Arthroplasty Patients Research Articles

Total knee arthroplasty in patient with poliomyelitis sequelae: maintaining a recurvatum is associated with better mid-term functional results.

Total knee arthroplasty (TKA) in patients with sequelae of poliomyelitis is a surgical challenge due to muscle weakness, bone deformities or post-polio syndrome (PPS). Few data exist to determine the factors contributing to poor functional results. This study aimed: (1) to describe a cohort of patients with poliomyelitis sequelae who underwent TKA; (2) to examine risk factors for poor functional outcome. A monocentric retrospective cohort study of all patients with poliomyelitis sequelae who underwent TKA between January 2006 and December 2019. Clinical, functional outcomes, radiographic results and occurrence of complications were collected. A total of 22 patients (24 knees) were included in the analysis, with a mean follow-up of 6.6 years (from 2 to 13.7 years). There was an improvement in KSS (28 +/- 23 vs. 81 +/- 6, respectively; p < 0.0001) as well as functional KSS (25 +/- 12 vs. 57.5 +/- 21, respectively; p = 0.0001). There was less occurrence of annual knee giving way episodes after total knee replacement (11.9+/-16.1 vs. 5.1+/-13.7, respectively; p = 0.04). Even though the total knee replacement allowed a slight recurvatum, it was smaller than the preoperative recurvatum (13° vs. 8°, respectively; p = 0.04). Seven complications with reintervention (7/24; 29%) were found. The presence of a residual post operative recurvatum correlated with better KSS (ρ = 0.53, CI95% [0.15; 0.77]; p = 0.008). The number of postoperative annual knee giving way episodes was inversely correlated with persistent postoperative recurvatum (ρ = -0.42, CI95% [-0.69; -0.01]; p = 0.04) but was not correlated with the type of constraint (ρ = -0.26, CI95% [-0.6; 0.15]; p = 0.21) nor with quadricipital muscle strength (ρ = 0.21, CI95% [-0.21; 0.56]; p = 0.33). TKA has a good mid-term functional outcome for knee osteoarthritis in patients with sequelae of poliomyelitis. Preserving a residual recurvatum postoperatively gives better clinical results without increasing the risk of ligament instability or early aseptic loosening. IV.

Computer-assisted total bilateral knee arthroplasty for a patient with severe hyperextension in residual poliomyelitis: a case report

Background. Total knee arthroplasty in patients in the residual stage of poliomyelitis is a technically difficult job. The reasons for this are anatomical features and therefore difficulties in an implant choice and conflicting results. In the present case report, we describe a unique method of a computer-navigated installation of a rotating-hinge implant in a non-standard position for a patient with residual poliomyelitis. The aim of the study is to demonstrate a method of a computer-navigated installation of rotating-hinge knee implants in a patient with severe hyperextension and valgus deformity in the residual stage of poliomyelitis. Case description. The clinical case presents a 55-year-old man with lower peripheral paraparesis as a consequence of poliomyelitis and bilateral valgus knee arthritis with severe hyperextension. The patient moved on crutches at a distance no more than 300 meters. Two-stage total knee arthroplasty was performed using a navigation system and second-generation rotating-hinge implants. At the 4-year follow-up period, we note a good clinical result, and the patient is satisfied with the total knee arthroplasty outcomes. Conclusion. The clinical case demonstrates good results of performing total knee arthroplasty in a patient with bilateral severe hyperextension and knee valgus deformity in residual poliomyelitis. Having analyzed available topic-related literature, we developed an original method of a computer-navigated installation of a second-generation rotating-hinge implant. The method can be an effective treatment solution for patients with knee arthritis deformity in the residual stage of poliomyelitis.

Early results of primary total hip arthroplasty performed in young adults at a regional Saudi-Arabian orthopedics center: a prospective observational study

Background. Younger patients undergoing primary total hip arthroplasty (THA) have different indications and outcomes than elderly patients. Furthermore, studies reporting the results of THA in young patients are scarce in our area. The aim of the study is to report the early experience and clinical results after total hip arthroplasty in patients ≤40 years old from a regional Saudi-Arabian hospital as a representative of the Arab (Middle Eastern) population. Methods. We conducted a prospective observational study over one year by following all patients (≤40 years) who underwent primary THA at a regional Saudi-Arabin orthopedics center. Twenty-five patients (a mean age of 31.60±6.07 years, and 14 (56%) were males) were eligible for final inclusion. The functional assessment was performed according to the Harris Hip Score (HHS), leg length discrepancy (LLD) was evaluated, and complications at any point were reported. Results. The commonest indication was advanced avascular necrosis (28%) followed by post-traumatic osteoarthritis (24%) and rheumatoid arthritis (24%). Cementless fixation was utilized in 20 (80%) THAs, and the bearing surface was either metal- or ceramic-on-polyethylene in 92% of THAs. After a mean follow up of 20.0±4.5 months, HHS improved from a pre-operative mean of 29.20±5.29 to 85.48±7.18 (p = 0.0001). Excellent and good results were reported in 84%. All working patients (52%) returned to their jobs after THAs. The leg length discrepancy improved significantly from a pre-operative mean of 2.12±1.01 cm to the last follow up mean of 0.72±0.4 cm, p = 0.0001. Two (8%) patients had superficial wound infections at the time of suture removal, which were treated successfully by daily dressing and antibiotics. None required revision. Conclusions. Primary total hip arthroplasty is the option for managing end-stage hip disease, even in younger patients when hip preservation surgeries are invalid. Our results showed improved functional outcomes and a return to pre-disease daily activities in most patients, with considerably lower complication incidence.

Identifying 10-year cumulative incidence and risk of revision following total hip arthroplasty in patients with and without a diagnosis of human immunodeficiency virus.

Prior studies have shown human immunodeficiency virus (HIV) may be a risk factor for early revision following THA, but little data exists looking at long-term implant survivorship. Therefore, the purpose of this study was to compare the 10-year cumulative incidence rate for revision following THA in patients with and without HIV. A retrospective cohort analysis of patients with HIV undergoing elective THA was conducted using a national database. Patients were stratified into asymptomatic HIV (AHIV) and acquired immune deficiency syndrome (AIDS) cohorts. These patients were propensity-score matched to a group of elective THA patients without HIV based on age, gender, and Charlson Comorbidity Index (CCI) at a 1:2 ratio. Kaplan-Meier and Cox Proportional Hazards Regression Analyses were used to assess cumulative incidence and risk of revisions within 10-years of the index procedure. In total, 678 patients were at-risk at the 10-year mark. There were no differences in 10-year risk of revision THA, amongst patients with HIV when compared to matched and unmatched controls (p > 0.05 for all). Patients with HIV did have an increased risk of periprosthetic joint infection (PJI) following THA when compared to the unmatched control (p = 0.001). Surgeons and patients can be reassured of comparable 10-year revision rates in patients with and without HIV. However, as these patients are at increased risk for PJI and PPF, especially those with AIDS, when compared to the general population, surgeons should consider PJI prophylactic modalities in this patient population.

Low-grade systemic inflammation, but not neuroinflammation, is associated with 12-month postoperative outcome after total hip arthroplasty in patients with painful osteoarthritis.

Better prediction of outcome after total hip arthroplasty (THA) is warranted. Systemic inflammation and central neuroinflammation are possibly involved in progression of osteoarthritis and pain. We explored whether inflammatory biomarkers in blood and cerebrospinal fluid (CSF) were associated with clinical outcome, and baseline pain or disability, 12 months after THA. A total of 50 patients from the Danish Pain Research Biobank (DANPAIN-Biobank) between January and June 2018 were included. Postoperative outcome was assessed as change in Oxford Hip Score (OHS) from baseline to 12 months after THA, pain was assessed on a numerical rating scale, and disability using the Pain Disability Index. Multiple regression models for each clinical outcome were included for biomarkers in blood and CSF, respectively, including age, sex, BMI, and Kellgren-Lawrence score. Change in OHS was associated with blood concentrations of tumour necrosis factor (TNF), interleukin-8 (IL-8), interleukin-6 receptor (IL-6R), glycoprotein 130 (gp130), and IL-1β (R2 = 0.28, p = 0.006), but not with CSF biomarkers. Baseline pain was associated with blood concentrations of lymphotoxin alpha (LTα), TNFR1, TNFR2, and IL-6R (R2 = 0.37, p < 0.001) and CSF concentrations of TNFR1, TNFR2, IL-6, IL-6R, and IL-1Ra (R2 = 0.40, p = 0.001). Baseline disability was associated with blood concentrations of TNF, LTα, IL-8, IL-6, and IL-1α (R2 = 0.53, p < 0.001) and CSF concentrations of gp130, TNF, and IL-1β (R2 = 0.26, p = 0.002). Thus, preoperative systemic low-grade inflammation predicted 12-month postoperative outcome after THA, and was associated with preoperative pain and disability. This study highlights the importance of systemic inflammation in osteoarthritis, and presents a possible path for better patient selection for THA in the future. Preoperative central neuroinflammation was associated with preoperative pain and disability, but not change in OHS after THA.

DAIR for periprosthetic joint infections—One week to save the joint?

BackgroundPredicting the success of a Debridement, Antibiotics, and Implant Retention (DAIR) procedure for periprosthetic joint infection (PJI) for hip and knee joint arthroplasty remains a challenge. A failed DAIR might adversely affect the outcome of any future revision surgery for PJI. Hence, the ability to identify and optimize factors predictive of DAIR success would help target the procedure to the appropriate patient cohort and avoid unnecessary surgery for patients where a DAIR is unlikely to eradicate infection.MethodsA retrospective review of our prospective Bone Infection Group database was performed to identify all patients who underwent a DAIR of their primary or revision hip or knee arthroplasty. All patients had a confirmed PJI as per MSIS 2013 criteria and an outcome according to the MSIS working group outcome-reporting tool. DAIR surgery was then grouped into groups of “successful” or “unsuccessful” outcomes.ResultsSixty-four consecutive patients with an acute PJI underwent a DAIR procedure between 2009 and 2020, with 46 procedures performed for knees and 18 for hips. Treatment was successful in 69% (37 knees and 7 hips). The chance of a successful DAIR was significantly greater if performed at or within one week of symptom onset compared to greater than one-week duration (adjusted odds ratio (OR) 0.11; P = 0.027; 95% CI [0.02–0.78])). For DAIR performed at or within one week of symptom onset, the success rate was 93% for knees and 80% for hips. The chance of a successful DAIR however was not influenced by whether the surgeon was an arthroplasty or non-arthroplasty surgeon (OR 0.28; P = 0.13; 95% CI [0.05–1.48])). Isolated Streptococcus infection had a success rate of 100%. Next came Coagulase-negative Staphylococci (71%) and Methicillin-susceptible Staphylococcus Aureus (65%). Polymicrobial infection had the worst outcome, with a success rate of 40%.ConclusionIn our experience, DAIR surgery performed within one week of symptom onset significantly increased the chance of successful infection eradication. Collaborative work is required to ensure arthroplasty patients can access prompt appropriate surgical decision-making as soon as concerns arise, remove barriers to early assessment and minimise delays to surgery.

Patients on Antidepressants Are at an Increased Risk of Adverse Events following Total Knee Arthroplasty.

A large proportion of total knee arthroplasty (TKA) patients are on antidepressant medications at the time of surgery. Postoperative outcomes of this patient demographic have not been characterized. This study compared the risk of 90-day adverse events and 5-year survival to revision surgery between patients on antidepressants and those not on antidepressants at the time of surgery. TKA patients were identified from the PearlDiver M151Ortho data set. Of these patients, those taking antidepressants (selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors) and those not taking antidepressants were identified and matched 1:1 based on patient age, sex, and Elixhauser Comorbidity Index scores. The incidence of 90-day adverse events was determined for the two groups and compared by multivariate analyses. Five-year survival to revision surgery was compared between TKA patients on antidepressants and those not on antidepressants. In total, 21.8% of TKA patients were taking antidepressants; 209,320 matched TKA patients on antidepressants and 837,066 not on antidepressants were extracted from the data set. Controlling for patient age, sex, and Elixhauser Comorbidity Index, those on antidepressants at the time of surgery had markedly higher odds of experiencing any (odds ratio [OR] 1.50), severe (OR 1.23), and minor (OR 1.61) adverse events in the 90 days following TKA (P < 0.0001 for all). Five-year survival to revision surgery of TKA patients on antidepressants was 96.4% (95% CI, 96.3% to 96.5%), compared with 96.9% (95% CI 96.8% to 96.9%) for patients not on antidepressants. TKA patients on antidepressants at the time of surgery were found to have markedly greater odds of experiencing 90-day postoperative adverse events but not clinically notable differences in five-year revision surgeries. TKA patients taking antidepressants could constitute a patient population at risk for inferior perioperative outcomes following surgery and thus may require additional counseling and mitigation strategies. Retrospective database study. Level III.

Shoulder Arthroplasty Patients Are Underscreened for Osteoporosis.

Osteoporosis screening and subsequent treatment has been shown to be efficacious in decreasing the rates of fragility fractures and periprosthetic fractures (PPF). However, current screening and treatment rates are low. This study aims to determine (1) the prevalence of total shoulder arthroplasty (TSA) patients who meet criteria for osteoporosis screening, (2) the prevalence of those screened, and (3) the 5-year cumulative incidence of fragility fracture (FF) and periprosthetic fractures (PPF). The PearlDiver database was used to identify all patients older than 50 years who underwent TSA. Guidelines from the American Association of Clinical Endocrinologists were used to stratify patients into "high risk" and "low risk" of osteoporosis cohorts using International Classification of Disease codes for various risk factors. The prevalence of osteoporosis screening using dual-energy x-ray absorptiometry (DXA) scan was analyzed, and the 5-year cumulative incidence of FF and PPF was calculated between the "low-risk" and "high-risk" groups using Kaplan-Meier analysis. In total, 66,140 (65.5%) who underwent TSA were considered "high risk" for osteoporosis. Of the "high-risk" patients, 11.7% patients received routine osteoporosis screening preoperatively. Within 5 years, "high-risk" TSA patients had markedly higher cumulative incidence for PPF (HR: 1.4; 95% CI: 1.0-1.9; P = 0.037) and FF (HR: 2.42; 95% CI: 2.1-2.8; P < 0.001) when compared with those at "low risk". There is a high prevalence of osteoporosis among patients undergoing TSA but a low rate of routine osteoporosis screening in this cohort. Patients with osteoporosis who are categorized as "high risk" have an increased rate of fragility fractures and PPF. Therefore, there is an opportunity to increase appropriate osteoporosis screening and management in this cohort, which may affect future risk of FF and periprosthetic fracture. III.

Neuropathic-like symptoms have an additional predictive value for chronic postsurgical pain in total hip and knee arthroplasty patients

BackgroundA significant portion of total knee and hip arthroplasty (TKA/THA) patients experience chronic postsurgical pain (CPSP). The prevalence of afflicted individuals ranges from 10 to 34%. CPSP is the main cause of postoperative dissatisfaction. For prevention purposes it is essential to know which preoperative factors are predictive for CPSP. It is unknown whether neuropathic-like symptoms add predictive value to known predictors for CPSP and dissatisfaction after TKA/THA.MethodsA prospective cohort study including 453 TKA/THA patients (TKA 208, THA 245) was conducted. Pain intensity (numeric rating scale [NRS]) and neuropathic-like symptoms (modified-painDETECT questionnaire [mPDQ]; score ≥ 13) were obtained preoperatively. One year postoperatively, CPSP and dissatisfaction (single NRS item (0–10); dissatisfied: ≤ 5) were captured: CPSP by means of the Oxford Knee/Hip Score (moderate or severe pain on question 1) as well by pain intensity at rest and with movement (NRS ≥ 1). Multivariate logistic regression modeling was used to determine the additive predictive value of preoperative neuropathic-like symptoms (mPDQ ≥ 13) on experiencing CPSP and dissatisfaction for the total group and for knee and hip patients separately.ResultsPreoperative neuropathic-like symptoms (m-PDQ ≥ 13) had an additional value for experiencing CPSP after one year, with odds ratios (p < 0.05) ranging from 2.16 (total group) to 4.15 (hip patients). Neuropathic-like symptoms had no additional value for predicting CPSP in knee patients or for predicting dissatisfaction.ConclusionThe results of this study showed that neuropathic-like symptoms (m-PDQ ≥ 13) have an additional predictive value over known predictors, especially in hip patients. Patients with neuropathic-like symptoms have over twice the odds of suffering from CPSP one year after TKA/THA. Neuropathic-like symptoms had no additional value for predicting dissatisfaction.

Comparison of Clinical Outcomes Between Arthroscopic Rotator Cuff Repair and Reverse Total Shoulder Arthroplasty in Patients With Massive Rotator Cuff Tears and High-Grade Fatty Atrophy Without Glenohumeral Osteoarthritis.

Despite the effectiveness of reverse total shoulder arthroplasty (RSA) and arthroscopic rotator cuff repair (ARCR) for treating massive rotator cuff tears (MRCTs), controversies remain in patients without glenohumeral osteoarthritis (GHOA). To compare clinical outcomes of ARCR or RSA in patients with MRCT with high-grade fatty atrophy without GHOA. Cohort study; Level of evidence, 3. This was a retrospective study on patients with MRCTs without GHOA and with grades 3 or 4 Goutallier muscle changes who underwent ARCR or RSA, with a minimum 2-year follow-up. Range of motion (ROM) and patient-reported outcomes (PROs) were collected-including visual analog scale for pain, American Shoulder and Elbow Surgeons score, Veterans Rand 12-Item Health survey, and Subjective Shoulder Value. Postoperative results were compared based on rotator cuff tendon healing in the ARCR group. A total of 81 patients met the study criteria-56 underwent ARCR and 25 underwent RSA. Patients in the RSA (age, 71.7 ± 7.7 years) group were older than those in the ARCR (age, 66.7 ± 7.4 years) group (P = .01) and more likely to have pseudoparalysis (52% vs 21.4%; P = .016). The mean follow-up for the ARCR and RSA groups was 56.5 ± 19 months and 36.1 ± 7.6 months, respectively (P < .001). The rate of patients with ≥2 tendons with grade 3 or 4 changes was higher in the RSA group compared with the ARCR group: 96% versus 47% (P < .001). PROs significantly improved after surgery in both groups (P < .05). Postoperative forward flexion (FF) and internal rotation were higher after ARCR compared with RSA-144°± 22° versus 113°± 25° and L3 ± L4 versus S1 ± S2, respectively (P <.001 and P = .002, respectively). Also, 31 of the rotator cuff repairs (55%) healed. PROs were similar between the healed and unhealed ARCR groups, with the only difference observed in postoperative FF-150°± 18° in the healed group versus 136°± 26° in the unhealed group (P = .044). Both ARCR and RSA improved functional outcomes in patients with MRCT without GHOA. While healing was moderate after ARCR, the postoperative ROM was greater after ARCR compared with RSA in appropriately selected patients. Moreover, healed rotator cuffs demonstrated improved postoperative FF compared with unhealed repairs.

Outcomes After Total Knee Arthroplasty in Patients With Autism: A Retrospective Database Study.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder associated with osteoarthritis for which total knee arthroplasty (TKA) may be considered. The safety and efficacy of TKA in patients with ASD had been poorly characterized. Total knee arthroplasty patients were identified using the M157 PearlDiver database. Patients with autism spectrum disorder were matched 1:4 with control TKA patients based on age, sex, and Elixhauser Comorbidity Index (ECI). 90-day adverse events were compared by multivariable regression, controlling for age, sex, and ECI. 5-year rates of revision were compared using Kaplan-Meier survival analyses. Of 1,194,063 TKA patients, ASD was identified in 352 (0.02%). Patients with autism spectrum disorder were younger (60.0 vs. 65.8 years, P < 0.001) with higher ECIs (7.8 vs. 4.2, P < 0.001) than control patients. Patients with autism spectrum disorder had higher odds of aggregated adverse events driven by sepsis (odds ratio [OR] 3.11), pneumonia (OR 3.55), and urinary tract infection (OR 3.02) (P < 0.0036 for each). 5-year revision rates were not significantly different for the matched cohorts (P = 0.8000). Total knee arthroplasty patients with ASD had elevated odds of several infectious adverse events and may warrant additional perioperative precautions. No notable differences were observed in most adverse outcomes investigated, nor in 5-year implant survival, suggesting that patients with ASD can safely be considered for TKA.

Total Hip Arthroplasty in Patients with Hip Osteoporosis: A Narrative Review.

Osteoporosis and osteopenia can affect patients undergoing arthroplasty of the hip, which is typically recommended for patients with severe osteoarthritis or elderly patients with a femoral neck fracture. Preoperative screening for this type of bone loss could be helpful to patients and prevent poor outcomes due to the rate of underdiagnosis of osteoporosis, which can reach 73% in patients undergoing hip arthroplasty. Complications associated with low bone mineral density include periprosthetic fractures as well as an increased revision rate. Although the benefit of antiresorptive medications postoperatively has been demonstrated, when administered preoperatively, worse outcomes were reported compared to its non-usage. Surgical management is as important as pre-medication. According to general recommendations, cemented implants provide greater benefit in osteoporotic patients. However, when using cementless implants, ribbed stems, straight tapered stems, stems with medial calcar contact, and titanium-composed stems can be used to prevent periprosthetic loss of bone mineral density; however, they should not be placed in a varus position. These stems can also be coated with zoledronate and other products.

Perioperative Considerations for Hip Arthroplasty in Patients with Rheumatoid Arthritis.

Due to its distinct features, rheumatoid arthritis (RA), an inflammatory autoimmune disorder, poses challenges in planning for surgical interventions. This review includes available evidence regarding perioperative considerations in management of RA patients, with a focus on hip surgery. RA can affect multiple joints, with development of extra-articular manifestations; therefore, preoperatively, comprehensive medical assessments, including cardiovascular or pulmonary evaluation must be considered in addition to surgical considerations. Modification of medications capable of controlling RA-related disease activity is critical, and requires collaboration with rheumatologists. Surgical considerations include the choice of surgical approach, implant selection, and problems related to weakened soft tissues, fragile bone density, and bony deformity such as protrusio acetabuli. Careful monitoring and more active rehabilitation are recommended for RA patients due to higher risk of postoperative complications. For achievement of optimal outcomes, use of a multidisciplinary perioperative approach is required for patients with RA.

The Impact of Patient Resiliency on Successful Same-Day Discharge and Postoperative Outcomes in Primary Total Hip and Knee Arthroplasty.

Total hip and knee arthroplasty rates in the outpatient setting continue to increase in the United States. Patient resiliency is one facet surgeons may consider when determining whether a patient would make a suitable candidate for same-day discharge. This study examined the relationship between resilience and success of same-day discharge in patients undergoing primary total hip and knee arthroplasty. A retrospective review was conducted to examine the effects of preoperative resiliency scores (Pain Self-Efficacy Questionnaire Abbreviated 2-Item Form [PSEQ-2]) on same-day discharge rates and patient-reported outcome measures (PROMs) at three months and one year postoperatively. Data analyses utilized logistic regressions to evaluate the odds of same-day discharge (SDD) success with preoperative PSEQ-2 resiliency scores. Mixed linear models were utilized to evaluate the relationship between preoperative PSEQ-2 resiliency scores and postoperative PROMs. Of the cohort of 700 total knee arthroplasty (TKA) patients, after controlling for confounding factors such as age and body mass index (BMI), patients who were discharged home on the day of surgery had significantly higher preoperative PSEQ-2 scores (P = 0.022). Of the cohort of 530 total hip arthroplasty (THA) patients, again after controlling for confounding factors such as age and body mass index (BMI), patients who were discharged home on the day of surgery trended towards significantly higher preoperative PSEQ-2 scores, although statistical significance was not reached (P = 0.058). There was a significant inverse relationship seen between preoperative PSEQ-2 scores and Global Mental Health scores at three months and one year postoperatively (P = 0.023). No other statistically significant relationships were seen between preoperative PSEQ-2 and the other PROMs. Preoperative resiliency scores were significantly higher in patients undergoing primary total hip and knee arthroplasty that were discharged home on the day of surgery. Preoperative resiliency scores did not predict higher postoperative PROMs.

Can blood flow restriction therapy improve quality of life and function in dissatisfied knee arthroplasty patients?

Approximately 10% to 20% of knee arthroplasty patients are not satisfied with the result, while a clear indication for revision surgery might not be present. Therapeutic options for these patients, who often lack adequate quadriceps strength, are limited. Therefore, the primary aim of this study was to evaluate the clinical effect of a novel rehabilitation protocol that combines low-load resistance training (LL-RT) with blood flow restriction (BFR). Between May 2022 and March 2024, we enrolled 45 dissatisfied knee arthroplasty patients who lacked any clear indication for revision to this prospective cohort study. All patients were at least six months post-surgery and had undergone conventional physiotherapy previously. The patients participated in a supervised LL-RT combined with BFR in 18 sessions. Primary assessments included the following patient-reported outcome measures (PROMs): Knee injury and Osteoarthritis Outcome Score (KOOS); Knee Society Score: satisfaction (KSSs); the EuroQol five-dimension five-level questionnaire (EQ-5D-5L); and the pain catastrophizing scale (PCS). Functionality was assessed using the six-minute walk Test (6MWT) and the 30-second chair stand test (30CST). Follow-up timepoints were at baseline, six weeks, three months, and six months after the start. Six weeks of BFR with LL-RT improved all the PROMs except the sports subscale of the KOOS compared to baseline. Highest improvements after six weeks were found for quality of life (QoL) (mean 28.2 (SD 17.2) vs 19 (SD 14.7); p = 0.002), activities of daily living (mean 54.7 (SD 18.7) vs 42.9 (SD 17.3); p < 0.001), and KSSs (mean 17.1 (SD 8.8) vs 12.8 (SD 6.7); p < 0.001). PROMs improvements continued to be present at three-month and six-month follow-up compared to baseline. However, no significant differences were observed in the paired comparisons of the six-week, three-month, and six-month follow-up. The same trends are observed for the 6MWT and 30CST. The reported regime demonstrates improved QoL and function of dissatisfied knee arthroplasty patients. In light of this, the pathway described may provide a valuable and safe treatment option for dissatisfied knee arthroplasty patients for whom therapeutic options are limited.

Implementation of a Patient-Specific Opioid Taper Calculator for Total Hip and Knee Arthroplasty: A Pre-Post Study

BackgroundGiven the association between high opioid use and postoperative complications after total joint arthroplasty, it is important to prescribe opioids responsibly in the postoperative period. While many pain regimen protocols exist to try and limit opioid use, an optimal approach to narcotic prescription for arthroplasty patients is yet to be established. This study evaluated the effects of using an individualized opioid taper calculator for patients undergoing elective primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). We hypothesized that using the calculator would lead to a decrease in the amount and variability of opioids prescribed postoperatively. MethodsAll primary THAs (117 pre- and 105 post-calculator) and TKAs (172 pre- and 139 post-calculator) meeting study inclusion and exclusion criteria were reviewed at a single academic hospital from January 2016 to December 2018 (pre-calculator) and January 2020 to December 2022 (post-calculator). The primary outcome measure was the quantity of opioids prescribed at discharge in morphine milligram equivalents (MME) between the two groups. Secondary measures included opioid refills, visual analog scale (VAS) pain scores, and emergency department (ED) presentations or clinic calls due to pain. Statistical significance was defined as P < 0.05. ResultsImplementation of the opioid taper calculator resulted in a 40% decrease in the median MME prescribed at discharge for both THA (450 versus 270; P < 0.0001) and TKA (450 versus 270; P < 0.0001) patients, respectively. There was no significant difference within the THA or TKA cohorts when comparing VAS pain scores (THA, three versus four; P = 0.47; TKA; five versus six, P = 0.26), and no increase in percentage of patients who had ED visits (THA, 5.98 versus 0.95%; P = 0.069; TKA, 6.40 versus 11.5%; P = 0.155) or calls to the clinic for pain (THA, 17.1 versus 24.8%; P = 0.186; TKA, 36.6 versus 37.4%; P = 0.906) between the pre-calculator and post-calculator groups. ConclusionsOur findings support the use of a patient-specific opioid taper calculator to decrease the volume and variability of narcotics prescribed postoperatively for THA and TKA pain management. Our findings confirmed the general applicability and effectiveness of the opioid taper calculator outside of its institution of origin.

Postoperative complications and cost implications in sickle cell disease patients undergoing total hip arthroplasty: A national inpatient sample study

BackgroundSickle cell disease (SCD) is a genetic condition affecting approximately 5 % of the global population, with significant prevalence in sub-Saharan Africa and an estimated 89,079 cases in the United States. Osteonecrosis, particularly of the femoral head (ONFH), is a common orthopaedic complication in SCD, often requiring total hip arthroplasty (THA) when conservative treatments fail. While THA can improve pain and function, it carries significant perioperative risks, with complication rates in patients with SCD as high as 67 %. This study aims to compare postoperative outcomes, medical costs, and the impact of different THA implant designs in patients with SCD versus a matched non-SCD cohort. MethodsThe study utilized the National Inpatient Sample (NIS) database. Postoperative outcomes in patients with and without SCD undergoing total hip arthroplasty between the fourth quarter of 2015 and 2020 were analyzed using propensity score matching and multivariable logistic regression modeling. Additionally, a subgroup analysis examined outcomes based on the use of cemented versus non-cemented implants. ResultsThe study analyzed 2,830,040 hip arthroplasty patients, including 2535 with sickle cell disease (SCD), and after propensity score matching, found that patients with SCD had significantly higher rates of postoperative complications such as periprosthetic fractures, dislocations, infections, and acute kidney injury. Multivariate analysis confirmed SCD as an independent risk factor for these complications, along with increased hospital stays and higher charges. Additionally, patients with SCD receiving cemented implants experienced worse outcomes, including higher risks of periprosthetic fractures and infections, compared to those with non-cemented implants. ConclusionThis study found that patients with sickle cell disease (SCD) undergoing total hip arthroplasty had significantly higher complication rates, increased healthcare costs, and longer hospital stays, with cemented implants posing greater risks compared to press-fit implants.

Are Patients’ Relationships to their Primary Contacts Associated with Postoperative Outcomes after Total Joint Arthroplasty?

BACKGROUNDSocial determinants strongly influence overall health, including recovery after total joint arthroplasty (TJA). The modern electronic health record (EHR) includes a list of individuals identified by patients as their primary contacts. We aimed to assess whether the relationship between patients and their documented primary contacts was associated with outcomes after TJA. METHODSWe retrospectively reviewed primary, elective total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) at a single institution from June 2011 to December 2022 and stratified patients into two groups: Family (F) [familial relationships to include spouse, first/second degree relative] or Non-Family (NF) [non-familial relationships such as friend, neighbor] based on patient relationship to their primary emergency contact. Baseline characteristics and postoperative outcomes were compared. Binary logistic regression was utilized to assess variables associated with all-cause revision. In total, 17,520 THAs were included: 16,123 (92.0%) in the F group and 1,397 (8.0%) in the NF group. Additionally, 20,397 TKAs were included: 18,819 (92.3%) in the F group and 1,578 (7.7%) in the NF group. RESULTSFor both THA and TKA patients, having a NF primary contact was independently associated with a higher risk of all-cause revision at the latest follow-up (OR [odds ratio]: 1.48 [95% CI (confidence interval): 1.05 to 2.08], P = 0.025) and (OR: 1.62 [95% CI: 1.10 to 2.38], P = 0.014), respectively. In both THA and TKA, the F group had shorter lengths of stay (P < 0.001) and was more likely to be discharged home (P < 0.001) compared to the NF group. CONCLUSIONTotal joint arthroplasty patients who have a familial primary contact demonstrate better postoperative outcomes compared to those who do not have a familial contact. Awareness of social support and additional postoperative support for patients who have NF primary contacts may be warranted following TJA.

Reverse Shoulder Arthroplasty in the Setting of Massive Proximal Humeral Bone Loss: A Systematic Review

Massive proximal humeral bone loss (PHBL) poses a technical challenge during reverse shoulder arthroplasty (RSA). Surgical treatment strategies include allograft-prosthetic composite (APC) reconstructions, endoprostheses, and other reverse shoulder arthroplasty constructs, however, there is a paucity of literature summarizing the outcomes and complications unique to this complex patient population. This study aimed to systematically review the literature to evaluate (1) patient-reported outcome measures (PROMs), (2) functional outcomes, and (3) complications according to surgical treatment strategy for patients with massive PHBL who undergo primary or revision shoulder arthroplasty. A systematic review of the PubMed/MEDLINE, Embase, and Cochrane databases was performed to identify studies reporting clinical outcomes and complications of reverse shoulder arthroplasty in patients with significant PHBL. Methodological quality was assessed for included studies. PROMs, radiographic outcomes, and postoperative functional outcomes were collected. Eleven studies evaluating clinical outcomes and complications of reverse shoulder arthroplasty in the setting of PHBL comprising 277 patients were included for review. The mean age was 66 years (range, 60-79 years). American Shoulder and Elbow Surgeons (ASES) score, Visual Analog Scale (VAS), and range of motion (ROM) were the most common outcomes collected, and patients exhibited significant improvements in mean scores postoperatively. Of the types of prostheses reported, there were 155 reverse shoulder arthroplasty (RSA) with allograft-prosthetic composite (APC) reconstructions, 48 proximal humeral replacement (PHR) endoprostheses, 41 RSA, 15 custom RSA, and 2 RSA with fibular strut allografts. The overall pooled complication rate was 30.1% (82/272) with revision/reoperation as the most common complication at 21% (57/272). The overall complication rate for RSA-APC reconstructions was 51% (79/155). The overall complication rate for PHR endoprostheses was 64.6% (31/48). Revision/reoperation rates were the most complication for both RSA-APC and PHR endoprostheses with rates of 20% and 31.3%, respectively. Treatment by APC reconstruction is the most common surgical technique described in the setting of massive PHBL. While shoulder arthroplasty can yield acceptable results for patients with substantial PHBL, such patients are at increased risk for complications and revision surgery.

Advancements and Strategies in Robotic Planning for Knee Arthroplasty in Patients with Minor Deformities

Advancements and Strategies in Robotic Planning for Knee Arthroplasty in Patients with Minor Deformities