BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the nativ...BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rate.There were three(1.2%)hospital readmissions within 90 d postoperatively.With a mean time to latest follow-up of 3.3 years,four patients(1.6%)required revision,two for arthrofibrosis,one for aseptic femoral loosening,and one for peri-prosthetic joint infection.There were significant improvements in KOOS JR,PROMIS Pain Intensity,PROMIS Pain Interference,PROMIS Mobility,and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.CONCLUSION The evaluated implant is an effective,novel design offering excellent outcomes and low complication rates.At a mean follow up of 3.3 years,four patients required revisions,three aseptic and one septic,resulting in an overall implant survival rate of 98.4%and an aseptic survival rate of 98.8%.The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.展开更多
AIM: To investigate the postoperative transfusion and complication rates of anemic and nonanemic total joint arthroplasty patients given tranexamic acid(TXA).METHODS: A cross-sectional prospective study was conducted ...AIM: To investigate the postoperative transfusion and complication rates of anemic and nonanemic total joint arthroplasty patients given tranexamic acid(TXA).METHODS: A cross-sectional prospective study was conducted of primary hip and knee arthroplasty cases performed from 11/2012 to 6/2014. Exclusion criteria included revision arthroplasty, bilateral arthroplasty, acute arthroplasty after fracture, and contraindication to TXA. Patients were screened prior to surgery, with anemia was defined as hemoglobin of less than 12 g/d L for females and of less than 13 g/d L for males. Patients were divided into four different groups, based on the type of arthroplasty(total hip or total knee) and hemoglobin status(anemic or nonanemic). Intraoperatively, all patients received 2 g of intravenous TXA during surgery. Postoperatively, allogeneic blood transfusion(ABT) was directed by both clinical symptomsand relative hemoglobin change. Complications were recorded within the first two weeks after surgery and included thromboembolism, infection, and wound breakdown. The differences in transfusion and complication rates, as well as the relative hemoglobin change, were compared between anemic and nonanemic groups.RESULTS: A total of 232 patients undergoing primary joint arthroplasty were included in the study. For the total hip arthroplasty cohort, 21%(18/84) of patients presented with preoperative anemia. Two patients in the anemic group and two patients in the nonanemic group needed ABTs; this was not significantly different(P = 0.20). One patient in the anemic group presented with a deep venous thromboembolism while no patients in the nonanemic group had an acute complication; this was not significantly different(P = 0.21). For nonanemic patients, the average change in hemoglobin was 2.73 ± 1.17 g/d L. For anemic patients, the average change in hemoglobin was 2.28 ± 0.96 g/d L. Between the two groups, the hemoglobin difference of 0.45 g/d L was not significant(P = 0.13). For the total knee arthroplasty cohort, 18%(26/148) of patients presented with preoperative anemia. No patients in either group required a blood transfusion or had an acute postoperative complication. For nonanemic patients, the average change in hemoglobin was 1.85 ± 0.79 g/d L. For anemic patients, the average change in hemoglobin was 1.09 ± 0.58 g/d L. Between the two groups, the hemoglobin difference of 0.76 g/d L was significant(P < 0.001). CONCLUSION: TXA administration results in low transfusion and complication rates and may be a useful adjunct for TJA patients with preoperative anemia.展开更多
BACKGROUND Total hip arthroplasty is a common surgical treatment for elderly patients with osteoporosis,particularly in postmenopausal women.In such cases,highly porous acetabular components are a favorable option in ...BACKGROUND Total hip arthroplasty is a common surgical treatment for elderly patients with osteoporosis,particularly in postmenopausal women.In such cases,highly porous acetabular components are a favorable option in achieving osseointegration.However,further discussion is needed if use of such acetabular components is justified under the condition of normal bone mass.AIM To determine the features of osseointegration of two different types of titanium implants[3-dimensional(3D)-printed and plasma-coated titanium implants]in bone tissue of a distal metaphysis in a rat femur model.METHODS This study was performed on 20 white male laboratory rats weighing 300-350 g aged 6 mo.Rats were divided into two groups of 10 animals,which had two different types of implants were inserted into a hole defect(2×3 mm)in the distal metaphysis of the femur:GroupⅠ:3D-printed titanium implant(highly porous);GroupⅡ:Plasma-coated titanium implant.After 45 and 90 d following surgery,the rats were sacrificed,and their implanted femurs were extracted for histological examination.The relative perimeter(%)of bone trabeculae[bone-implant contact(BIC%)]and bone marrow surrounding the titanium implants was measured.RESULTS Trabecular bone tissue was formed on the 45th day after implantation around the implants regardless of their type.45 d after surgery,group I(3D-printed titanium implant)and groupⅡ(plasma-coated titanium implant)did not differ in BIC%(83.51±8.5 vs 84.12±1.73;P=0.838).After 90 d,the BIC%was higher in group I(87.04±6.99 vs 81.24±7.62;P=0.049),compared to groupⅡ.The relative perimeter of the bone marrow after 45 d did not differ between groups and was 16.49%±8.58%for groupⅠ,and 15.88%±1.73%for groupⅡ.Futhermore,after 90 d,in groupⅠthe relative perimeter of bone marrow was 1.4 times smaller(12.96±6.99 vs 18.76±7.62;P=0.049)compared to the relative perimeter of bone marrow in groupⅡ.CONCLUSION The use of a highly porous titanium implant,manufactured with 3D printing,for acetabular components provides increased osseointegration compared to a plasma-coated titanium implant.展开更多
AIM To investigate whether normal thickness cartilage in osteoarthritic knees demonstrate depletion of proteoglycan or collagen content compared to healthy knees.METHODS Magnetic resonance(MR) images were acquired fro...AIM To investigate whether normal thickness cartilage in osteoarthritic knees demonstrate depletion of proteoglycan or collagen content compared to healthy knees.METHODS Magnetic resonance(MR) images were acquired from5 subjects scheduled for total knee arthroplasty(TKA)(mean age 70 years) and 20 young healthy control subjects without knee pain(mean age 28.9 years). MR images of T1ρ mapping, T2 mapping, and fat suppressed proton-density weighted sequences were obtained.Following TKA each condyle was divided into 4 parts(distal medial, posterior medial, distal lateral, posterior lateral) for cartilage analysis. Twenty specimens(bone and cartilage blocks) were examined. For each joint,the degree and extent of cartilage destruction was determined using the Osteoarthritis Research Society International cartilage histopathology assessment system.In magnetic resonance imaging(MRI) analysis, 2 readers performed cartilage segmentation for T1ρ/T2 values and cartilage thickness measurement.RESULTS Eleven areas in MRI including normal or near normal cartilage thickness were selected. The corresponding histopathological sections demonstrated mild to moderate osteoarthritis(OA). There was no significant difference in cartilage thickness in MRI between control and advanced OA samples [medial distal condyle, P = 0.461;medial posterior condyle(MPC), P = 0.352; lateral distal condyle, P = 0.654; lateral posterior condyle, P = 0.550],suggesting arthritic specimens were morphologically similar to normal or early staged degenerative cartilage.Cartilage T2 and T1ρ values from the MPC were significantly higher among the patients with advanced OA(P= 0.043). For remaining condylar samples there was no statistical difference in T2 and T1ρ values between cases and controls but there was a trend towards higher values in advanced OA patients. CONCLUSION Though cartilage is morphologically normal or near normal, degenerative changes exist in advanced OA patients. These changes can be detected with T2 and T1ρ MRI techniques.展开更多
AIM To review and report functional outcomes, complications,and survivorship associated with total knee arthroplasty(TKA) in the treatment of post-traumatic arthritis(PTA).METHODS We conducted a systematic review acco...AIM To review and report functional outcomes, complications,and survivorship associated with total knee arthroplasty(TKA) in the treatment of post-traumatic arthritis(PTA).METHODS We conducted a systematic review according to the PRISMA guidelines. We searched PubMed, Cochrane Library, and SCOPUS in December 2015 for Englishlanguage clinical research studies, both prospective and retrospective, examining the use of TKA for the treatment of PTA. All relevant articles were accessed in full. The manual search included references of retrieved articles.We extracted data on patients' demographics and clinical outcomes, including preoperative diagnosis and pre- and post-operative functional scores. We summarized the data and reported the results in tables and text.RESULTS Sixteen studies, four prospective and ten retrospective,examined patients who underwent TKA for PTA due to fractures of the proximal tibia, patella, and/or distal femur. Eleven studies utilized the Knee Society Scores criteria to assess functional outcomes. All studies utilizing these criteria reported an improvement in functional and knee scores of patients following TKA. Further, studies reported an increased range of motion(ROM) and reduction of pain following surgery. The most commonly reported complications with TKA included infection, stiffness, wound complications, intraoperative rupture of tendons, and osteolysis/polyethylene wear. The overwhelming majority of these complications occurred within the first two years following surgery. Six studies examined the survivorship of TKA with subsequent revision for any reason as an endpoint. Compared to patients with osteoarthritis, patients with PTA required more revisions, the majority for polyethylene wear.CONCLUSION Although associated with higher complication rates,TKA is an effective treatment for PTA, as it improves ROM, pain and functional outcomes.展开更多
BACKGROUND Patients who undergo orthopedic procedures are often given excess opioid medication.Understanding the relationship between pain and opioid consumption following total hip arthroplasty(THA)is key to creating...BACKGROUND Patients who undergo orthopedic procedures are often given excess opioid medication.Understanding the relationship between pain and opioid consumption following total hip arthroplasty(THA)is key to creating safe and effective opioid prescribing guidelines.AIM To evaluate the association between the quantity of opioid consumption in relation to pain scores both pre-and postoperatively in patients undergoing primary THA.METHODS We retrospectively reviewed patients who underwent primary THA from November 2018-May 2019 and answered both the visual analog scale(VAS)pain and opioid medication questionnaires pre-and postoperatively.Both surveys were delivered daily for 7-days before surgery through the first 30 postoperative days.Survey results were divided into preoperative,postoperative days 1-7,postoperative days 8-14,and postoperative days 15-30 for analysis.Mean opioid pill consumption and VAS pain scores in each time period were determined and compared to patients’preoperative status using hierarchical Poisson and linear regressions,respectively.RESULTS There were 105 patients included.Mean VAS pain scores were the highest preoperatively 7.41±1.72.However,VAS pain scores significantly declined in each successive postoperative category compared to preoperative scores:postoperative day 1-7(5.07±1.79;P<0.001),postoperative day 8-14(3.60±1.64;P<0.001),and postoperative day 15-30(3.15±1.63;P<0.001).Mean opioid pill consumption preoperatively was 0.68±1.29 pills.Compared to preoperative opioid consumption,opioid use was significantly greater between postoperative days 1-7(1.51±1.58;P=0.001)and postoperative days 8-14(1.00±1.27;P=0.043).Opioid consumption declined below preoperative levels between postoperative days 15-30(0.35±0.72;P=0.160)which correlates with a VAS pain score of 3.15.CONCLUSION All patients experienced significant benefit and pain relief from having undergone THA.Average postoperative opioid consumption decreased below preoperative consumption between postoperative days 15-30,which was associated with a VAS pain score of 3.15.These results can be used to appropriately guide opioid prescribing practices and set patient expectations regarding pain management following THA.展开更多
Total hip arthroplasty(THA) is an increasingly common procedure among elderly individuals.Although conversion THA is currently bundled in a diagnosis related group(DRG) with primary THA,there is a lack of literature s...Total hip arthroplasty(THA) is an increasingly common procedure among elderly individuals.Although conversion THA is currently bundled in a diagnosis related group(DRG) with primary THA,there is a lack of literature supporting this classification and it has yet to be identified whether conversion THA better resembles primary or revision THA.This editorial analyzed the intraoperative and postoperative factors and functional outcomes following conversion THA,primary THA,and revision THA to understand whether the characteristics of conversion THA resemble one procedure or the other,or are possibly somewhere in between.The analysis revealed that conversion THA requires more resources both intraoperatively and postoperatively than primary THA.Furthermore,patients undergoing conversion THA present with poorer functional outcomes in the long run.Patients undergoing conversion THA better resemble revision THA patients than primary THA patients.As such,patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates.Conversion THA procedures should be planned accordingly with proper anticipation of the greater needs both in the operating room,and for in-patient and followup care.We suggest that conversion THA be reclassified in the same DRG with revision THA as opposed to primary THA as a step towards better allocation of healthcare resources for conversion hip arthroplasties.展开更多
BACKGROUND Today,biological fixation of uncemented press-fit acetabular components plays an important role in total hip arthroplasty.Long-term stable fixation of these implants depends on the osseointegration of the a...BACKGROUND Today,biological fixation of uncemented press-fit acetabular components plays an important role in total hip arthroplasty.Long-term stable fixation of these implants depends on the osseointegration of the acetabular cup bone tissue into the acetabular cup implant,and their ability to withstand functional loads.AIM To compare the strength of bone-implant osseointegration of four types of porous metal implants in normal and osteoporotic bone in rabbits.METHODS The study was performed in 50 female California rabbits divided into nonovariectomized(non-OVX)and ovariectomized groups(OVX)at 6 mo of age.Rabbits were sacrificed 8 wk after the implantation of four biomaterials[TTM,CONCELOC,Zimmer Biomet's Trabecular Metal(TANTALUM),and ATLANT]in a 5-mm diameter defect created in the left femur.A biomechanical evaluation of the femur was carried out by testing implant breakout force.The force was gradually increased until complete detachment of the implant from the bone occurred.RESULTS The breakout force needed for implant detachment was significantly higher in the non-OVX group,compared with the OVX group for all implants(TANTALUM,194.7±6.1 N vs 181.3±2.8 N;P=0.005;CONCELOC,190.8±3.6 N vs 180.9±6.6 N;P=0.019;TTM,186.3±1.8 N vs 172.0 N±11.0 N;P=0.043;and ATLANT,104.9±7.0 N vs 78.9 N±4.5 N;P=0.001).In the OVX group,The breakout forces in TANTALUM,TTM,and CONCELOC did not differ significantly(P=0.066).The breakout force for ATLANT in the OVX group was lower by a factor of 2.3 compared with TANTALUM and CONCELOC,and by 2.2 compared with TTM(P=0.001).In the non-OVX group,the breakout force for ATLANT was significantly different from all other implants,with a reduction in fixation strength by a factor of 1.9(P=0.001).CONCLUSION TANTALUM,TTM,and CONCELOC had equal bone-implant osseointegration in healthy and in osteoporotic bone.ATLANT had significantly decreased osseointegration(P=0.001)in healthy and in osteoporotic bone.展开更多
AIM:To determine the impact of different characteristics on postoperative outcomes for patients in a joint arthroplasty Perioperative Surgical Home(PSH) program.METHODS:A retrospective review was performed for patient...AIM:To determine the impact of different characteristics on postoperative outcomes for patients in a joint arthroplasty Perioperative Surgical Home(PSH) program.METHODS:A retrospective review was performed for patients enrolled in a joint arthroplasty PSH program who had undergone primary total hip arthroplasty(THA) and total knee arthroplasty(TKA).Patients were preoperatively stratified based on specific procedure performed,age,gender,body mass index(BMI),American Society of Anesthesiologists Physical Classification System(ASA) score,and Charleston Comorbidity Index(CCI) score.The primary outcome criterion was hospital length of stay(LOS).Secondary criteria including operative room(OR) duration,trans-fusion rate,Post-Anesthesia Care Unit(PACU) stay,readmission rate,post-operative complications,and discharge disposition.For each outcome,the predictor variables were entered into a generalized linear model with appropriate response and assessed for predictive relationship to the dependent variable.Significance level was set to 0.05.RESULTS:A total of 337 patients,200 in the TKA cohort and 137 in the THA cohort,were eligible for the study.Nearly two-third of patients were female.Patient age averaged 64 years and preoperative BMI averaged 29 kg/m2.The majority of patients were ASA score Ⅲ and CCI score 0.After analysis,ASA score was the only variable predictive for LOS(P = 0.0011) and each increase in ASA score above 2 increased LOS by approximately 0.5 d.ASA score was also the only variable predictive for readmission rate(P = 0.0332).BMI was the only variable predictive for PACU duration(P = 0.0136).Specific procedure performed,age,gender,and CCI score were not predictive for any of the outcome criteria.OR duration,transfusion rate,postoperative complications or discharge disposition were not significantly associated with any of the predictor variables.CONCLUSION:The joint arthroplasty PSH model reduces postoperative outcome variability for patients with different preoperative characteristics and medical comorbidities.展开更多
文摘BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rate.There were three(1.2%)hospital readmissions within 90 d postoperatively.With a mean time to latest follow-up of 3.3 years,four patients(1.6%)required revision,two for arthrofibrosis,one for aseptic femoral loosening,and one for peri-prosthetic joint infection.There were significant improvements in KOOS JR,PROMIS Pain Intensity,PROMIS Pain Interference,PROMIS Mobility,and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.CONCLUSION The evaluated implant is an effective,novel design offering excellent outcomes and low complication rates.At a mean follow up of 3.3 years,four patients required revisions,three aseptic and one septic,resulting in an overall implant survival rate of 98.4%and an aseptic survival rate of 98.8%.The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.
文摘AIM: To investigate the postoperative transfusion and complication rates of anemic and nonanemic total joint arthroplasty patients given tranexamic acid(TXA).METHODS: A cross-sectional prospective study was conducted of primary hip and knee arthroplasty cases performed from 11/2012 to 6/2014. Exclusion criteria included revision arthroplasty, bilateral arthroplasty, acute arthroplasty after fracture, and contraindication to TXA. Patients were screened prior to surgery, with anemia was defined as hemoglobin of less than 12 g/d L for females and of less than 13 g/d L for males. Patients were divided into four different groups, based on the type of arthroplasty(total hip or total knee) and hemoglobin status(anemic or nonanemic). Intraoperatively, all patients received 2 g of intravenous TXA during surgery. Postoperatively, allogeneic blood transfusion(ABT) was directed by both clinical symptomsand relative hemoglobin change. Complications were recorded within the first two weeks after surgery and included thromboembolism, infection, and wound breakdown. The differences in transfusion and complication rates, as well as the relative hemoglobin change, were compared between anemic and nonanemic groups.RESULTS: A total of 232 patients undergoing primary joint arthroplasty were included in the study. For the total hip arthroplasty cohort, 21%(18/84) of patients presented with preoperative anemia. Two patients in the anemic group and two patients in the nonanemic group needed ABTs; this was not significantly different(P = 0.20). One patient in the anemic group presented with a deep venous thromboembolism while no patients in the nonanemic group had an acute complication; this was not significantly different(P = 0.21). For nonanemic patients, the average change in hemoglobin was 2.73 ± 1.17 g/d L. For anemic patients, the average change in hemoglobin was 2.28 ± 0.96 g/d L. Between the two groups, the hemoglobin difference of 0.45 g/d L was not significant(P = 0.13). For the total knee arthroplasty cohort, 18%(26/148) of patients presented with preoperative anemia. No patients in either group required a blood transfusion or had an acute postoperative complication. For nonanemic patients, the average change in hemoglobin was 1.85 ± 0.79 g/d L. For anemic patients, the average change in hemoglobin was 1.09 ± 0.58 g/d L. Between the two groups, the hemoglobin difference of 0.76 g/d L was significant(P < 0.001). CONCLUSION: TXA administration results in low transfusion and complication rates and may be a useful adjunct for TJA patients with preoperative anemia.
文摘BACKGROUND Total hip arthroplasty is a common surgical treatment for elderly patients with osteoporosis,particularly in postmenopausal women.In such cases,highly porous acetabular components are a favorable option in achieving osseointegration.However,further discussion is needed if use of such acetabular components is justified under the condition of normal bone mass.AIM To determine the features of osseointegration of two different types of titanium implants[3-dimensional(3D)-printed and plasma-coated titanium implants]in bone tissue of a distal metaphysis in a rat femur model.METHODS This study was performed on 20 white male laboratory rats weighing 300-350 g aged 6 mo.Rats were divided into two groups of 10 animals,which had two different types of implants were inserted into a hole defect(2×3 mm)in the distal metaphysis of the femur:GroupⅠ:3D-printed titanium implant(highly porous);GroupⅡ:Plasma-coated titanium implant.After 45 and 90 d following surgery,the rats were sacrificed,and their implanted femurs were extracted for histological examination.The relative perimeter(%)of bone trabeculae[bone-implant contact(BIC%)]and bone marrow surrounding the titanium implants was measured.RESULTS Trabecular bone tissue was formed on the 45th day after implantation around the implants regardless of their type.45 d after surgery,group I(3D-printed titanium implant)and groupⅡ(plasma-coated titanium implant)did not differ in BIC%(83.51±8.5 vs 84.12±1.73;P=0.838).After 90 d,the BIC%was higher in group I(87.04±6.99 vs 81.24±7.62;P=0.049),compared to groupⅡ.The relative perimeter of the bone marrow after 45 d did not differ between groups and was 16.49%±8.58%for groupⅠ,and 15.88%±1.73%for groupⅡ.Futhermore,after 90 d,in groupⅠthe relative perimeter of bone marrow was 1.4 times smaller(12.96±6.99 vs 18.76±7.62;P=0.049)compared to the relative perimeter of bone marrow in groupⅡ.CONCLUSION The use of a highly porous titanium implant,manufactured with 3D printing,for acetabular components provides increased osseointegration compared to a plasma-coated titanium implant.
基金Supported by The National Center for Research Resources and the National Center for Advancing Translational Sciences,National Institutes of Health,No.UL1 TR000153
文摘AIM To investigate whether normal thickness cartilage in osteoarthritic knees demonstrate depletion of proteoglycan or collagen content compared to healthy knees.METHODS Magnetic resonance(MR) images were acquired from5 subjects scheduled for total knee arthroplasty(TKA)(mean age 70 years) and 20 young healthy control subjects without knee pain(mean age 28.9 years). MR images of T1ρ mapping, T2 mapping, and fat suppressed proton-density weighted sequences were obtained.Following TKA each condyle was divided into 4 parts(distal medial, posterior medial, distal lateral, posterior lateral) for cartilage analysis. Twenty specimens(bone and cartilage blocks) were examined. For each joint,the degree and extent of cartilage destruction was determined using the Osteoarthritis Research Society International cartilage histopathology assessment system.In magnetic resonance imaging(MRI) analysis, 2 readers performed cartilage segmentation for T1ρ/T2 values and cartilage thickness measurement.RESULTS Eleven areas in MRI including normal or near normal cartilage thickness were selected. The corresponding histopathological sections demonstrated mild to moderate osteoarthritis(OA). There was no significant difference in cartilage thickness in MRI between control and advanced OA samples [medial distal condyle, P = 0.461;medial posterior condyle(MPC), P = 0.352; lateral distal condyle, P = 0.654; lateral posterior condyle, P = 0.550],suggesting arthritic specimens were morphologically similar to normal or early staged degenerative cartilage.Cartilage T2 and T1ρ values from the MPC were significantly higher among the patients with advanced OA(P= 0.043). For remaining condylar samples there was no statistical difference in T2 and T1ρ values between cases and controls but there was a trend towards higher values in advanced OA patients. CONCLUSION Though cartilage is morphologically normal or near normal, degenerative changes exist in advanced OA patients. These changes can be detected with T2 and T1ρ MRI techniques.
文摘AIM To review and report functional outcomes, complications,and survivorship associated with total knee arthroplasty(TKA) in the treatment of post-traumatic arthritis(PTA).METHODS We conducted a systematic review according to the PRISMA guidelines. We searched PubMed, Cochrane Library, and SCOPUS in December 2015 for Englishlanguage clinical research studies, both prospective and retrospective, examining the use of TKA for the treatment of PTA. All relevant articles were accessed in full. The manual search included references of retrieved articles.We extracted data on patients' demographics and clinical outcomes, including preoperative diagnosis and pre- and post-operative functional scores. We summarized the data and reported the results in tables and text.RESULTS Sixteen studies, four prospective and ten retrospective,examined patients who underwent TKA for PTA due to fractures of the proximal tibia, patella, and/or distal femur. Eleven studies utilized the Knee Society Scores criteria to assess functional outcomes. All studies utilizing these criteria reported an improvement in functional and knee scores of patients following TKA. Further, studies reported an increased range of motion(ROM) and reduction of pain following surgery. The most commonly reported complications with TKA included infection, stiffness, wound complications, intraoperative rupture of tendons, and osteolysis/polyethylene wear. The overwhelming majority of these complications occurred within the first two years following surgery. Six studies examined the survivorship of TKA with subsequent revision for any reason as an endpoint. Compared to patients with osteoarthritis, patients with PTA required more revisions, the majority for polyethylene wear.CONCLUSION Although associated with higher complication rates,TKA is an effective treatment for PTA, as it improves ROM, pain and functional outcomes.
文摘BACKGROUND Patients who undergo orthopedic procedures are often given excess opioid medication.Understanding the relationship between pain and opioid consumption following total hip arthroplasty(THA)is key to creating safe and effective opioid prescribing guidelines.AIM To evaluate the association between the quantity of opioid consumption in relation to pain scores both pre-and postoperatively in patients undergoing primary THA.METHODS We retrospectively reviewed patients who underwent primary THA from November 2018-May 2019 and answered both the visual analog scale(VAS)pain and opioid medication questionnaires pre-and postoperatively.Both surveys were delivered daily for 7-days before surgery through the first 30 postoperative days.Survey results were divided into preoperative,postoperative days 1-7,postoperative days 8-14,and postoperative days 15-30 for analysis.Mean opioid pill consumption and VAS pain scores in each time period were determined and compared to patients’preoperative status using hierarchical Poisson and linear regressions,respectively.RESULTS There were 105 patients included.Mean VAS pain scores were the highest preoperatively 7.41±1.72.However,VAS pain scores significantly declined in each successive postoperative category compared to preoperative scores:postoperative day 1-7(5.07±1.79;P<0.001),postoperative day 8-14(3.60±1.64;P<0.001),and postoperative day 15-30(3.15±1.63;P<0.001).Mean opioid pill consumption preoperatively was 0.68±1.29 pills.Compared to preoperative opioid consumption,opioid use was significantly greater between postoperative days 1-7(1.51±1.58;P=0.001)and postoperative days 8-14(1.00±1.27;P=0.043).Opioid consumption declined below preoperative levels between postoperative days 15-30(0.35±0.72;P=0.160)which correlates with a VAS pain score of 3.15.CONCLUSION All patients experienced significant benefit and pain relief from having undergone THA.Average postoperative opioid consumption decreased below preoperative consumption between postoperative days 15-30,which was associated with a VAS pain score of 3.15.These results can be used to appropriately guide opioid prescribing practices and set patient expectations regarding pain management following THA.
文摘Total hip arthroplasty(THA) is an increasingly common procedure among elderly individuals.Although conversion THA is currently bundled in a diagnosis related group(DRG) with primary THA,there is a lack of literature supporting this classification and it has yet to be identified whether conversion THA better resembles primary or revision THA.This editorial analyzed the intraoperative and postoperative factors and functional outcomes following conversion THA,primary THA,and revision THA to understand whether the characteristics of conversion THA resemble one procedure or the other,or are possibly somewhere in between.The analysis revealed that conversion THA requires more resources both intraoperatively and postoperatively than primary THA.Furthermore,patients undergoing conversion THA present with poorer functional outcomes in the long run.Patients undergoing conversion THA better resemble revision THA patients than primary THA patients.As such,patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates.Conversion THA procedures should be planned accordingly with proper anticipation of the greater needs both in the operating room,and for in-patient and followup care.We suggest that conversion THA be reclassified in the same DRG with revision THA as opposed to primary THA as a step towards better allocation of healthcare resources for conversion hip arthroplasties.
文摘BACKGROUND Today,biological fixation of uncemented press-fit acetabular components plays an important role in total hip arthroplasty.Long-term stable fixation of these implants depends on the osseointegration of the acetabular cup bone tissue into the acetabular cup implant,and their ability to withstand functional loads.AIM To compare the strength of bone-implant osseointegration of four types of porous metal implants in normal and osteoporotic bone in rabbits.METHODS The study was performed in 50 female California rabbits divided into nonovariectomized(non-OVX)and ovariectomized groups(OVX)at 6 mo of age.Rabbits were sacrificed 8 wk after the implantation of four biomaterials[TTM,CONCELOC,Zimmer Biomet's Trabecular Metal(TANTALUM),and ATLANT]in a 5-mm diameter defect created in the left femur.A biomechanical evaluation of the femur was carried out by testing implant breakout force.The force was gradually increased until complete detachment of the implant from the bone occurred.RESULTS The breakout force needed for implant detachment was significantly higher in the non-OVX group,compared with the OVX group for all implants(TANTALUM,194.7±6.1 N vs 181.3±2.8 N;P=0.005;CONCELOC,190.8±3.6 N vs 180.9±6.6 N;P=0.019;TTM,186.3±1.8 N vs 172.0 N±11.0 N;P=0.043;and ATLANT,104.9±7.0 N vs 78.9 N±4.5 N;P=0.001).In the OVX group,The breakout forces in TANTALUM,TTM,and CONCELOC did not differ significantly(P=0.066).The breakout force for ATLANT in the OVX group was lower by a factor of 2.3 compared with TANTALUM and CONCELOC,and by 2.2 compared with TTM(P=0.001).In the non-OVX group,the breakout force for ATLANT was significantly different from all other implants,with a reduction in fixation strength by a factor of 1.9(P=0.001).CONCLUSION TANTALUM,TTM,and CONCELOC had equal bone-implant osseointegration in healthy and in osteoporotic bone.ATLANT had significantly decreased osseointegration(P=0.001)in healthy and in osteoporotic bone.
文摘AIM:To determine the impact of different characteristics on postoperative outcomes for patients in a joint arthroplasty Perioperative Surgical Home(PSH) program.METHODS:A retrospective review was performed for patients enrolled in a joint arthroplasty PSH program who had undergone primary total hip arthroplasty(THA) and total knee arthroplasty(TKA).Patients were preoperatively stratified based on specific procedure performed,age,gender,body mass index(BMI),American Society of Anesthesiologists Physical Classification System(ASA) score,and Charleston Comorbidity Index(CCI) score.The primary outcome criterion was hospital length of stay(LOS).Secondary criteria including operative room(OR) duration,trans-fusion rate,Post-Anesthesia Care Unit(PACU) stay,readmission rate,post-operative complications,and discharge disposition.For each outcome,the predictor variables were entered into a generalized linear model with appropriate response and assessed for predictive relationship to the dependent variable.Significance level was set to 0.05.RESULTS:A total of 337 patients,200 in the TKA cohort and 137 in the THA cohort,were eligible for the study.Nearly two-third of patients were female.Patient age averaged 64 years and preoperative BMI averaged 29 kg/m2.The majority of patients were ASA score Ⅲ and CCI score 0.After analysis,ASA score was the only variable predictive for LOS(P = 0.0011) and each increase in ASA score above 2 increased LOS by approximately 0.5 d.ASA score was also the only variable predictive for readmission rate(P = 0.0332).BMI was the only variable predictive for PACU duration(P = 0.0136).Specific procedure performed,age,gender,and CCI score were not predictive for any of the outcome criteria.OR duration,transfusion rate,postoperative complications or discharge disposition were not significantly associated with any of the predictor variables.CONCLUSION:The joint arthroplasty PSH model reduces postoperative outcome variability for patients with different preoperative characteristics and medical comorbidities.
