patient characteristics of rTJA RCT cohorts with the characteristics of national patient database cohorts. RCT studies for rTJA were aggregated. Patient demographics in this group were compared against Healthcare Cost and Utilization Project-National Inpatient Sample (NIS) and American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) patient cohorts. Forty-six RCTs met inclusion criteria. There were 3,780 total patients across 46 RCTs. The average age of patients in the rTJA RCT cohort was 66.4 ± 9.4 while in the NIS cohort was 67.3 ± 11.1 (d = 0.08, effect size = small). The average body mass index (BMI) of the rTJA RCT cohort was 31.1 ± 5.7 while the NSQIP cohort was 31.7 ± 8.3 (d = 0.08, effect size = small). For rTJA, effect sizes for age, BMI, sex, ethnicity, smoking, and diabetes were all small or very small.Overall, the rTJA RCT patient cohort does not differ significantly compared with the general patient population undergoing rTJA. Differences in demographic and clinical characteristics between the rTJA RCT cohort and database cohorts were minimal to small, indicating that these differences are unlikely to impact clinical outcomes.
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Affiliation(s)
- Jonathan S Yu
- Department of Orthopaedic Surgery, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Vidushi Tripathi
- Weill Cornell Medical College, Weill Cornell Medicine, New York, New York
| | - Patrick Magahis
- Weill Cornell Medical College, Weill Cornell Medicine, New York, New York
| | - Michael Ast
- Hip and Knee Replacement, Hospital for Special Surgery, New York, New York
| | - Peter Sculco
- Hip and Knee Replacement, Hospital for Special Surgery, New York, New York
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
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Carender CN, Bedard NA, Fruth KM, Taunton MJ, Pagnano MW, Abdel MP. Modular dual-mobility constructs outperformed large femoral heads in 299 revision total hip arthroplasties at mid-term follow-up. Bone Joint J 2025; 107-B:58-64. [PMID: 39743935 DOI: 10.1302/0301-620x.107b1.bjj-2024-0170.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
Aims The purpose of this study was to directly compare the Modular Dual Mobility (MDM) Mobile Bearing Hip System (Stryker, USA) and large femoral heads (LFHs) in revision total hip arthroplasties (THAs) at mid-term follow-up, with specific emphasis on survival free of re-revision for dislocation, any re-revision, dislocation, and the risk of metal-related complications. Methods We identified 299 revision THAs performed at a single tertiary care academic institution from March 2011 to July 2014. Aseptic loosening of the acetabular component (n = 65), dislocation (n = 58), and reimplantation as part of a two-stage exchange protocol (n = 57) were the most common reasons for index revision. MDM constructs were used in 123 cases, and LFHs were used in 176 cases. Mean age was 66 years (28 to 93), mean BMI was 31 kg/m2 (18 to 55), and 45% (n = 136) were female. Mean follow-up was seven years (2 to 12). Results The ten-year survival free of re-revision for dislocation was 99% (95% CI 95 to 100) in the MDM cohort and 91% (95% CI 84 to 96) in the LFH cohort, with a significantly increased risk of re-revision for dislocation in the LFH cohort (HR 7.1 (95% CI 1.3 to 40.8); p = 0.023). The ten-year survival free of any re-revision was 92% (95% CI 82 to 99%) in the MDM cohort and 84% (95% CI 74 to 90) in the LFH cohort with a significantly increased risk of any re-revision in the LFH cohort (HR 2.6 (95% CI 1.1 to 5.9); p = 0.024). The ten-year survival free of any dislocation was 95% (95% CI 85 to 99) in the MDM cohort and 87% (95% CI 78 to 92) in the LFH cohort with a significantly increased risk of any dislocation in the LFH cohort (HR 2.7 (95% CI 1.1 to 6.3); p = 0.028). There were no re-revisions or reoperations for metallosis or corrosion in the MDM cohort. Conclusion In this head-to-head comparison, revision THAs with a MDM construct safely and effectively lowered the risk of re-revision for dislocation, any re-revision, and any dislocation compared to LFH at mid-term follow-up. There were no re-revisions or reoperations for metallosis or corrosion in the MDM cohort.
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Affiliation(s)
| | - Nicholas A Bedard
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristin M Fruth
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Taunton
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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McCormick KL, Mastroianni MA, Kolodychuk NL, Herndon CL, Shah RP, Cooper HJ, Sarpong NO. Complications and Survivorship After Aseptic Revision Total Hip Arthroplasty: Is There a Difference by Surgical Approach? J Arthroplasty 2025; 40:203-207. [PMID: 38936438 DOI: 10.1016/j.arth.2024.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Revision total hip arthroplasty (rTHA) has traditionally been performed through the posterolateral approach (PA). Anterior approaches (AA) for rTHA are increasingly being utilized. The purpose of this study was to compare complications and survivorship from re-revision and reoperation after aseptic rTHA performed using an AA versus a PA. METHODS We retrospectively reviewed patients who underwent aseptic rTHA either through an AA (direct anterior approach [DAA], anterior-based muscle sparing [ABMS]) or PA from January 2017 to December 2021. There were 116 patients who underwent AA-rTHA (DAA 50, ABMS 66) or PA-rTHA (n = 105). Patient demographics, complications, and postoperative outcomes were collected. RESULTS The most common indication in both groups was aseptic loosening (n = 26, 22.4% AA, n = 28, 26.7% PA). Acetabular revision alone was most common in the AA group (n = 33, 28.4%), while both components were most commonly revised in the PA groups (n = 47, 44.8%). In all the AA-rTHA group, the index total hip arthroplasty was performed through a PA in 51% of patients, while the PA-rTHA group had the index procedure performed via AA in 4.8%. There was no statistically significant difference in re-revision rate between the DAA, ABMS, or PA groups (9.55 versus 5.3% versus 11.4%, respectively, P = .11). The most common overall reason for re-revision was persistent instability, with no difference in incidence of postoperative hip dislocation (n = 4, 6.8% DAA, n = 3, 5.3%, n = 10, 9.5% PA; P = .31). CONCLUSIONS This study demonstrates no difference in complication or re-revision survivorship after aseptic rTHA performed through a DAA, ABMS approach, or PA, nor between anterior or posterior-based approaches. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kyle L McCormick
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Michael A Mastroianni
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Nicholas L Kolodychuk
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Carl L Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Roshan P Shah
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Nana O Sarpong
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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Hsu YC, Hsu AHS, Wu CT, Tan TL, Wang JW, Kuo FC. Association between IV and topical tranexamic acid use and periprosthetic joint infections in hip and knee arthroplasty: a retrospective study. BMC Musculoskelet Disord 2024; 25:1033. [PMID: 39702243 DOI: 10.1186/s12891-024-08080-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 11/14/2024] [Indexed: 12/21/2024] Open
Abstract
BACKGROUND Anemia and blood transfusions are recognized as risk factors for periprosthetic joint infections (PJI). Tranexamic acid (TXA) is established in reducing perioperative blood loss and transfusion requirements. Our study investigates the impact of perioperative TXA administration on the incidence of PJI in patients undergoing total joint arthroplasty (TJA) and evaluates the association of intravenous (IV) and topical applications with PJI occurrence. METHODS A retrospective review was performed on 8042 patients who underwent primary total hip arthroplasty (THA) and knee arthroplasty (TKA) from January 2009 to December 2020, with a minimum one-year follow-up at our institution. We compared patients who received TXA (n = 3664, with 2345 receiving it IV and 1319 topically) to those who did not (n = 4378). 0.5-1.25 g of IV TXA was administered before skin incision, and 1.5-3 g of topical TXA was injected intra-articularly or into the drainage tube during surgery. The primary outcome was PJI development within one year, defined by the 2013 International Consensus Meeting criteria. Secondary outcomes included blood transfusion, hospital length of stay (LOS), venous thromboembolism (VTE), and 90-day readmission. We employed multivariate logistic regression and propensity score weighting to adjust for potential confounders and conducted subgroup analyses to assess PJI odds in TKA and THA patients treated with IV and topical TXA. RESULTS The TXA group demonstrated a lower PJI occurrence (1.1% vs. 2.1%, p < 0.001), less blood transfusion (14.4% vs. 22.7%, p < 0.001) and shorter LOS (5.6 ± 1.6 vs. 6.5 ± 2.5, p < 0.001) compared to those without TXA. There was no difference between the two groups with regards to VTE and 90-day readmission. Perioperative TXA administration demonstrated lower PJI in multivariate analysis (OR 0.54, 95% CI 0.36-0.80, p = 0.002), and in propensity score weighting (OR 0.53, 95% CI 0.36-0.80, p = 0.002). In the subgroup analysis, both IV and topical administration of TXA resulted in decreased PJI (IV group: OR 0.53, 95% CI, 0.33-0.84, p = 0.007, topical group: OR 0.51, 95% CI, 0.29-0.89, p = 0.018), especially in primary TKA (IV TXA, OR 0.49, 95% CI, 0.29-0.83, p = 0.008; Topical TXA, OR, 0.56, 95% CI, 0.32-0.98, p = 0.042). CONCLUSION Perioperative TXA administration in primary hip and knee arthroplasty is significantly associated with a reduced PJI occurrence. Both IV and topical TXA routes showed similar association with reduced PJI occurrence, with a notable correlation observed in primary TKA.
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Affiliation(s)
- Yun-Chen Hsu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 833, Taiwan
| | - Allen Herng Shouh Hsu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 833, Taiwan
| | - Cheng-Ta Wu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 833, Taiwan
| | - Timothy L Tan
- Sequoia Institute for Surgical Service, Visalia, CA, USA
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jun-Wen Wang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 833, Taiwan.
- College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
| | - Feng-Chih Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 833, Taiwan.
- College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
- Center for General Education, Cheng Shiu University, Kaohsiung, Taiwan.
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Khatod M, Chan PH, Prentice HA, Fasig BH, Paxton EW, Reddy NC, Kelly MP. Dual-Mobility Articulations in Revision Total Hip Arthroplasty: A Comparison with Metal or Ceramic on Highly Cross-Linked Polyethylene and Constrained Articulations. J Bone Joint Surg Am 2024; 106:2313-2321. [PMID: 39418353 DOI: 10.2106/jbjs.24.00168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2024]
Abstract
BACKGROUND The increased availability of dual-mobility acetabular constructs (DMCs) provides surgeons with a newer option to increase the effective femoral head size in revision total hip arthroplasty (rTHA). We sought to evaluate risks of re-revision and prosthetic dislocation following rTHA involving a DMC compared with other articulations. METHODS A cohort study was conducted using data from a U.S. integrated health-care system's Total Joint Replacement Registry. Adult patients who underwent primary THA and went on to undergo an aseptic rTHA in 2002 to 2022 were identified. Patients who received a DMC, a constrained liner, or a metal or ceramic unipolar femoral head on highly cross-linked polyethylene (XLPE) at the time of rTHA were the treatment groups. Subsequent aseptic re-revision and dislocation were the outcomes of interest. Multivariable Cox proportional-hazards regression was used to evaluate the risks of the outcomes, with adjustment for patient, operative, and surgeon confounders. RESULTS The analyzed rTHAs comprised 375 with a DMC, 268 with a constrained liner, 995 with a <36-mm head on XLPE, and 2,087 with a ≥36-mm head on XLPE. DMC utilization increased from 1.0% of rTHAs in 2011 to 21.6% in 2022. In adjusted analyses, a higher re-revision risk was observed for the constrained liner (hazard ratio [HR] = 2.43, 95% confidence interval [CI] = 1.29 to 4.59), <36 mm on XLPE (HR = 2.05, 95% CI = 1.13 to 3.75), and ≥36 mm on XLPE (HR = 2.03, 95% CI = 1.19 to 3.48) groups compared with the DMC group. A higher dislocation risk was observed in both XLPE groups (<36 mm: HR = 2.04, 95% CI = 1.33 to 3.14; ≥36 mm: HR = 2.46, 95% CI = 1.69 to 3.57) compared with the DMC group; a nonsignificant trend toward a higher dislocation rate in the group with a constrained liner than in the DMC group was also observed. CONCLUSIONS In a large U.S.-based cohort, rTHAs using DMCs had the lowest re-revision risk and dislocation risk. Both outcomes were significantly lower than those using a unipolar femoral head on XLPE, re-revision risk was significantly lower than using a constrained liner, and dislocation risk trended toward a lower risk than using a constrained liner. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Monti Khatod
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, West Los Angeles, California
| | - Priscilla H Chan
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, California
| | - Heather A Prentice
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, California
| | - Brian H Fasig
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, California
| | - Elizabeth W Paxton
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, California
| | - Nithin C Reddy
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, San Diego, California
| | - Matthew P Kelly
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Harbor City, California
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King PJ. Dual-Mobility Articulations in Revision Hip Arthroplasty: Commentary on an article by Monti Khatod, MD, et al.: "Dual-Mobility Articulations in Revision Total Hip Arthroplasty. A Comparison with Metal or Ceramic on Highly Cross-Linked Polyethylene and Constrained Articulations". J Bone Joint Surg Am 2024; 106:e51. [PMID: 39692718 DOI: 10.2106/jbjs.24.00816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2024]
Affiliation(s)
- Paul J King
- Luminis Health Anne Arundel Medical Center, Annapolis, Maryland
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43
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Yeramosu T, Farrar JM, Malik A, Satpathy J, Golladay GJ, Patel NK. Predicting Early Hospital Discharge Following Revision Total Hip Arthroplasty: An Analysis of a Large National Database Using Machine Learning. J Arthroplasty 2024:S0883-5403(24)01286-5. [PMID: 39662849 DOI: 10.1016/j.arth.2024.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 11/27/2024] [Accepted: 12/03/2024] [Indexed: 12/13/2024] Open
Abstract
BACKGROUND Revision total hip arthroplasty (rTHA) was recently removed from the Medicare inpatient-only list. However, appropriate candidate selection for outpatient rTHA remains paramount. The purpose of this study was to evaluate the utility of a large national database using machine learning (ML) and traditional multivariable logistic regression (MLR) models in predicting early hospital discharge (EHD) (< 24 hours) following rTHA. Furthermore, this study aimed to use the trained ML models, cross-referenced with traditional MLR, to determine key perioperative variables predictive of EHD following rTHA. METHODS Data were obtained from a large national database from 2021. Patients who had unilateral rTHA procedures were included. Demographic, preoperative, and operative variables were analyzed as inputs for the models. An ML regression model and various ML techniques were used to predict EHD and were compared using the area under the curve, calibration, Brier score, and decision curve analysis. Feature importance was identified from the overall best-performing model. Of the 3,097 patients in this study, 866 (27.96%) underwent EHD. RESULTS The random forest model performed the best overall and identified aseptic surgical indication, operative time < three hours, absence of anemia (hematocrit < 40% in men and < 35% in women), neuraxial anesthesia type, White race, men, independent functional status, body mass index > 20, age < 75 years, and the presence of home support as factors predictive of EHD. Each of these variables was also significant in the MLR model. CONCLUSIONS Each ML model and MLR displayed good performance and identified clinically important variables for determining candidates for EHD following rTHA. Machine learning (ML) techniques such as random forest may allow clinicians to accurately risk stratify their patients preoperatively to optimize resources and improve patient outcomes.
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Affiliation(s)
- Teja Yeramosu
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Jacob M Farrar
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Avni Malik
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Jibanananda Satpathy
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Nirav K Patel
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
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Lourens EC, Zhai Y, Harries D, Lewis PL, Kurmis AP. Early Patient-Reported Outcome Measures Following Computer Navigated Total Hip Arthroplasty: A Study From the Australian Orthopaedic Association National Joint Replacement Registry. J Arthroplasty 2024:S0883-5403(24)01282-8. [PMID: 39647800 DOI: 10.1016/j.arth.2024.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 11/27/2024] [Accepted: 12/03/2024] [Indexed: 12/10/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is a well-established treatment for symptomatic hip osteoarthritis (OA). The use of computer navigation in THA aims to achieve the reconstruction of the joint more consistently and precisely. The aim of this study was to contrast patient-reported outcome measures (PROMs) for THA procedures with and without commercially available navigation technologies. METHODS Postoperative PROMs for primary THA procedures performed for OA between August 2018 and December 2022 and recorded in the Australian Orthopaedic Association National Joint Replacement Registry were analyzed. Procedures using computer navigation were compared to those using conventional instrumentation. Baseline patient characteristics and surgeon volume were subanalyzed. Multivariable regressions were used to compare postoperative PROMs. RESULTS There were 13,400 THA procedures for OA with PROMs recorded and 749 with navigation. The mean (SD) EuroQol-visual analog scales (EQ-VASs) scores for navigated cases were 67.3 (19.3) preoperatively and 81.7 (15.0) postoperatively, compared with 66.0 (20.3) and 80.5 (15.8) for the non-navigated group. Oxford Hip scores and patient-reported change were similar between groups. The change from preoperative to postoperative EQ-VAS and Oxford Hip score did not significantly differ between computer-navigated and non-navigated cases. After adjusting for patient and procedure factors, the use of computer navigation was associated with a higher rate of procedure satisfaction (rate ratio 1.03, 95% confidence interval 1.01 to 1.06, P = 0.02). CONCLUSIONS While procedural satisfaction was marginally higher following navigated THA (P = 0.02), there were no statistically significant differences in the change in EQ-VAS or when comparing navigated with "non-navigated" approaches for primary THAs. Based on the reviewed national registry data for PROMS, we were unable to demonstrate clinically relevant evidence to support claims of superiority of non-navigated or navigated primary THAs. Further work, including similar comparisons with long-term follow-up, will be of value in elucidating if a true clinically relevant difference exists.
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Affiliation(s)
- Ernest C Lourens
- Mount Gambier Hospital, Limestone Coast Local Health Network, Mount Gambier, South Australia, Australia
| | - Yuze Zhai
- College of Medicine & Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Dylan Harries
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Peter L Lewis
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Andrew P Kurmis
- College of Medicine & Public Health, Flinders University, Adelaide, South Australia, Australia; Department of Orthopaedic Surgery, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia; Discipline of Medical Specialties, University of Adelaide, Adelaide, South Australia, Australia
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Van Roekel N, Lutnick E, Pavlesen S, Henry M, Haider M, Phillips M. Perioperative Femur Fractures in muscle sparing anterolateral - Modified Watson-Jones approach to primary total hip arthroplasty: A retrospective cohort study. J Clin Orthop Trauma 2024; 59:102828. [PMID: 39650718 PMCID: PMC11617703 DOI: 10.1016/j.jcot.2024.102828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 11/15/2024] [Indexed: 12/11/2024] Open
Abstract
Background Periprosthetic femur fractures (PFF) are a rare early complication in primary total hip arthroplasty (THA) that may result in revision and burden the healthcare system. A previous study identified a PFF rate of 8.3 % at 90 days with the modified anterolateral Watson-Jones (AL) approach to THA. This study assesses the PFF rate and risk factors with this approach at 90 days and 1-year post-operative follow-up. Methods 580 primary THAs performed using the AL approach were retrospectively reviewed for risk factors associated with perioperative PFF including demographics, intra-operative and postoperative factors, and disposition. Results 507 included patients had a 90-day PFF rate of 1.6 % (n = 8): 6 intraoperative (1.2 %), and 2 postoperative (0.4 %), significantly lower than previously reported (p < 0.001). 1 additional postoperative PFF fracture was operatively managed with open reduction internal fixation (ORIF) on day 302; 1-year PFF rate was 2.5 %. All fractures healed uneventfully after treatment. The 1-year return to operating room rate for PFF was 0.3 %. Patients with PFF were significantly older (p = 0.036) compared to non-PFF patients. Implant type significantly predicted PFF. Conclusion The rarity of PFF among our cohort highlights the efficacy of the AL approach to avoid this complication.
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Affiliation(s)
- N. Van Roekel
- Department of Orthopaedics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, USA
| | - E. Lutnick
- Department of Orthopaedics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, USA
| | - S. Pavlesen
- Department of Orthopaedics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, USA
| | - M. Henry
- Department of Orthopaedics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, USA
| | - M.N. Haider
- Department of Orthopaedics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, USA
| | - M. Phillips
- Department of Orthopaedics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, USA
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Röhrl A, Klawonn F, Füchtmeier B, Wulbrand C, Gessner A, Zustin J, Ambrosch A. Results of a monocentric field study: value of histology compared to sonication method and conventional tissue culture in the diagnosis of periprosthetic joint infection (PJI). Infection 2024; 52:2287-2296. [PMID: 38730201 DOI: 10.1007/s15010-024-02278-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/21/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND To confirm the diagnosis of periprosthetic joint infection (PJI), the Infectious Diseases Society of America (IDSA) and the International Consensus Meeting (ICM) have defined criteria that include histology as a minor criterion and the sonication method only as an additional criterion. The aim of this monocentric, retrospective study was to investigate the value of histology and whether sonication leads to a more accurate diagnosis. MATERIALS AND METHODS All revision surgeries for knee and hip arthroplasty between 2017 and 2020 were included. With regard to microbiological diagnostic, conventional culture of periprosthetic biopsies and sonication of explant material were performed. In addition, histology and non-specific inflammatory markers (CRP, leukocytes) were recorded. RESULTS A total of 78 patients with PJI and 62 aseptic controls were included. From both microbiological methods (conventional culture / sonication), Staphyloccus (S.) epidermidis and S. aureus were detected most frequently. However, compared to the conventional microbiology, a higher sensitivity was calculated for sonication, albeit with a lower specificity in relation to a PJI. In two logistic regression models for the significance of all diagnostic parameters in PJI, the AUC was 0.92 and 0.96 with histology in particular making the decisive contribution in both models (p < 0. 001, both models). CONCLUSION Since histology showed the highest accuracy in the current study, its importance in the PJI criteria should be reevaluated. Sonication shows a high sensitivity for germ detection with a lower specificity and should only be used in combination with the conventional culture for microbiolgical diagnostics.
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Affiliation(s)
- Alexander Röhrl
- Department of Trauma Surgery, Orthopaedics & Sports Medicine, Hospital of Brothers of Mercy, Regensburg, Germany
| | - Frank Klawonn
- Biostatistics, Helmholtz Centre for Infection Research, Brunswick, Germany
- Institute for Information Engineering, Ostfalia University, Wolfenbüttel, Germany
| | - Bernd Füchtmeier
- Department of Trauma Surgery, Orthopaedics & Sports Medicine, Hospital of Brothers of Mercy, Regensburg, Germany
| | - Christian Wulbrand
- Department of Trauma Surgery, Orthopaedics & Sports Medicine, Hospital of Brothers of Mercy, Regensburg, Germany
| | - Andre Gessner
- Institute of Clinical Microbiology and Infection Prevention, University Hospital, Regensburg, Germany
| | - Jozef Zustin
- Private Histopathology Service, Regensburg, Germany
- Gerhard Domagk Institute of Pathology, University Medical Center, Münster, Germany
| | - Andreas Ambrosch
- Institute of Laboratory Medicine, Microbiology and Infection Prevention, Hospital of Brothers of Mercy, Prüfeninger Straße 86, 93049, Regensburg, Germany.
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Gaillard-Campbell D, Gross T. Magnum metal-on-metal uncemented total hip replacement: 8- to 18-year outcomes of 211 cases. Musculoskelet Surg 2024; 108:449-457. [PMID: 38833069 PMCID: PMC11582121 DOI: 10.1007/s12306-024-00831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/17/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Reports of adverse reactions to metal debris contributed in part to a decline in use of large-bearing metal-on-metal total hip devices. We hypothesize an optimal trunnion design may reduce risk of this failure mode in large-bearing total hip arthroplasty systems. The purpose of this study is to report mid- to long-term outcomes for a single-surgeon series of 211 total hip arthroplasties using the large-bearing Biomet Magnum metal-on-metal system. MATERIALS AND METHODS Between December 2004 and January 2016, the primary surgeon performed 211 uncemented Magnum total hip arthroplasties in 181 patients. The average length of follow-up was 10.1 ± 3.5 years (range 8-18 years). RESULTS Using failure of any component as the endpoint, the overall survivorship rate was 98.1% at 10 years and 97.4% at 18 years. These eight failures (3.8% of cohort) included one case of adverse wear-related failure (0.5%), two cases of acetabular ingrowth failure (0.9%), three cases of trunnion corrosion (1.4%), one failure of late infection (0.5%), and one inappropriate revision of components for trochanteric nonunion without instability (0.5%). Excluding failed cases, all components were radiographically stable with no radiolucencies. Except for the one wear failure, ion testing revealed that 97.2% of cases were within optimal whole blood metal ion levels with the remaining ion test results within acceptable levels. CONCLUSIONS With the uncemented Magnum metal-on-metal total hip, we achieved 97.4% 18-year implant survivorship, exceeding the NICE criteria and registry benchmarks for implant survivorship. We observed a trunnion corrosion rate of 1.4% and no cases of instability. The single case of adverse wear-related failure was caused by acetabular component malposition.
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Affiliation(s)
- D Gaillard-Campbell
- Midlands Orthopaedics and Neurosurgery, PA, 1910 Blanding Street, Columbia, SC, 29201, USA.
| | - T Gross
- Midlands Orthopaedics and Neurosurgery, PA, 1910 Blanding Street, Columbia, SC, 29201, USA
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Bains SS, Dubin JA, Salib CG, Monárrez R, Remily E, Hameed D, Swartz GN, Katanbaf R, Nace J, Delanois RE. The Epidemiology of the Revision Total Hip Arthroplasty in the United States From 2016 to 2022. Arthroplast Today 2024; 30:101517. [PMID: 39524991 PMCID: PMC11550771 DOI: 10.1016/j.artd.2024.101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 07/16/2024] [Accepted: 08/13/2024] [Indexed: 11/16/2024] Open
Abstract
Background The number of revision total hip arthroplasties (THAs) is projected to reach 572,000 cases annually by 2030 in the United States. This may be attributed to the successes of primary THAs combined with an aging population, patients desire to remain active, and expanded indications for younger patients. Given the evolving nature of revision THAs, an epidemiological analysis of (1) etiologies; (2) demographics, including age and region; and (3) lengths of stay (LOSs) may minimize the gap between appropriate understanding and effective intervention. Methods From 2016 to 2022, a national, all-payer database was queried. Incidences and indications were analyzed for a total of 102,476 patients who had revision THA procedures. Patients were stratified according to etiology of failure, age, US census region, primary payor class, and mean LOS. Results The most common etiologies for revision THA procedures were dislocation (16.7%) and infection (12.7%), followed by periprosthetic fracture (6.9%). The largest age group was 65-74 years (30.9%), followed by >75 years (28.6%), then 55-64 (26.5%). The South had the largest total procedure cohort (36.9%), followed by the Midwest (27.5%), then the Northeast (19.7%), and the West (15.9%). The mean LOS was 4.10 days (range, 1.0-20.0). Conclusions Dislocation and infection remain leading indications for revision THA. These findings can properly guide surgeons toward appropriate management as well as toward active steps to minimizing these outcomes.
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Affiliation(s)
- Sandeep S. Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
| | - Jeremy A. Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
| | - Christopher G. Salib
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
| | - Rubén Monárrez
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
| | - Ethan Remily
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
| | - Gabrielle N. Swartz
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
| | - Reza Katanbaf
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
| | - James Nace
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
| | - Ronald E. Delanois
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
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49
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Li KW, Rong S, Li H. Construction of a Clinical Prediction Model for Complications After Femoral Head Replacement Surgery. J Clin Med Res 2024; 16:554-563. [PMID: 39635335 PMCID: PMC11614405 DOI: 10.14740/jocmr6047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 10/30/2024] [Indexed: 12/07/2024] Open
Abstract
Background While femoral head replacement is widely used with remarkable efficacy, the complexity and diversity of postoperative complications pose a serious prognostic challenge. There is an urgent need to develop a clinical prediction model that can integrate multiple factors and accurately predict the risk of postoperative complications to guide clinical practice and optimize patient management strategies. This study is dedicated to constructing a postoperative complication prediction model based on statistics and machine learning techniques, in order to provide patients with a safer and more effective treatment experience. Methods A total of 186 patients who underwent femoral head replacement in the Orthopedic Department of our hospital were collected in this study. Forty-two of the patients had at least one postoperative complication, and 144 had no complications. The preoperative and postoperative data of patients were collected separately and medical history was collected to study the correlation factors affecting the occurrence of postoperative complications in patients and to establish a prediction model. Results Possibly relevant factors were included in a one-way logistic regression, which included the patient's gender, age, body mass index, preoperative diagnosis of the mode of injury, osteoporosis or lack thereof, as well as medical history, surgical-related information, and laboratory indices. After analyzing the results, it was concluded that operation time, alanine transaminase (ALT), aspartate aminotransferase (AST), white blood cell count, serum albumin, and osteoporosis, were the risk factors affecting the development of complications after femoral head replacement in patients (P < 0.2). The data obtained were further included in a multifactorial regression, and the results showed that operation time, AST, white blood cell count, serum albumin, and osteoporosis were independent risk factors for complications after the patients underwent femoral head replacement (P < 0.05). Conclusion Based on the results of this study, five factors, including duration of surgery, AST, white blood cell count, serum albumin, and osteoporosis, were identified as independent risk factors for complications after patients underwent femoral head replacement. In addition, the prediction model developed in this study has a high scientific and clinical application value, providing clinicians and patients with an important tool for assessing the risk of complications after affected femoral head replacement.
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Affiliation(s)
- Ke Wei Li
- Pediatric Orthopedics, The Third Hospital of Shijiazhuang, Shijiazhuang City, Hebei Province, China
| | - Shuai Rong
- Pediatric Orthopedics, The Third Hospital of Shijiazhuang, Shijiazhuang City, Hebei Province, China
| | - Hao Li
- Pediatric Orthopedics, The Third Hospital of Shijiazhuang, Shijiazhuang City, Hebei Province, China
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50
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Karlidag T, Dasci MF, Steinhoff J, Gehrke T, Citak M. What is the diagnostic accuracy of neutrophil to lymphocyte ratio and monocyte to lymphocyte ratio in detecting acute periprosthetic joint infections? A gender-specific analysis. Arch Orthop Trauma Surg 2024; 144:5071-5078. [PMID: 38147079 DOI: 10.1007/s00402-023-05162-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/26/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE The accurate and timely diagnosis of periprosthetic joint infection (PJI) is critical for guiding optimal treatment management and success, highlighting the requirement of readily available inexpensive serum biomarkers to increase the diagnostic accuracy for PJI. Many studies have investigated the diagnostic accuracy of neutrophil to lymphocyte ratio (NLR) and monocyte to lymphocyte ratio (MLR). However, there is a lack of existing literature regarding optimal thresholds for acute PJI. The purpose of this study was to reveal the most appropriate cut-off values for MLR and NLR in detecting acute PJI with a gender specific analysis. METHODS Patients were classified as having an acute PJI if they met the International Consensus Meeting (ICM) 2018 modified criteria. Patients who had a negative clinical and diagnostic workup for a PJI and the presence of erythema on the index surgical area were included in the erysipelas group (control group). Data obtained from all patients included age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI), procedure type (THA or TKA), serum C-reactive protein (CRP), and blood studies at the admission and culture results were retrieved from the electronic medical record. RESULTS ROC curve analysis was used to determine the gender-specific optimal threshold values for CRP, NLR, and MLR. Comparing the sensitivities and specificities of NLR and MLR at the identified best thresholds in males and females, the study found similar sensitivities of NLR in males and females with 0.84 and 0.84, respectively. On the other hand, an MLR of 0.67 or more reported a notably higher specificity in male patients [0.90 (95% CI 0.75-0.96) versus 0.70 (95% CI 0.56-0.80)]. CONCLUSION NLR and MLR represent commonly ordered, low-cost, simple, and readily available complete cell count laboratory values and should be used as adjunct tests with reasonable diagnostic accuracy in detecting acute PJIs. Moreover, with its excellent specificity and PPV, MLR could provide valuable insight in diagnosing acute PJI, particularly in male patients. LEVEL OF EVIDENCE Level III Retrospective Cohort analysis.
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Affiliation(s)
- Taner Karlidag
- Department of Orthopedics and Traumatology, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
- Department of Orthopedics and Traumatology, Gaziantep City Hospital, Gaziantep, Turkey
| | - Mustafa Fatih Dasci
- Department of Orthopedics and Traumatology, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Julian Steinhoff
- Department of Orthopedics and Traumatology, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopedics and Traumatology, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopedics and Traumatology, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
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