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Acta Medica Okayama Jun 2024Although several studies have suggested a possible association between sarcopenia and knee osteoarthritis (OA) in the elderly, there remains no definitive evidence....
Although several studies have suggested a possible association between sarcopenia and knee osteoarthritis (OA) in the elderly, there remains no definitive evidence. Recently, however, the serum creatinine/cystatin C ratio (sarcopenia index: SI) was reported to correlate with skeletal muscle mass. The present retrospective study therefore investigated the impact of reduced skeletal muscle mass on advanced knee OA using SI. In 55 individuals scheduled for knee osteotomy or knee arthroplasty, correlations between SI and patient-reported outcomes such as the Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Oxford Knee Score (OKS) were explored. Significant associations were found between SI and the KSS functional activity score (β=0.37; p=0.022), KOOS subscale for activities of daily living (β=0.42; p=0.0096), and OKS (β=0.42; p=0.0095). This study underscores the role of reduced muscle mass in functional outcomes and introduces SI as a valuable marker for assessing muscle loss in knee OA patients.
Topics: Humans; Osteoarthritis, Knee; Male; Female; Aged; Sarcopenia; Retrospective Studies; Muscle, Skeletal; Middle Aged; Aged, 80 and over; Activities of Daily Living; Arthroplasty, Replacement, Knee
PubMed: 38902212
DOI: 10.18926/AMO/67199 -
The Journal of Bone and Joint Surgery.... Jun 2024
The Important Advances in Aseptic Revision of Total Hip Replacement: Commentary on an article by Christopher N. Carender, MD, et al.: "Contemporary Aseptic Revision Total Hip Arthroplasty in Patients ≤50 Years of Age. Results of >500 Cases".
Topics: Humans; Arthroplasty, Replacement, Hip; Reoperation; Hip Prosthesis; Prosthesis Failure; Middle Aged; Age Factors
PubMed: 38900015
DOI: 10.2106/JBJS.24.00329 -
The Journal of Bone and Joint Surgery.... Jun 2024Periprosthetic fractures can be devastating complications after total joint arthroplasty (TJA). The management of periprosthetic fractures is complex, spanning expertise...
BACKGROUND
Periprosthetic fractures can be devastating complications after total joint arthroplasty (TJA). The management of periprosthetic fractures is complex, spanning expertise in arthroplasty and trauma. The purpose of this study was to examine and project trends in the operative treatment of periprosthetic fractures in the United States.
METHODS
A large, public and private payer database was queried to capture all International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes for periprosthetic femoral and tibial fractures. Statistical models were created to assess trends in treatment for periprosthetic fractures and to predict future surgical rates. An alpha value of 0.05 was used to assess significance. A Bonferroni correction was applied where applicable to account for multiple comparisons.
RESULTS
In this study, from 2016 to 2021, 121,298 patients underwent surgical treatment for periprosthetic fractures. There was a significant increase in the total number of periprosthetic fractures. The incidence of periprosthetic hip fractures rose by 38% and that for periprosthetic knee fractures rose by 73%. The number of periprosthetic fractures is predicted to rise 212% from 2016 to 2032. There was a relative increase in open reduction and internal fixation (ORIF) compared with revision arthroplasty for both periprosthetic hip fractures and periprosthetic knee fractures.
CONCLUSIONS
Periprosthetic fractures are anticipated to impose a substantial health-care burden in the coming decades. Periprosthetic knee fractures are predominantly treated with ORIF rather than revision total knee arthroplasty (TKA), whereas periprosthetic hip fractures are predominantly treated with revision total hip arthroplasty (THA) rather than ORIF. Both periprosthetic knee fractures and periprosthetic hip fractures demonstrated increasing trends in this study. The proportion of periprosthetic hip fractures treated with ORIF relative to revision THA has been increasing.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Periprosthetic Fractures; United States; Reoperation; Female; Fracture Fixation, Internal; Male; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Aged; Incidence; Middle Aged; Femoral Fractures; Tibial Fractures
PubMed: 38900013
DOI: 10.2106/JBJS.23.00868 -
Scientific Reports Jun 2024Total knee arthroplasty (TKA) improves patients' Health-related quality of life (HRQoL) compared to before surgery. However, based on our knowledge, the improvement in...
Total knee arthroplasty (TKA) improves patients' Health-related quality of life (HRQoL) compared to before surgery. However, based on our knowledge, the improvement in HRQoL after TKA, which depends on various factors, has yet to be investigated compared to healthy people. This study aimed to evaluate the HRQoL of patients compared to healthy people and the factors affecting the HRQoL after TKA. In this matched case-control study (1002 participants), HRQoL in 501 patients who underwent TKA between 2015 and 2022 at Shafa Yahyainan Hospital affiliated with Iran University of Medical Sciences were compared with 501 healthy controls. HRQoL was evaluated in two parts (before compared to 12 months after TKA and 12 months after TKA compared to the healthy population). The 36-item short-form health survey (SF-36) was used to evaluate HRQoL 12 months after surgery. The influencing factors on HRQoL were evaluated by multivariate logistic regression analysis. No significant difference was observed in the demographic characteristics of the participants in the two groups. The mean overall SF-36 score, 12 months after surgery, significantly improved compared to before surgery (64.21 ± 22.2 vs. 37.55 ± 15.13, p:0.001). The mean total score of SF-36 was statistically similar between the case and control groups (64.21 ± 22.2 VS 72.53 ± 25.3). The multivariate analysis showed that sex, BMI, number of comorbidities, postoperative compliance, and complications were significantly related to the decrease in patients' HRQoL (P < 0.001).TKA can improve the HRQoL except for two subscales of happiness/vitality and physical performance, similar to the healthy population. Female gender, obesity and overweight, comorbidity, bilateral TKA, non-adherence to postoperative physiotherapy, and complications were associated with decreased HRQoL.
Topics: Humans; Quality of Life; Arthroplasty, Replacement, Knee; Male; Female; Case-Control Studies; Middle Aged; Aged; Iran; Osteoarthritis, Knee; Surveys and Questionnaires
PubMed: 38898136
DOI: 10.1038/s41598-024-65042-z -
The Journal of Arthroplasty Jun 2024Given the heightened risk of postoperative complications associated with obesity, delaying total hip arthroplasty (THA) in patients who have a body mass index (BMI) > 40...
INTRODUCTION
Given the heightened risk of postoperative complications associated with obesity, delaying total hip arthroplasty (THA) in patients who have a body mass index (BMI) > 40 to maximize pre-operative weight loss has been advocated by professional societies and orthopaedic surgeons. While the benefits of this strategy are not well understood, previous studies have suggested that a 5% reduction in weight or BMI may be associated with reduced complications after THA.
METHODS
We identified 613 patients who underwent primary THA in a single institution during a 7-year period, and who had a BMI > 40 recorded 9 to 12 months prior to surgery. Subjects were stratified into three cohorts based on whether their baseline BMI decreased by > 5% (147 patients, 24%), was unchanged (+/-5%) (336 patients, 55%), or increased by > 5% (130 patients, 21%) on the day of surgery. The frequency of 90-day Hip Society and Centers for Medicare & Medicaid Services (CMS) complications was compared between these cohorts. There were significant baseline differences between the cohorts with respect to baseline American Society of Anesthesiologists Class (P < 0.001) and hemoglobin A1C (P = 0.011), which were accounted for in a multivariate regression analysis.
RESULTS
In univariate analysis, there was a lower incidence of readmission (P = 0.025) and total complications (P = 0.005) in the increased BMI cohort. The overall complication rate was 18.4% in the decreased BMI cohort, 17.6% in the unchanged cohort, and 6.2% in the increased cohort. However, multivariable regression analysis controlling for potential confounders did not find that preoperative change in BMI was associated with differences in 90-day complications between cohorts (P > 0.05).
CONCLUSION
Patients who have a BMI > 40 and achieved a clinically significant (> 5%) BMI reduction prior to THA did not have a lower risk of 90-day complications or readmissions. Thus, delaying THA in these patients to encourage weight loss may result in restricting access to a beneficial surgery without an appreciable safety benefit.
PubMed: 38897262
DOI: 10.1016/j.arth.2024.06.016 -
The Journal of Arthroplasty Jun 2024Modular metaphyseal engaging (MME) femoral components in total hip arthroplasty (THA) allow optimized femoral length, offset, and anteversion and are useful in patients...
INTRODUCTION
Modular metaphyseal engaging (MME) femoral components in total hip arthroplasty (THA) allow optimized femoral length, offset, and anteversion and are useful in patients with unusual proximal femoral anatomy. Fretting, corrosion, and stem fractures above the modular sleeve are complications associated with these implants. The purpose of this study was to identify failure mechanisms of retrieved MME femoral components at our institution, identify all broken stem cases, and evaluate how often an extended trochanteric osteotomy (ETO) was required for removal.
METHODS
All consecutively retrieved MME femoral components from September 2002 to May 2023 were reviewed. Patient demographics, procedure information, component specifications, indications for removal, and requirements for further revision surgery were reviewed. Descriptive statistics were calculated for the variables of interest.
RESULTS
There were 131 retrieved MME components. The mean age at surgery was 59 years (range, 28 to 75), 49% were women, the mean body mass index (BMI) was 29.4 (range, 20.7 to 33.3), and the mean American Society of Anesthesiologists (ASA) score was 2.4 ± 0.5. There were 102 (78%) stems of one design (Stem A), and the remaining 29 (22%) were of a different design (Stem B). Of the 131 components, ten (7.6%) failed secondary to a stem fracture proximal to the modular sleeve. Regarding each MME stem design, 4 of 102 (4%) of Stem A and 6 of 29 (21% of Stem B) fractured. All broken stems required additional intervention for removal during revision THA, using an extended trochanteric osteotomy (N = 9) or cortical window (N = 1) in which an intraoperative proximal femoral fracture occurred.
CONCLUSIONS
Broken MME stems present a challenge for orthopaedic surgeons during revision THA. When a stem fracture occurs above the ingrown sleeve, the distal splines may also have osseous interdigitation into the clothespin. Thus, when revising a broken MME stem, an ETO should be performed, and the segment should be long enough to allow distal access.
PubMed: 38897261
DOI: 10.1016/j.arth.2024.06.018 -
Journal of Orthopaedic Surgery (Hong... 2024Local infiltration analgesia (LIA), adductor canal block (ACB), and infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) are popular...
Efficacy of adding infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) to adductor canal block and local infiltration analgesia in total knee arthroplasty: A retrospective cohort study.
OBJECTIVE
Local infiltration analgesia (LIA), adductor canal block (ACB), and infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) are popular multimodal analgesia techniques used during total knee arthroplasty (TKA). This study aimed to explore the efficacy of adding the IPACK technique to ACB and LIA in patients undergoing TKA.
METHODS
In this retrospective cohort study, patients who underwent primary unilateral TKA were divided into two groups based on their date of admission. Sixty-three patients underwent IPACK, ACB and LIA (IPACK group) during surgery, while 60 patients underwent ACB and LIA (control group). The primary outcome was the postoperative administration of morphine hydrochloride as a rescue analgesic. Secondary outcomes included time to first rescue analgesia, postoperative pain assessed using the visual analog scale (VAS), functional recovery assessed by knee range of motion and ambulation distance, time until hospital discharge, and complication rates.
RESULTS
The two groups were similar in average postoperative 0-to-24-h morphine consumption (11.8 mg for the control group vs 12.7 mg for the IPACK group, = .428) and average total morphine consumption (18.2 mg vs 18.0 mg, = .983) during hospitalization. There were also no significant differences in the secondary outcomes.
CONCLUSIONS
The addition of IPACK to ACB and LIA did not provide any clinical analgesic benefits. Orthopedic surgeons and anesthesiologists are justified in using ACB and LIA without IPACK for TKA.
Topics: Humans; Retrospective Studies; Arthroplasty, Replacement, Knee; Male; Female; Aged; Popliteal Artery; Nerve Block; Pain, Postoperative; Middle Aged; Analgesics, Opioid; Morphine; Anesthetics, Local; Pain Measurement; Anesthesia, Local; Analgesia; Pain Management
PubMed: 38896879
DOI: 10.1177/10225536241265445 -
Journal of Occupational Rehabilitation Jun 2024In a new Finnish Coordinated Return to Work (CRTW) model, patients are referred to occupational health care after hip or knee arthroplasty. This study evaluated the CRTW...
Return to Work Following Hip or Knee Arthroplasty: A One-Year Prospective Cohort Study in Participants with Direct Referral from Hospital to Occupational Health Care Services.
PURPOSE
In a new Finnish Coordinated Return to Work (CRTW) model, patients are referred to occupational health care after hip or knee arthroplasty. This study evaluated the CRTW model's effect on return to work (RTW), activities used in occupational health care and in the workplace, and the patient- and work-related factors affecting early RTW.
METHODS
209 participants with occupational health care service underwent primary hip (THA) or total/unicondylar knee (KJA) arthroplasty and completed self-reported questionnaires after arthroplasty and at time of RTW. Factors affecting RTW, and the roles of occupational health care and the workplace in RTW were evaluated. Time to RTW was determined as days between the arthroplasty and RTW.
RESULTS
Mean time to RTW was 69 days after THA and 87 days after KJA. For easing RTW, work arrangements were made for 56% of the participants. The most utilized adjustments of work were enabling remote work and arranging limitations in work tasks. Participants with earlier RTW had lower physical workload, higher professional status and motivation to work, less pre-arthroplasty sick leave, and more positive personal expectations about the time to RTW compared to participants with later RTW (p < 0.001 for all). The linear regression and dominance analyses showed participants' own expectations and pre-arthroplasty sick leave as the strongest factors affecting time to RTW.
CONCLUSIONS
The CRTW model seems to shorten time to RTW after THA and KJA. Occupational health care and workplace play important roles in supporting RTW. Patients' own expectations should be noted when giving pre-arthroplasty information.
PubMed: 38896401
DOI: 10.1007/s10926-024-10218-7 -
Journal of Bone and Joint Infection 2024: Periprosthetic joint infections (PJIs) have emerged as a focal point in the realm of orthopedics, garnering widespread attention owing to the escalating incidence... (Review)
Review
: Periprosthetic joint infections (PJIs) have emerged as a focal point in the realm of orthopedics, garnering widespread attention owing to the escalating incidence rates and the profound impact they impose on patients undergoing total joint arthroplasties (TJAs). Year after year, there has been a growing trend in the analysis of multiple risk factors, complication rates, and surgical treatments in the field. This study aims to illuminate the status of the sex-related differences in periprosthetic joint infections and advance research in this field. : A systematic review was carried out following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The final reference list comprised longitudinal studies (both retrospective and prospective) and randomized controlled trials. A sex-based analysis was conducted to assess differences between males and females. : A total of 312 studies were initially identified through online database searches and reference investigations. Nine studies were subsequently included in the review. Eight out of nine studies examined the risk of developing PJI after total joint replacement. Notably, only half of these studies demonstrated a statistically significant value, with a value , indicating a higher risk of infectious complications in males compared to females. : According to the current literature, there appears to be a propensity for males to develop periprosthetic joint infection after total joint arthroplasty at a higher rate than the female population. Enhancing sex-related analysis in this field is imperative for gathering more robust evidence and insights.
PubMed: 38895102
DOI: 10.5194/jbji-9-137-2024 -
Journal of Clinical Medicine May 2024Many people with pain from osteoarthritis (OA) of the knee are either not ready for surgery or may never be surgical candidates. Genicular artery embolization (GAE) is a... (Review)
Review
Many people with pain from osteoarthritis (OA) of the knee are either not ready for surgery or may never be surgical candidates. Genicular artery embolization (GAE) is a new proposed management for those with pain despite maximum medical management. It has historically been used to manage recurrent spontaneous haemarthrosis following total knee replacement, but newer studies are showing a positive effect in managing pre-arthroplasty knee OA. The goal of this review is to summarise current and relevant literature from searches of computerised databases and relevant journals, and analyse their results. Studies included show that GAE has promising outcomes in managing mild to moderate OA knee pain in those who have exhausted at least 3 months of conservative therapy. Most studies show improvements in VAS pain and PROM scores (including KOOS, and/or WOMAC). Minimal adverse effects have been associated in up to two years of follow up, the majority of which are self-resolving. The article précises a concise general procedural technique for performing GAE, as well as comparing and contrasting different embolic agents that may be utilised. GAE shows promising outcomes in management of mild to moderate OA knee pain. In the future, there will need to be higher volume studies to determine effectiveness, suitable candidates, and other potential adverse effects.
PubMed: 38892967
DOI: 10.3390/jcm13113256