Total Arthroplasty Research Articles

Correlation of revision rate of unicompartmental knee arthroplasty with total knee arthroplasty: a meta-analysis of clinical studies and worldwide arthroplasty registers.

The purpose of this study was to elucidate differences and similarities in revision rates amongst studies and national registers featuring total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). Thereby comparability and reproducibility between study and register findings should be created. Clinical studies published between 2004 and September 2023 involving TKA or UKA were reviewed for total arthroplasty numbers, revision rates and demographic data. Findings were calculated as "revisions per 100 component years (CY)" and divided according to the nationality of the center. National arthroplasty registers were searched for numbers of arthroplasties and revisions alongside with demographic data. Revision rates in registers were compared to one another and comparison to revision rates from collected studies was drawn. After evaluation, 98 studies and seven registers met our inclusion criteria and were included in this study. Cumulative percent revision rate in studies was 3.35% after a mean follow-up of 5.7years, corresponding to 0.71 revisions per 100 CY for TKA and 7.67% after a mean follow-up of 4.9years, corresponding to 1.3 revisions per 100 CY for UKA. Registers showed mean overall revision rates of 5.63% for TKA and 11.04% for UKA. A positive correlation of revision rates of TKA and UKA in studies and registers was found, with overall revision rates of UKA comparted to TKA being 2.29 times higher in clinical studies and 1.96 times higher in registers. Revision rates in registers were 1.56 times higher than presented in clinical studies.

Prosthetic Joint Infection Research Models in NZW Rabbits: Opportunities for Standardization-A Systematic Review.

Prosthetic joint infection (PJI) is a major complication following total arthroplasty. Rising antimicrobial resistance (AMR) to antibiotics will further increase therapeutic insufficiency. New antibacterial technologies are being developed to prevent PJI. In vivo models are still needed to bridge the translational gap to clinical implementation. Though rabbit models have been used most frequently, there is no consensus about methodology and measured outcomes. The PubMed, Scopus, and EMBASE databases were searched for literature on PJI in rabbit models. Data extraction included bias control, experimental design, and outcome measures of the NZW rabbit models in the articles. A total of 60 articles were included in this systematic literature review. The articles were divided into six groups based on the PJI intervention: no intervention used (21%), revision surgery (14%), prevention with only antibiotics (21%), prevention with surface modifications (7%), prevention with coatings (23%), and others (14%). Despite the current availability of guidelines and recommendations regarding experimental design, bias control, and outcome measures, many articles neglect to report on these matters. Ultimately, this analysis aims to assist researchers in determining suitable clinically relevant methodologies and outcome measures for in vivo PJI models using NZW rabbits to test new antimicrobial technologies.

Revision Reverse Total Shoulder Arthroplasty Using an Augmented Glenoid Baseplate: A Review of Current Glenoid Baseplate Options and a Case Report

Introduction: Total and hemi-shoulder arthroplasty have proved to be a safe and effective option for patients with symptomatic osteoarthritis. In some cases, glenoid implant failures or erosion can lead to acquired glenoid bone loss, complicating potential revision surgery. This paper presents a review of glenoid implant options for total shoulder arthroplasty and a case study which discusses a new augmented reverse baseplate for the revision of a failed hemi-shoulder arthroplasty. The patient was fully informed and gave written consent to submit the details of this case for publication in a peer-reviewed journal. Case Description: An 80-year-old retired professor with a prior history of right shoulder hemiarthroplasty presented with worsening right shoulder pain. She failed conservative care and wanted a conversion to a reverse total shoulder arthroplasty. The erosion on the patient's glenoid was severe enough for the surgeon to elect for the use of a metal augmented baseplate to fill the acquired defect and correct version and inclination. After an uneventful postoperative and recovery progression, at her one-year follow-up visit, she was pain-free and active, with significant improvements in her visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM). Discussion: The advent of metal augmentation with advanced glenoid preparation instruments allows shoulder specialists the ability to address implant-associated acquired glenoid bone loss and soft tissue deficiencies with ease and confidence and reduce additional clinical challenges.

Long-term outcomes of the Universal 2 total wrist arthroplasty

AimsThe Universal 2 total wrist arthroplasty (TWA) aims to alleviate wrist pain and restore function. This study investigates the survival time, revision rate, complication rate, and performs radiological analysis on Universal 2 TWAs in the long term. MethodsForty-seven Universal 2 TWA in 45 patients were performed between 2006 and 2014. Patient satisfaction, DASH score, complications, revision rate and radiological analysis of the TWA were recorded. ResultsMean follow-up was 11.7 years (range 2.5–17.6 years). There was significant improvement in post-operative DASH score (mean 58.3, SD 13) compared to preoperative DASH scores (mean 33, SD 20, p < 0.001). At latest follow-up, 65 % of patients would undergo the procedure, a reduction from 87 % at mid-term follow-up. On radiological analysis, 26 wrists had lucencies of at least one component. Complications occurred in 18 wrists (38 %). Eleven TWA (23 %) were revised at a mean 7.3 years post-operation (range 2.0–13.7 years). Mean survival of the implant was 13.6 years (12.2–15.0 years 95 % CI). Kaplan-Meier analysis identified no significant differences in survivorship between inflammatory arthritis (13.2 years, 11.5–14.9 years 95 % CI) and osteoarthritis (12.9 years, 11.0–14.8 years 95 % CI, p = 0.39). ConclusionAt long-term follow-up, the Universal 2 TWA can produce significant improvements in DASH scores and good satisfaction rates. However, a significant number of implants showed radiological loosening, with a high associated complication and revision rate. Patients should be adequately counselled on these risks pre-operatively.

A Short-term clinical and radiologic outcomes of reverse total shoulder arthroplasty with navigation system in Asian population: A retrospective comparative study

BackgroundIn reverse total arthroplasty (rTSA), glenoid component positioning is a critical factor for outcomes especially in Asian population with smaller glenoid. The purpose of this study was to compare the clinical and radiologic outcomes of rTSA with and without the navigation system with a minimum follow-up of two years in Asian population. MethodsThis was a retrospective comparative study of 33 rTSA with the navigation system (NAV group) and 40 conventional rTSA (CON group). Radiologic measurements regarding the position of the glenoid component, glenoid vault perforation by the central cage, and scapular notching, as well as clinical outcomes including range of motion (ROM), functional scores and complications were compared. Number, length, and angulation of screws were assessed. ResultsThe mean age was 73.9 ± 5.9 years with a mean follow-up of 30.1 ± 6.4 months. The NAV group more frequently utilized augmented baseplate (P < 0.001), showed less superior inclination (P = 0.030) and had lower incidence of glenoid vault perforation (P = 0.040). The length of superior (P = 0.001) and inferior screws (P = 0.045) was longer in the NAV group. In the NAV group compared to the CON group, more inferior orientation of superior screws (P < .001), more anterior orientation for inferior screws (P = 0.031), and anterior screws (P = 0.003) were observed. The NAV group showed significantly less penetration into the suprascapular fossa by a superior screw (P = 0.007). Final ROM, functional scores, and complications showed no significant differences between two groups. ConclusionIn short-term follow-up, the use of a navigation system in rTSA showed no significant difference in clinical outcomes and complications compared to conventional implantation. However, it enabled a lower superior inclination and a reduced glenoid vault perforation by the central cage, simultaneously allowing for the insertion of longer peripheral screws in a safer direction compared to conventional implantation.

Return to Play Outcomes in Elite Athletes after Cervical and Lumbar Motion Preservation Spine Surgery: A Systematic Review.

Systematic Review. The primary purpose of this article was to survey the present literature and report on return to play outcomes in elite athletes after undergoing motion preservation spinal surgery. For elite performance, athletes require adequate mobility and throughout the trunk, torso, and spine to achieve maximal force production. Therefore, elite athletes that have failed conservative treatment may seek to undergo motion preserving surgical options such as total disc arthroplasty and lumbar microdiscectomy. Individual studies have reported on return to play (RTP) outcomes following individual motion preservation surgical procedures, no systematic reviews have formally to reported on RTP outcomes, post-operative performance, and reoperation rates on these procedures in elite athletes. A systematic review was conducted from inception until February 2024 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. One reviewer queried PubMed for relevant studies that reported on RTP outcomes in elite athletes following motion preservation spinal surgery (MPSS) based on title and abstract (n=1,404). After the original search query, an additional reviewer screened full length articles. A total of 11 studies met the inclusion criteria. Special consideration was given to RTP rates, post-operative performance, and reoperation rates. A total of 612 elite athletes from the National Basketball Association, Major League Baseball, National Football League, National Hockey League, and other professional sporting organizations underwent cervical and lumbar MPSS to treat various spinal pathologies. Various motion sparing techniques were used to treat various pathologies. After undergoing MPSS, RTP rates ranged from 75-100% for lumbar cases and 83.3-100% for cervical cases. Most athletes successfully returned to sport between. Post-operative performance varied with some athletes performing at the same level prior to surgery and some performing at a decreased level. Motion preservation spinal surgery is a feasible option when properly indicated. Future studies are needed to compare return to sport rates, post-operative performance, and re-operation rates between motion preservation spinal surgery to spinal arthrodesis.

Biomechanical analysis of cadaveric wrists before and after MOTEC wrist arthroplasty using a hexapod robot.

This study compares wrist motion, biomechanical behaviour and radiographic parameters before and after total wrist arthroplasty using a fourth-generation spherical articulation prosthesis. A total of 10 cadaveric specimens were assessed using a hexapod Stewart platform robot. After arthroplasty, there were significant increases in both stiffness and phase angle of wrist motion across all planes of motion assessed. In three specimens, a sudden increase in moment was observed on load/displacement curves. Radiographically, carpal height increased by 14%, and the centre of rotation was displaced 11.1 mm proximally, 4.6 mm dorsally and 3.9 mm radially. This stretched the musculotendinous units, tightening the joint, while increasing the moment arm of the wrist flexors and decreasing the moment arm of the extensors, potentially important in the development of postoperative flexion contractures. Possible alterations in technique and/or implant design are considered to assist surgeons in achieving optimal clinical and survivorship outcomes.

The footprint mismatch of cervical disc arthroplasty comes from degenerative factor besides ethnic factor

A mismatch in footprints of cervical total disc arthroplasty (CTDA) implants occasionally occurred in Asian population and it had been attributed solely to ethnic factor. Yet, cervical degeneration process may play a role. Our purpose was to compare the cervical vertebra morphometric data with and without degeneration. The study included patients with CT scans of cervical spine from our hospital between January, 2019, and September, 2021. The total cervical degenerative index (TCDI) of each patient were collected by adding CDI score for 5 disc-levels. Patients were categorized into normal (TCDI 0–5) and degeneration groups (TCDI 6–60). Various measurements of the C3–C7 vertebral body and endplate were taken. Forty-nine patients in the normal group and 55 in the degeneration group were included. No significant difference was noted in gender, BH, BW, or BMI except age and TCDI (p < .001). During degeneration, disproportional endplate size changes were observed, with an increment ratio of 12–20% in the anteroposterior and 5–17% in the mediolateral plane throughout C3–C7, while vertebral body height remained constant. In conclusion, degeneration process, besides ethnic factor, causes the endplate size and shape mismatch. This information can help spine surgeon choose appropriate implants in CTDA surgery.

Does the use of topical vancomycin during primary hip or knee arthroplasty protect from infections?

BackgroundInfection is one of the main complications of hip and knee arthroplasties. Topical application vancomycin to prevent postoperative infections is efficient in spine surgery, and is spreading in prosthetic surgery. However, its clinical relevance and safety are still under debate. Thus, we conducted the present study to (1) assess whether topical vancomycin reduces peri-prosthetic infection rate, and (2) investigate its influence on surgical wound complications. HypothesisOur hypothesis was that topical administration of diluted vancomycin during arthroplasty would reduce infection rate within the first postoperative year. Material and methodsIn total, 1900 hip and knee arthroplasties were performed between 2014 and 2021 in a single hospital. From July 2018 and December 2021, 910 prostheses were implanted with intra-articular instillation of vancomycin and tranexamic acid. From November 2014 to June 2018, 990 prostheses were set up without vancomycin. During a follow-up of minimum 12 months, we reported periprosthetic infections occurring during the first postoperative year, as well as vancomycin-induced general or cutaneous complications. ResultsWe observed periprosthetic infections in 9/990 cases (0.91%) of the control group and 10/910 cases (1.1%) of the vancomycin group (p = 0.82). In parallel, we observed wound complications (erythema, seroma, hematoma, dehiscence and delay in wound healing) in 19/990 (1.9%) and 10/910 cases (1.1%) of the control and vancomycin group, respectively (p = 0.19). There were no general complications resulting from the application of vancomycin. DiscussionTopical diluted vancomycin does not reduce periprosthetic infection risk, and has no effect on the occurrence of surgery wound complications. Considering the present findings, the use of vancomycin cannot be recommended in current practice to prevent infections following hip and knee arthroplasties. Finally, its use does not induce any specific complications, whether local (cicatrisation) or general (related to ototoxicity or nephrotoxicity). Level of evidenceIII; case control study.

Arthrodesis using Iliac Crest autograft in revision surgery of the first metatarsophalangeal joint total arthroplasty for the treatment of Hallux Rigidus: a retrospective study

PurposeThe treatments for hallux rigidus (HR) encompass a wide spectrum, including conservative methods and surgical approaches such as arthroplasty and arthrodesis. This study aims to evaluate the outcomes of revision with arthrodesis following the failure of the first metatarsophalangeal joint total arthroplasty (MTPJ1TA).Materials and methodsPatients who had surgery at two advanced orthopedic centers between January 1, 2020, and January 1, 2024, were reviewed. Those with at least 6 months of postoperative follow-up were assessed for demographics (gender, age, side), reoperation rates, complications, Visual Analogue Scale (VAS) scores, Foot and Ankle Disability Index (FADI) scores, and American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal and Interphalangeal Scale (AOFAS-HMI) scores. Radiological evaluations included hallux valgus angle (HVA), intermetatarsal angle (IMA), dorsiflexion angle (DFA), and first ray length (FRL) in anteroposterior and lateral views.ResultsOf 27 patients, 4 were male (15%) and 23 female (85%), with an average age of 56.18 ± 7.49 years (range 41–72). Arthrodesis was performed in 26 patients, with one requiring reoperation due to implant failure. Average VAS scores were 7.14 preoperatively and 3.55 postoperatively (p < 0.05). Average FADI scores were 50.51 preoperatively and 71.51 postoperatively (p < 0.05). Average AOFAS-HMI scores were 51.22 preoperatively and 70.59 postoperatively (p < 0.05). Average HVA was 19.7° preoperatively and 6.29° postoperatively (p < 0.05). Average IMA was 10.66° preoperatively and 11.37° postoperatively (p = 0.406). Average DFA was 34.14° preoperatively and 22.33° postoperatively (p < 0.05). Average anteroposterior FRL was 10.17 cm preoperatively and 10.77 cm postoperatively (p < 0.05). Average lateral FRL was 10.12 cm preoperatively and 10.42 cm postoperatively (p < 0.05). None of the patients in the study exhibited postoperative donor site complications or transfer metatarsalgia, while a 100% rate of bone union was observed.ConclusionWe think that revision of MTPJ1TA with arthrodesis is a safe treatment option. Additionally, the use of an iliac crest autograft can be a viable option to restore bone stock and create a biological environment conducive to fusion. This study evaluates revision surgery with arthrodesis in the largest patient group with failed MTPJ1TA, highlighting its significance in the field. However, further studies are needed to determine the ideal surgical procedure.

The Three-Dimensional Relationship of the Axes of the Capitate and Third Metacarpal

We quantified the morphology and angulation of the third metacarpal (MC3) relative to the capitate using three-dimensional computed tomography data to inform surgical procedures such as total wrist arthroplasty and wrist arthrodesis. Specifically, we report the three-dimensional location of the intersections of the long axis of MC3 axis with the capitate cortical surface, the sagittal and coronal angles between the MC3 and capitate axes, and the MC3 shaft angle in the sagittal plane. We tested the hypothesis that these metrics did not differ between women and men. Three-dimensional bone models of the capitate and MC3 were analyzed in 130 subjects (61M and 69F). Long axes of the MC3 and capitate were computed. The intersection of the metacarpal long axis with the cortical surface of the capitate, the angle between the metacarpal-capitate axes, and metacarpal shaft angle were calculated and compared between men and women. The long axis of the MC3 intersected the capitate at two locations on the outer cortical surface of the capitate. The proximal intersection was located near the midportion of the capitate, whereas the distal intersection was typically located within the capitate-MC3 articulation. The angle between the axes of the capitate and MC3 in the sagittal plane was a mean of 15°, ranging from 5° to 23°. The mean sagittal MC3 shaft angle was 166° and ranged from 158° to 173°.There were only subtle differences in these metrics between the sexes. The long axis of the MC3 penetrates the dorsal surface of the capitate about its midportion, but there is notable variation in this location as well as in the angular relationships. Three-dimensional measurements of the relationships between the third metacarpal and the capitate may serve as an important reference for the placement of intramedullary wires, plates, devices, and prosthetics.

Caution Regarding ChatGPT's Appropriateness and Reliability Regarding Surgery for Wrist Arthritis.

Chat Generative Pre-Trained Transformer (ChatGPT), an artificial intelligence (AI) program, is widely used for information compilation. This study sought to analyze the quality and consistency of the information generated by ChatGPT regarding common procedures for wrist arthritis. 32 standardized questions regarding wrist osteoarthritis and related procedures (4-corner-fusion [4CF], proximal row carpectomy [PRC], resurfacing capitate pyrocarbon implant, wrist denervation, and total wrist arthrodesis and arthroplasty) were presented to the ChatGPT-3.5 interface 3 separate times, without feedback. ChatGPT's answers were evaluated for medical accuracy by 3 reviewers and rated as "appropriate," "appropriate but incomplete," or "inappropriate." Ratings were then converted to numerical values to calculate an intraclass correlation coefficient (ICC). A DISCERN score was used to assess quality, and Flesch-Kincade Grade Level and Flesch Reading Ease Score for readability. 75% of the responses were deemed "appropriate," with 23 questions receiving unanimous appropriate ratings across all responses. The ICC was 0.97 (95% CI [0.46, 0.98]), indicating excellent reliability. DISCERN score was 60 (good). The Flesch-Kincaid Grade Level was 14.6 ± 1.9, and the Flesch Reading Ease Score was 25.3 ± 6.7, implying a college reading level. The information that ChatGPT provided for PRC and total wrist arthrodesis and arthroplasty, appeared to be more reliable than for 4CF and denervation. ChatGPT's reliability and accuracy of information varied across procedures, possibly due to unknown and diverse sources. Furthermore, while some answers were factually correct, many provided generic information across differing questions, limiting usefulness. ChatGPT must be used cautiously and the limitations understood.

Wrist Arthrodesis with Double Ulna Intussusception for Failed Wrist Arthroplasty

Abstract Background Salvage procedures for failed total wrist arthroplasty have variable results and limitations such as donor site morbidity, malunion, delayed or nonunion. We present a case of substantial bone loss after failed wrist arthroplasty and a surgical technique in which the distal ulna is transferred and intussuscepted to achieve union between the residual distal radius and metacarpals. Case Description A 48-year-old female with rheumatoid arthritis presented with wrist prosthetic joint infection 16 years after total wrist arthroplasty. With extensive bone loss following implant removal and multiple debridements, the remaining distal ulna was resected and intussuscepted between the residual radius and second and third metacarpals. The patient achieved incorporation of the graft at 12 weeks and fusion at 20 weeks, with resolution of pain and restoration of digit function at 2 years. Literature Review Standard means of wrist arthrodesis utilizing iliac crest autograft and femoral head allograft may be limited to address substantial bone loss following total wrist implant removal. Intussusception has been utilized in the elbow, hip, and diaphysis to optimize graft–host bone contact and achieve union. While ulna-utilizing procedures have been described for oncologic and traumatic indications, to our knowledge, double intussusception has not been described for salvage procedures after failed wrist arthroplasty. Clinical Relevance Intussuscepting the distal ulna within the distal radius and metacarpals as an interpositional arthrodesis provides autologous graft, increased surface contact, and length restoration in cases of poor bone quality and significant bone loss following revision of a total wrist implant.

Comparison between Total Hip Arthroplasty for Avascular Osteonecrosis of Femoral Head and That for Fixation Failure of Femoral Neck Fracture

Objective: To compare the clinical and radiologic results between primary total hip replacement arthroplasty (THRA) in patients with avascular necrosis of femoral head (AVN) and secondary THRA in patients with fixation failure of femoral neck fracture.Methods: From March 2014 to February 2021, we retrospectively evaluated a total of 53 patients who underwent either THRA for AVN (33 cases) or THRA for fixation failure of femoral neck fracture (20 cases). Clinical performances and Hemodynamic scales were evaluated. Radiologic analyses were conducted to assess stem alignment, stem stability, the appearance of heterotrophic ossification, stress shielding, and any signs of osteolysis or loosening.Results: THRA for AVN showed a mean blood loss of 881 mL and a 2.1 g/dL preoperative–postoperative (preop–postop) hemoglobin (Hb) difference. Meanwhile, THRA for fixation failure of femoral neck fracture showed a mean blood loss of 1,072 mL and a 3.2 g/dL preop–postop Hb difference (P= 0.017 and P= 0.034, respectively). The mean operation time was 70 minutes in THRA for AVN and 91 minutes in THRA for fixation failure of femoral neck fracture (P= 0.035). Stem alignment was varus 1.50° in AVN and varus 3.50° in fixation failure of femoral neck fracture. There was one case of a varus femoral stem in AVN and six such cases in the fixation failure of femoral neck fractures. This was a statistically significant difference (P= 0.010 and P= 0.020, respectively).Conclusion: Secondary THRA in patients with fixation failure of femoral neck fracture showed longer operation time, larger bleeding, and more varus stem alignment than primary THRA in patients with AVN.

Zoledronic Acid and Enriched Autologous Bone Marrow Stem Cell Implantation for Femoral Head Osteonecrosis.

This study evaluated the clinical results of zoledronic acid in the treatment of early osteonecrosis of the femoral head (ONFH). Study retrospectively analyzed 60 patients with zoledronic acid with bone marrow stem cell(BMSC) implantation (The study group) and 64 patients with BMSC implantation (The control group). The primary evaluation index included VAS, HHS, collapsed rate, and total hip replacement arthroplasty (THA) conversion rate. The study group had a lower VAS (1.12 ± 0.22 vs 1.44 ± 0.32) and higher HHS (75.07 ± 3.66 vs 68.78 ± 2.24) compared to the control group in 6months after surgery (P < 0.05). In the study group, 12 hips (20%) collapsed, and 7 of 60 hips (11.67%) required THA surgery at the last follow-up. However, 25 hips (38.8%) collapsed in the control group, and 19 hips (29.69%) required THA surgery. The study group had a lower collapsed rate (P = 0.029) and THA conversion rate (P = 0.016) in survival analysis. Zoledronic acid and BMSC implantation in the treatment of early ONFH is safe and effective, reduces pain shortens recovery time, and reduces collapsed rate and THA conversion rate in ONFH patients.

Clinical results and computed tomography analysis of intuitive shoulder arthroplasty (ISA) stemless at a minimum follow-up of 2 years

IntroductionThe utilization of stemless anatomic total shoulder arthroplasty is on the rise. Epiphyseal fixation leads to radiological bone remodeling, which has been reported to exceed 40% in certain studies series. The aim of this study was to present the clinical and radiological outcomes of a stemless implant with asymmetric central epiphyseal fixation at an average follow-up of 31 months. MaterialsThis retrospective multicenter study examined prospective data of patients undergoing total anatomic arthroplasty with ISA Stemless implant and followed up at least 2 years. Clinical assessment included preoperative and final follow-up measurements of active range of motion (ROM), Constant score, and Subjective Shoulder Value (SSV). Anatomical epiphyseal reconstruction and bone remodeling at the 2-year follow-up were assessed by standardized Computed Tomography Scanner (CT scan). Statistical analysis employed unpaired Student's t-test or chi-squared test depending on the variable type, conducted using EasyMedStat software (version 3.22; www.easymedstat.com). ResultsFifty patients (mean age 68 years, 62% females) were enrolled, with an average follow-up of 31 months (24-44). Primary osteoarthritis (68%) with type A glenoid (78%) was the prevailing indication. The mean Constant score and SSV improved significantly from 38 ± 11 to 76 ± 11 (p<0.001) and from 31% ± 16 to 88% ± 15 (p<0.001) respectively at the last follow-up. Forward elevation, external rotation and internal rotation ROM increased by 39° ± 42, 28° ± 21 and 3,2 ± 2,5 points respectively, surpassing the Minimally Clinically Important Difference (MCID) after total shoulder arthroplasty. No revisions were necessary. CT scans identified 30% osteolysis in the posterior-medial calcar region, devoid of clinical repercussions. No risk factors were associated with bone osteolysis. ConclusionAt an average follow-up of 31 months, ISA Stemless implant provided favorable clinical results. CT analysis revealed osteolysis-like remodeling in the posterior-medial zone of the calcar (30%), without decline in clinical outcomes and revisions. Long-term follow-up studies are mandated to evaluate whether osteolysis is associated with negative consequences.

Total arthroplasty in valgus knee: an update in the robotics era

Total arthroplasty in valgus knee: an update in the robotics era

Oxidized LDL Accelerates Cartilage Destruction and Inflammatory Chondrocyte Death in Osteoarthritis by Disrupting the TFEB-Regulated Autophagy-Lysosome Pathway.

Osteoarthritis (OA) involves cartilage degeneration, thereby causing inflammation and pain. Cardiovascular diseases, such as dyslipidemia, are risk factors for OA; however, the mechanism is unclear. We investigated the effect of dyslipidemia on the development of OA. Treatment of cartilage cells with low-density lipoprotein (LDL) enhanced abnormal autophagy but suppressed normal autophagy and reduced the activity of transcription factor EB (TFEB), which is important for the function of lysosomes. Treatment of LDL-exposed chondrocytes with rapamycin, which activates TFEB, restored normal autophagy. Also, LDL enhanced the inflammatory death of chondrocytes, an effect reversed by rapamycin. In an animal model of hyperlipidemia-associated OA, dyslipidemia accelerated the development of OA, an effect reversed by treatment with a statin, an anti-dyslipidemia drug, or rapamycin, which activates TFEB. Dyslipidemia reduced the autophagic flux and induced necroptosis in the cartilage tissue of patients with OA. The levels of triglycerides, LDL, and total cholesterol were increased in patients with OA compared to those without OA. The C-reactive protein level of patients with dyslipidemia was higher than that of those without dyslipidemia after total knee replacement arthroplasty. In conclusion, oxidized LDL, an important risk factor of dyslipidemia, inhibited the activity of TFEB and reduced the autophagic flux, thereby inducing necroptosis in chondrocytes.

Indications, complications and outcomes of modular stems in total hip revision arthroplasty: a systematic review of the literature

Indications, complications and outcomes of modular stems in total hip revision arthroplasty: a systematic review of the literature

Incidence of blood transfusion and associated risk factors during hip arthroplasty hospitalization

To investigate the incidence and risk factors of blood transfusion during hospitalization in patients receiving hip arthroplasty. Clinical data of 347 hip arthroplasty patients admitted between January and January 2019 and December 2021. Patients were divided into 184 patients in the transfusion group and 164 patients in the nontransfusion group according to whether they received blood transfusion during hospitalization. The basic medical history data, biochemical results and surgical conditions of the patients in two groups were collected and compared. They were divided into total hip arthroplasty (THA) and hemiarthroplasty (HA) according to the different surgical methods. One-way analysis and Spearman correlation were used to analyze the factors associated with blood transfusion in hip arthroplasty patients. Multi-factor logistic regression analysis was performed for statistically significant(P<0.05) indicators, thus screening for independent risk factors for blood transfusion during hospitalization in hip arthroplasty patients. The receiver operating characteristic(ROC)curves for intraoperative bleeding in all hip arthroplasty patients, total hip arthroplasty patients, and hemi arthroplasty patients were plotted and compared, and area under curve(AUC) and the optimal threshold were calculated. A total of 347 patients were included for hip arthroplasty, including 207 total hip arthroplasty and 140 hemi arthroplasty. The transfusion rates of all hip arthroplasty patients, total hip arthroplasty patients and hemi arthroplasty patients were 53.03%(184/347), 53.14%(110/207) and 52.86%(74/140), respectively. Multifactorial logistic regression analysis showed that preoperative cystatin C (OR=2.739, P=0.001), hemoglobin at admission (OR=0.960, P<0.000 1), intraoperative bleeding (OR=1.010, P<0.000 1), postoperative pneumonia (OR=1.897, P=0.024), and right hip arthroplasty (OR=2.277, P=0.002) were independent risk factors for all hip arthroplasty patients;hemoglobin at admission (OR=0.978, P=0.016), intraoperative bleeding (OR=1.012, P<0.000 1), and postoperative pneumonia (OR=2.769, P=0.013) were independent risk factors for total hip arthroplasty;hemoglobin at admission (OR=0.930, P<0.000 1), intraoperative bleeding (OR=1.010, P<0.000 1), preoperative cystatin C (OR=2.277, P=0.023), and right hip arthroplasty (OR=2.428, P=0.046) were independent risk factors for hemi arthroplasty. Hemoglobin on admission and intraoperative bleeding were common risk factors for total and hemi arthroplasty. The AUCs were 0.688, 0.778, and 0.652 for total hip arthroplasty patients, total hip arthroplasty patients, and hemi arthroplasty patients, respectively. Intraoperative bleeding volume and preoperative hemoglobin are important risk factors for transfusion during hip arthroplasty hospitalization, and cystatin C may be a new biomarker for transfusion during hip arthroplasty hospitalization. At the same time, given the high incidence and potential risk of blood transfusion in hip arthroplasty, interventions should be made during hospitalization for identified risk factors.