Journal of Arthroplasty

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BACKGROUND: More solid organ transplant (SOT) patients are undergoing total knee arthroplasty (TKA). This study sought to identify risk factors associated with medical complications, implant survivorship, and patient mortality in TKA patients who had prior SOT. METHODS: We identified 176 TKAs in patients who had prior SOT. Of these, 77 had a prior renal transplant (RT), 77 had a prior liver transplant (LT), and 22 had multiple prior transplants (MT). Median survival was estimated using Kaplan-Meier method...

BACKGROUND: The aim of this study was to evaluate the responsiveness of different patient-reported outcome measures (PROMs) in patients with primary total knee arthroplasty (TKA). METHODS: In this prospective observational study, we assessed patients with TKA before the surgery, after four months, after one year, and after two years. Measures were the objective Knee Society Score (KSS) and the following PROMs: Knee injury and Osteoarthritis Outcome Score (KOOS), KOOS-12, Forgotten Joint Score (FJS-12), High-Activity Arthroplasty Score (HAAS), and EQ-5D-3L...

BACKGROUND: Femoral nerve injury is noted as a serious neurological complication following total hip arthroplasty (THA) performed via a direct anterior approach (DAA). Therefore, we aimed to clarify the anatomical course of the femoral nerve around the acetabular rim and in relation to retractor placement during DAA. METHODS: According to standard protocol, a DAA for THA was performed on 69 hemipelves from formalin-preserved full-body donors. The surgery was halted after retractor placement at the anterior part of the acetabulum...

INTRODUCTION: Dual mobility acetabular cups (DMC) were designed to increase the effective femoral head size and improve stability with the goal of reducing revision risk at the potential cost of polyethylene thickness. We sought to evaluate revision risk following primary elective total hip arthroplasty (THA) with DMC compared to highly crosslinked polyethylene (XLPE). METHODS: A cohort study was conducted using data from a United States (US) integrated healthcare system's total joint arthroplasty registry...

BACKGROUND: Total hip arthroplasty (THA) is the operation of choice for salvage of post-traumatic arthritis following acetabular fracture. While high failure rates have been reported for these procedures, existing literature reports mainly on historical implant designs and techniques. We aimed to describe implant survivorships, complications, radiographic results, and clinical outcomes of contemporary THA following prior open reduction internal fixation (ORIF) of an acetabular fracture...

BACKGROUND: Constrained inserts in total knee arthroplasty (TKA) may offer additional stability, but can this insert type allow unrestricted movements or will the extra conformity cause kinematic conflict with the cam/post mechanism in deeper flexion? The objective of this study was to evaluate the weight-bearing kinematics of both traditional and constrained Bi-Cruciate Stabilized (BCS) TKA inserts to determine if the rollback induced by the cam/post mechanism will work in unison with the constrained polyethylene insert...

BACKGROUND: A shift towards same-day discharge (SDD) in primary elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) has created a need to optimize patient selection and improve same day recovery pathways. The objectives of this study were 1) to identify our institution's most common causes for failed SDD, and 2) to evaluate risk factors associated with failed SDD. METHODS: A retrospective review of SDD patients undergoing primary TKA or THA from January 2021 to September 2022 was conducted...

INTRODUCTION: Patients undergoing total joint arthroplasty (TJA) who report penicillin allergy (PA) are frequently administered second-line antibiotics, though recent evidence suggests that this may be unnecessary and could increase infection risk. Many institutions have aimed to improve antibiotic deployment via allergy testing and screening; however, there is little standardization to this process. This review aimed to evaluate: 1) antibiotic selection in patients who report PA and assess the impact of screening and testing interventions; 2) rates of allergic reactions in patients who report PA; and 3) the association between reported PA and screening or testing programs and odds of superficial skin infection (SSI) or periprosthetic joint infection (PJI)...

BACKGROUND: Curved periacetabular osteotomy requires detachment and retraction of the hip flexors. In this study, we evaluated hip flexor muscle status by magnetic resonance imaging (MRI) shortly after curved periacetabular osteotomy. METHODS: We retrospectively evaluated 60 hips of 56 patients by MRI 1 week and 3 months after curved periacetabular osteotomy performed from August 2017 to December 2019. We classified the condition of the flexors as follows: Grade 0, normal; Grade I, strain/edema; Grade II, partial tear; and Grade III, complete tear...

BACKGROUND: The radiographic assessment of bone morphology impacts implant selection and fixation type in total hip arthroplasty (THA) and is particularly important in the context of minimizing periprosthetic femur fracture (PFF) risk. We utilized a deep learning (DL) algorithm to automate femoral radiographic parameters and determined which automated parameters were associated with early PFF. METHODS: Radiographs from a publicly available database and from patients undergoing primary cementless THA at a high-volume institution (2016 to 2020) were obtained...

BACKGROUND: Increasing numbers of patients suffering from hip osteoartritis will lead to increased orthopaedic health care consumption. Artificial intelligence might alleviate this problem, but its efficacy is rarely tested in clinical practice. Machine learning (ML) might optimize orthopaedic consultation workflow by predicting treatment strategy (non-operative or operative) prior to consultation. The purpose of this study was to assess ML prediction accuracy by comparing ML predictions to the outcome of clinical consultations...

Mechanical alignment (MA) and its tenets have been considered essential for total knee arthroplasty (TKA) success since they were introduced in 1973. However, over time, there have been colossal advances in our knowledge and understanding of the anatomy and kinematics of the knee, as well as in surgical precision and implants. However, the MA systematic principles of prosthetic arthroplasty and implant position related to the lower extremity mechanical axis, have only recently been called into question. The high rates of dissatisfaction and residual pain reported after MA TKA prompted this questioning and leaves plenty of room for improvement...

BACKGROUND: Current pre-operative Total Knee Arthroplasty (TKA) planning strategies are bone-referencing and do not consider the ligamentous profile of the knee. This study assessed the mean Hip-Knee-Ankle (HKA) angle of the planned Distracted Alignment (DA), an alignment output using a joint distraction radiology and planning protocol, which incorporates pre-operative evaluation of ligament laxity. MATERIALS AND METHODS: A retrospective study of 144 knees undergoing TKA was performed...

BACKGROUND: Cementless tibial baseplates in total knee arthroplasty (TKA) include fixation features (e.g., pegs, spikes, keels) to ensure sufficient primary bone-implant stability. While the design of these features plays a fundamental role in biologic fixation, the effectiveness of anterior spikes in reducing bone-implant micromotion remains unclear. Therefore, we asked: can an anterior spike reduce the bone-implant micromotion of cementless tibial implants? METHODS: We performed computational finite element analyses on 13 tibiae obtained from the CT (Computed Tomography)-scans of patients scheduled for primary TKA...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

INTRODUCTION: In accordance with the high incidence of bilateral knee osteoarthritis, many patients have undergone bilateral total knee arthroplasty (BTKA). Whether patients undergo bilateral procedures in a staged or simultaneous fashion, the physical and mental burden of undergoing two major orthopaedic procedures is considerable. The aims of this study were to (1) investigate differences between minimal clinically important difference (MCID) achievement between staged versus simultaneous BTKA, and (2) identify the patient variables, specifically mental scores, that were associated with MCID achievement in patients undergoing BTKA...

AIMS: The influence of anesthetic type on mental health after total hip arthroplasty (THA) is poorly understood. Adverse effects of general anesthesia on cognition following major non-cardiac surgery are well known, but mental health following THA is less well-studied. We hypothesized that neuraxial anesthesia would provide favorable mental health profiles compared with general anesthesia after THA. MATERIALS AND METHODS: Prospectively collected Patient-Reported Outcomes Measurement Information System-10 (PROMIS) Global Mental Health (GMH) scores at preoperative baseline and 1, 3, and 6 months after THA were accessed on 4,353 patients in the Pulmonary Embolism Prevention After HiP and KneE Replacement (PEPPER) Trial (ClinicalTrials...

BACKGROUND: Sequential modifications to the manufacturing process of highly cross-linked polyethylene (HXLPE) have improved the wear resistance and implant survival of these liners in total hip arthroplasty (THA). However, no study has examined the long-term (mean 10 year) wear rates and clinical outcomes of third-generation HXLPE in THA. The aim of our study was to report the longest-to-date analysis of wear rates and clinical outcomes of a third-generation HXLPE liner. METHODS: A series of 133 THAs using a specific HXLPE acetabular liner were retrospectively evaluated...