Long-Term Risk of Prosthetic Joint Infection in Patients With Hypoalbuminemia Following Hip or Knee Arthroplasty.

Current status and factors influencing analysis on readiness of hospital discharge among elderly patients following hip and knee arthroplasty under the concept of enhanced recovery after surgery: A cross-sectional study.

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for postoperative pain management after hip and knee arthroplasties but have been associated with renal adverse effects. The risk may increase when NSAIDs are combined with diuretics and angiotensin converting enzyme (ACE) inhibitors or Angiotensin-II-receptor antagonists. The aim of this substudy is to assess potential renal adverse effects of an eight-day postoperative treatment with ibuprofen in patients undergoing hip or knee arthroplasty during 90-days follow-up. This substudy is part of the PERISAFE trial-a randomized, placebo-controlled, blinded multicenter trial including 2904 patients undergoing hip or knee arthroplasty. Patients are randomized to receive either ibuprofen 400 mg three times daily or identical placebo three times daily for 8 days postoperatively. The primary outcome is the number of patients with renal dysfunction according to RIFLE criteria Level 1-5, at any point during the 90-day follow-up. The substudy is powered at 86.3% to detect or discard a 40% relative risk reduction in the placebo group, assuming an incidence of acute renal injury of 6.2%. The ethical approval for this substudy is included in the main PERISAFE trial, which has been approved by the Danish Medicine Agency, the National Committee on Health Research Ethics (EU CT no. 2022-502502-32-00), and the Danish Data Protection Agency (REG-149-2022).

3D functional balancing in hip arthroplasty: Why the future of total hip arthroplasty must move beyond 2D thinking

Femoral neck fractures (FNF) in older adults are frequently managed with either total hip arthroplasty (THA) or hemiarthroplasty (HA). Despite improvements in surgical techniques, mortality rates after hip fracture surgery remain high. Identifying predictors of early mortality may enhance surgical decision-making, optimize perioperative management, and improve patient outcomes. The purpose of this study was to determine the short- and mid-term mortality rates after THA and HA for FNF, to identify clinical, demographic, and laboratory factors associated with 30-, 90-, and 180-day mortality, and to establish clinically relevant cutoff thresholds for significant continuous variables to stratify risk. We retrospectively reviewed 2379 consecutive patients treated for sub-capital FNF at a tertiary trauma center between [insert study years]. Of these, 831 underwent THA and 1548 underwent HA. Mortality was assessed at 30, 90, and 180 days postoperatively. Demographic, clinical, and laboratory parameters were analyzed using univariate and multivariate logistic regression models. Receiver operating characteristic (ROC) curve analysis was performed to identify optimal cutoff thresholds for significant continuous predictors. Among THA patients, mortality was 1.4% at 30 days, 3.4% at 90 days, and 5.1% at 180 days. Postoperative albumin ≤2.85g/dL predicted 30-day mortality, while C-reactive protein (CRP)>19.15mg/dL was independently associated with mortality at 90 and 180 days. Among HA patients, mortality was 6.6% at 30 days, 12.9% at 90 days, and 17.6% at 180 days. Predictors of 30-day mortality included white blood cell count (WBC)>14.48×109/L, albumin <3.55g/dL, and Charlson Comorbidity Index (CCI)>7.5. At 90 and 180 days, age >83.65 and>89.34 years, WBC >13.49×109/L, albumin <3.35-3.45g/dL, creatinine >1.08mg/dL, and CCI >6.5 were associated with higher mortality risk. This study identified several laboratory and clinical markers that predict short- and mid-term mortality following hip arthroplasty for FNF. Hypoalbuminemia, elevated inflammatory markers, renal dysfunction, and high comorbidity burden were consistent risk factors. Incorporating these parameters into preoperative assessment may improve patient selection, perioperative optimization, and shared decision-making. III.

Total hip arthroplasty (THA) via the direct anterior approach (DAA) is favored for avoiding gluteal muscle disruption and promoting faster recovery. A known complication of DAA is greater trochanteric fracture (GTFX). This study compared patient-reported outcomes (PROs) between patients who sustained GTFX and those who did not following THA using DAA. A retrospective review was conducted of patients who underwent THA via DAA. Primary outcomes included Mental and Physical Patient-Reported Outcomes Measurement Information System scores, Hip Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), and Forgotten Joint Score. Secondary outcomes included ambulation status, disposition, length of stay, complications, emergency department visits, and return to the operating room within 1 year. Patients without at least baseline and 6-month or 1-year PROs were excluded. Ninety-two THAs were analyzed; 13 patients (14%) sustained a GTFX. Baseline characteristics and preoperative PROs were similar between groups. At 6 months, the GTFX group had significantly lower HOOS JR scores (68.5 ± 18.1) compared to the non-GTFX group (79.8 ± 18.0; P = .0472). No significant differences in PROs were observed at 1-year. Two patients (15%) with GTFX and 2 (3%) without GTFX returned to the operating room (P = .0943). No other significant differences in secondary outcomes were noted. GTFX following THA via DAA are associated with worse HOOS JR scores at 6 months, suggesting a temporary delay in recovery. However, these differences resolve by 1 year, indicating GTFX may not impact long-term functional outcomes.

Technology-assisted total hip arthroplasty (THA)-including computer-navigated and robotic-assisted techniques-has emerged as a strategy to enhance component alignment and potentially improve postoperative outcomes. Although prior studies have described increasing utilization, contemporary trends and associated complication rates remain underexplored. A retrospective cohort study was conducted using a large national database to identify patients who underwent primary elective THA between 2010 and 2023. Patients were stratified into conventional vs technology-assisted THA groups, with the latter defined by the use of computer navigation or robotic assistance. Annual utilization trends were evaluated using linear regression, and 90-day postoperative complications were compared using multivariate logistic regression after adjusting for demographic, clinical, and regional factors. Among 1,062,597 patients undergoing primary elective THA, 4% received technology-assisted procedures. Utilization increased from 1.2% in 2010 to 12% in 2023-a 927% relative increase. Regional variation was notable, with highest utilization in the Northeast and the lowest in the Midwest. Technology-assisted THA was associated with lower odds of 90-day complications (5.36% vs 6.26%; adjusted odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.75-0.80), particularly reduced odds of dislocation (OR: 0.64; 95% CI: 0.60-0.69) and periprosthetic joint infection, though with higher odds of wound dehiscence (OR: 1.15; 95% CI: 1.07-1.23). Utilization of technology-assisted THA has increased substantially across the United States, accompanied by improved short-term outcomes, most notably decreased dislocation. These findings support the potential clinical benefits of surgical technology in THA, while underscoring the need for ongoing evaluation of long-term results.

Acetabular revision is a challenging procedure, especially in patients with large defects. This study aimed to evaluate how the severity of acetabular bone loss influences reconstruction of the center of rotation (COR) and how the COR influences clinical outcomes and patient-reported outcome measures (PROMs). Patients who underwent acetabular revision at a tertiary hospital from January 2013 to December 2018 were included. Patients were grouped according to the Paprosky and Saleh classifications. To determine the COR, we applied the method described by Fessy. The Harris Hip Score (HHS), Western Ontario McMaster Arthritis Index (WOMAC) and Short Form 12 (SF-12) were used to determine clinical outcomes and PROMs at a median of 41 months of follow-up. A total of 117 acetabular revisions were performed. The Paprosky classification was I for 54 acetabular defects (46.15%); II for 36 acetabular defects (30.76%); and III for 27 acetabular defects (23.07%). The Saleh classification was as follows: I for 54 (46.15%); II for 26 (22.22%); III for 19 (16.23%); IV for 16 (13.67%) and V for 2 (1,7%) acetabular defects. The percentage of patients who achieved an appropriate COR was 60.1% according to the Fessy method. This method showed a statistically significant association between the severity of the acetabular defect and the ability to accurately reconstruct the center of rotation. Similarly, no differences were observed in patients' functional outcomes (HHS, WOMAC, and SF-12 scores) based on whether the hip center of rotation was restored. Likewise, no differences were found in complication rates regardless of COR restoration or the degree of bone loss. These findings suggest that, in complex acetabular revisions, prioritizing stable fixation and bone preservation rather than perfect anatomic restoration of the center of rotation does not adversely affect functional outcomes.

Increasing Patient Age and General Anesthesia are Risk Factors for Readmission after Same-Day Discharge in Total Hip Arthroplasty.

Three-Dimensional Pelvic Kinematics During Direct Anterior Approach Total Hip Arthroplasty on an Orthopaedic Table.

Comparison of High-tensile Suture and 16-gauge Wire for Prophylactic Fixation in Total Hip Arthroplasty: A Biomechanical Study.

To examine the impact of frailty on 30-day outcomes of open reduction internal fixation (ORIF) alone or ORIF + total hip arthroplasty (THA) (fix-and-replace) for the treatment of acetabular fractures. . Retrospective Cohort. A total of 700 hospitals in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Included were patients aged 60 years or older undergoing ORIF ± THA for OTA/AO type 62 A-C fractures from 2015 to 2020. Preoperative frailty was assessed by the revised Risk Analysis Index (not frail: <21, prefrail: 21-30, frail: 31-40, severely frail: >40) and the 5-Item Modified Frailty Index factor. All outcome measures were in-hospital or within 30 days postoperatively, including the "favorable outcome," defined as no readmission, length of stay (LOS) < cohort median, and no major complication or death. There were 585 patients included [ORIF (88%): mean age-70.5 ± 14.2, sex-41.4% female; ORIF + THA (12%): mean age-77.0 ± 13.4; sex-65.7% female]. Frail patients (n = 353, 65.5%) were more likely to experience a complication [OR: 3.31, CI: (1.83-5.96)] and mortality (3.7% vs. 0.0%). ORIF + THA had higher association with postoperative transfusion [OR: 2.70, CI: (1.63-4.48)] but lower association with LOS >3 days [OR: 0.41, CI: (0.24-0.72)] and nonhome discharge [OR: 0.52, CI: (0.27-0.98)] than ORIF. Prefrail and frail patients undergoing ORIF + THA were more likely to achieve favorable outcomes than those nonfrail or severely frail [OR: 9.69, (3.40-27.57)]. Surgical intervention for acetabular fractures carried a 30-day complication risk of 12%-19% for frail patients. Frailty had similar predictability to age for early morbidity after surgery to treat acetabular fractures. Open reduction and internal fixation with the addition of an acute THA was associated with a higher rate of blood transfusion and shorter hospital LOS in frail patients with acetabular fractures. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Risk factors for allogeneic transfusion in young adults undergoing simultaneous bilateral direct anterior total hip arthroplasty within an ERAS framework.

Three-Dimensional Hands-on Total Hip Arthroplasty Simulation After Surgically Treated Acetabular Fractures: A Technical Note on 8 Cases.

Bone inflammation in postmenopausal women with type 2 diabetes or obesity in relation to Wnt signaling and bone strength.

Clinical performance and durability of short taper-wedge femoral stems in direct anterior total hip arthroplasty: Insights from a five-year retrospective analysis.

This study examined the effects of a 20-minute mindfulness-based intervention (MBI) on preoperative pain, desire for pain medication, and anxiety among adults scheduled for knee or hip arthroplasty, compared with a pain psychoeducation intervention (control condition). A single-site, two-arm, parallel-group, randomized, controlled trial. Participants attending a preoperative education program were randomized to either a MBI or pain psychoeducation intervention, which were matched in format (group), duration (20 minutes), and frequency (once). Pain intensity, pain unpleasantness, desire for pain medication, and anxiety symptoms were assessed using 0 to 10 numeric rating scales immediately before and after the intervention. T-tests evaluated within-group change. Intention-to-treat generalized linear mixed modeling evaluated between-group pre-post changes in outcomes. Among 170 enrolled participants (86 MBI; 84 control), 160 (94%) completed all study procedures. Both MBI and control participants markedly reduced their pain-related and anxiety symptoms postintervention; however, only the MBI group reduced their pain medication desire. Generalized linear mixed modeling revealed that the MBI group, compared with the control group, markedly decreased their pain intensity (P < 0.001; d = 0.85), pain unpleasantness (P < 0.001; d = 0.64), desire for pain medication (P = 0.008; d = 0.41), and anxiety symptoms (P < 0.001; d = 0.55). On average, the MBI decreased pain intensity by over two points, and a higher percentage of participants in the MBI condition reported clinically meaningful reductions in pain intensity (ie, by at least 30%) compared with the control participants (60% versus 26%, respectively, P < 0.001). These findings suggest the effectiveness of a brief MBI in reducing preoperative pain and anxiety among adults preparing for knee or hip arthroplasty, underscoring the potential of MBIs to safely address pain and anxiety in surgical settings.

The author reviews his longterm experience in the develop of techniques and implants using kinematic alignment.

Periprosthetic femur fractures (PFFs) are a leading cause of revision following primary total hip arthroplasty. Although triple-tapered, noncemented, collared stems have been associated with a lower incidence of PFFs, most studies are from single institutions. The purpose of this work was to investigate PFF incidence and early device survivorship of a modern-designed, noncemented, collared stem as reported in the American Joint Replacement Registry (AJRR). All primary total hip arthroplasty cases in patients older than 65 years from January 2021 to December 2024, submitted to AJRR as of September 2024, with Medicare data, were queried in this 2-year analysis. Data were stratified into three treatment cohorts: a recently introduced noncemented collared stem, aggregated noncemented collarless stems, and aggregated cemented stems in the US market. This analysis included 8,432 noncemented collared stems, 74,300 noncemented collarless stems, and 9,293 cemented stems. Cumulative 2-year revision and PPF incidence were determined per International Classification of Diseases 9 and 10 codes. The AJRR data were linked to Medicare claims data through a unique identifier provided by the Research Data Assistance Center (ResDAC). The noncemented collared stem had the lowest all-cause 2-year revision incidence of 1.32% compared with cemented (2.02%) and noncemented collarless (2.22%) cohorts ( P < 0.001). The 2-year PFF incidence was equivalent between the noncemented collared (0.19%) and cemented (0.20%) cohort ( P = 0.99). The 2-year PPF incidence was markedly lower for the noncemented collared cohort than the noncemented collarless cohort (0.19% vs. 0.65%, P < 0.001). In this large retrospective AJRR cohort, markedly lower 2-year all-cause revision were observed with a modern, triple-tapered, noncemented, collared stem compared with noncemented, collarless stems. Notably, the incidence of PFF with this noncemented, collared stem was threefold lower than all noncemented, collarless stems and equivalent to all cemented stem designs.

Osteonecrosis of the femoral head (ONFH) is a progressive condition that often requires surgical intervention. Although treatment strategies have traditionally emphasized joint-preserving procedures in younger patients, advances in implant technology and perioperative management may have altered contemporary surgical decision-making. However, large-scale evidence describing temporal changes in surgical treatment patterns for ONFH is limited. Using the Japanese Diagnosis Procedure Combination (DPC) database, we conducted a nationwide retrospective cohort study of patients who underwent surgical treatment for ONFH between December 2012 and March 2023. Surgical procedures were categorized as total hip arthroplasty (THA), bipolar hemiarthroplasty (BHA), proximal femoral osteotomy, pelvic osteotomy, or hip arthroscopy. Temporal trends in procedure selection were evaluated overall and by age group. Postoperative complications, including infection, deep vein thrombosis (DVT), pulmonary embolism, periprosthetic fracture, and in-hospital mortality, were compared between THA and BHA using univariate and multivariable logistic regression analyses. A total of 36,109 patients were included. THA was the most frequently performed procedure throughout the study period, with its proportion increasing from 72.6% in 2012 to 90.6% in 2022, while the use of BHA and joint-preserving osteotomy steadily declined. Among patients aged ≤ 20years, proximal femoral osteotomy predominated until 2020; thereafter, arthroplasty procedures accounted for more than half of all surgeries in this age group. Similar shifts toward THA were observed in patients aged 21-40years. In adjusted analyses, BHA was associated with a higher risk of postoperative infection and DVT, whereas THA was associated with a higher risk of periprosthetic fracture and in-hospital mortality. No significant differences were observed in dislocation or pulmonary embolism rates. Nationwide data demonstrate a substantial shift in surgical management of ONFH in Japan, with increasing use of THA and declining reliance on joint-preserving procedures, even among younger patients. While arthroplasty has become the dominant treatment modality, careful consideration of long-term outcomes, complication profiles, and patient age remains essential. Integration of large-scale administrative data with detailed clinical and imaging information may further refine optimal treatment strategies for ONFH.