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Siljander BR, Chandi SK, Coxe FR, Nguyen JT, Sculco PK, Chalmers BP, Bostrom MP, Gausden EB. A Consecutive Series of Vancouver B2 Periprosthetic Femur Fractures Treated With Contemporary Monoblock Versus Modular Revision Stems: Clinical and Radiographic Outcomes. J Arthroplasty 2024:S0883-5403(24)00262-6. [PMID: 38537840 DOI: 10.1016/j.arth.2024.03.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 04/30/2024] Open
Abstract
BACKGROUND Tapered fluted titanium (TFT) stems are the implant design of choice for managing Vancouver B2 periprosthetic femur fractures (PFFs), producing reliable results over the past few decades. The aim of this study was to compare the radiographic and clinical outcomes of Vancouver B2 PFFs treated with contemporary monoblock versus modular TFTs. METHODS A consecutive series of 113 patients (72 women, 64%, mean age 70 years [range, 26 to 96]) who had a B2 PFF were treated with either a monoblock (n = 42) or modular (n = 71) TFT stem between 2008 and 2021. The mean body mass index was 30 ± 7. The mean follow-up was 2.9 years. A radiographic review was performed to assess leg length and offset restoration, endosteal cortical contact length, and stem subsidence. Kaplan-Meier analyses were used to determine survivorship without revision, reoperation, or dislocation. RESULTS There was no difference in the restoration of leg length (0.3 ± 8.0 mm) or offset (2.8 ± 8.2 mm) between the monoblock and modular cohorts (P > .05). Mean endosteal cortical contact length (47.2 ± 26.6 versus 46.7 ± 2 6.4 mm, P = .89) and stem subsidence (2.7 ± 3.5 versus 2.4 ± 3.2 mm, P = .66) did not differ. No difference in patient-reported outcome measures (Hip Disability and Osteoarthritis Outcome Score-Joint Replacement; Veterans RAND 12 Item Health Survey Physical and Mental; visual analog score; and Lower Extremity Activity Scale) between the groups was observed. Survivorship at 2 years free from reoperation, revision, and dislocation was 90.4, 90.3, and 97.6%, respectively, for the monoblock cohort; and 84.0, 86.9, and 90.0%, respectively, for the modular cohort. CONCLUSIONS No significant differences in radiographic or clinical outcomes were observed between patients treated with monoblock or modular TFTs in this large series of B2 PFFs.
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Affiliation(s)
- Breana R Siljander
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Sonia K Chandi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Francesca R Coxe
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Joseph T Nguyen
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Brian P Chalmers
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Mathias P Bostrom
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Elizabeth B Gausden
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Villa JM, Pannu TS, Ozery M, Jin Y, Piuzzi NS, Patel PD, Higuera CA. Does Time to Aseptic Failure After Primary Total Hip Arthroplasty Affect Clinical and Patient-Reported Outcomes? J Arthroplasty 2024; 39:180-186. [PMID: 37531980 DOI: 10.1016/j.arth.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/12/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Evidence on the effects of time-to-failure from primary total hip arthroplasty (THA) to aseptic first-revision on clinical results and patient-reported outcome measures (PROMs) is scarce. Therefore, we sought to compare demographics, operative times, lengths of stay, discharge dispositions, 90-day readmissions, re-revision rates, mortalities, and PROMs between early and late aseptic THA revisions. METHODS This study is a retrospective review of a prospectively collected institutional database of all elective hip procedures. In total, 572 patients who underwent aseptic revision after primary THA from August 2015 to December 2018 were analyzed. Patients were stratified into either early revision (<3-years; n = 176) or late revision (≥3-years; n = 396) cohorts. RESULTS Significantly more patients were revised earlier for bone-related (ie, periprosthetic fractures) (22.7% versus 8.3%) or other various complications (19.9% versus 5.8%), whereas more late revisions were performed to treat implant-related failures (6.8% versus 37.1%), respectively. Operative time was significantly shorter in early versus late revisions (133 versus 157 minutes). A significantly higher delta-change/improvement from baseline/preoperative to 1-year postoperative was found for hip disability and osteoarthritis outcome score physical function (HOOS-PS), veterans-RAND-12 physical and mental components (VR-12-PCS and MCS, respectively) of early revisions. However, HOOS-PS and HOOS-Pain at 1-year of follow-up were significantly worse in early revisions. CONCLUSION With exception of operative time, time-to-failure had no significant influence on clinical results. Despite greater improvements on PROMs from preoperative to postoperative, patients undergoing early revisions after primary THA perceive significantly higher levels of pain and worse physical functionality at 1-year of follow-up.
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Affiliation(s)
- Jesus M Villa
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Tejbir S Pannu
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Matan Ozery
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Yuxuan Jin
- Department of Orthopaedic Surgery, Cleveland Clinic Main Campus, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Main Campus, Cleveland, Ohio
| | - Preetesh D Patel
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Carlos A Higuera
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
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Driscoll DA, Anderson C, Bornes TD, Nocon A, Bostrom MPG, Sculco TP, Sculco PK. Does Acetabular Bone Loss Severity Associate with Patient Reported Outcome Measures and Reoperation Rate in Revision Total Hip Arthroplasty? J Arthroplasty 2023:S0883-5403(23)00389-3. [PMID: 37088225 DOI: 10.1016/j.arth.2023.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION Acetabular bone loss is a challenging clinical problem when performing revision total hip arthroplasty (rTHA). This study aimed to evaluate how acetabular bone loss severity influences (1) clinical outcomes and (2) patient reported outcome measures (PROMs) in rTHA patients. METHODS Patients who underwent rTHA with acetabular component revision from January 2016 to February 2022 were included. Treating surgeons determined Paprosky acetabular bone loss classification intraoperatively. Patients were grouped based on numeric classification (PI, PII, or PIII) to categorize severity. Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR.) and Lower Extremity Activity Scale (LEAS) score were collected preoperatively and one year postoperatively. There were 197 patients included. Paprosky classification was PI for 47 patients (23.9%), PII for 113 patients (57.4%), and PIII for 37 patients (18.8%). Mean clinical follow-up was 29 months (range, 1 to 69). RESULTS Reoperation rate was 0% (0 patients), 6.2% (7 patients), and 10.8% (4 patients) for PI, PII and PIII groups respectively (p=0.052). Mean preoperative HOOS, JR. and LEAS for PI, PII and PIII groups were significantly different, but one-year postoperative HOOS, JR. and LEAS did not differ significantly. Rates of HOOS, JR. minimal clinically important difference (MCID) achievement differed significantly between bone loss groups. CONCLUSION In this study of rTHA patients, greater acetabular bone loss severity was associated with worse preoperative PROMs and trended towards higher reoperation rate. Postoperative PROMs for bone loss severity groups were statistically similar. Patients who had worse acetabular bone loss were more likely to achieve HOOS, JR. MCID postoperatively.
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Affiliation(s)
- Daniel A Driscoll
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA.
| | - Christopher Anderson
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Troy D Bornes
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Allina Nocon
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Mathias P G Bostrom
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Thomas P Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Sato EH, Stevenson KL, Blackburn BE, Peters C, Archibeck MJ, Pelt CE, Gililland JM, Anderson LA. Recovery Curves for Patient Reported Outcomes and Physical Function After Total Hip Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00358-3. [PMID: 37068568 DOI: 10.1016/j.arth.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Patient reported outcome measures (PROMs) are frequently used for evaluating patient satisfaction and function following total hip arthroplasty (THA). Functional measures along with chronologic modeling may help set expectations perioperatively. Our goal was to define the trajectory of recovery and function in the first year following THA. METHODS Prospective data from 1,898 patients in a multicenter study was analyzed. The PROMs included the Hip disability and Osteoarthritis Score for Joint Replacement (HOOS-JR) and EuroQol-5 dimension (EQ5D). Physical activity was recorded on a wearable technology. Data was collected pre-operatively and at one, three, six, and twelve months post-operatively. Generalized estimating equations were used to evaluate outcomes over time. RESULTS Significant improvement occurred between pre- and post-operative time points for all PROMs. The PROMs showed the greatest proportional recovery within the first month post-operatively, each improving by at least one minimal clinically important difference (MCID). Daily steps and flights of stairs took longer to reach at least one MCID (three months and one year, respectively). Gait speed and walking asymmetry returned to baseline by three months, but did not reach a MCID of improvement by one-year. CONCLUSION Patients can be counseled that the greatest proportional improvement in PROMs is within one month after THA, while function surpasses pre-operative baselines by three-months, and gait quality may not improve until after one-year. This can help set realistic expectations and target interventions toward patients deviating from the norm.
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Affiliation(s)
- Eleanor H Sato
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Brenna E Blackburn
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher Peters
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Michael J Archibeck
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher E Pelt
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy M Gililland
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Lucas A Anderson
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Bendich I, Tarity TD, Alpaugh K, Lyman S, Diane A, Sculco PK, McLawhorn AS. Identifying Aseptic Revision Total Knee Arthroplasty Diagnoses That Achieve Minimal Clinically Important Difference and Patient Acceptable Symptom State. J Arthroplasty 2023:S0883-5403(23)00020-7. [PMID: 36702437 DOI: 10.1016/j.arth.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/08/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Minimal clinically important difference (MCID) defines a meaningful clinical change in patient-reported outcome measures. Patient acceptable symptom state (PASS) provides a patient-reported outcome measures threshold value to indicate a satisfactory clinical state. MCID and PASS for revision total knee arthroplasty (rTKA) are ill-defined. Moreover, it is unknown whether diagnosis influences the likelihood of achieving MCID or PASS. The purpose of this study was to calculate MCID for aseptic rTKA and compare the percentage of patients achieving MCID and PASS per diagnosis. METHODS An institutional registry of rTKA was used. First-time aseptic rTKA were included. Demographics, revision diagnosis, preoperative Knee Injury and Osteoarthritis Outcome Score, Jr (KOOS Jr), and 1-year postoperative KOOS Jr were recorded. The 1-year postoperative KOOS Jr PASS score was available. MCID was calculated using distribution-based methods. Three hundred fifty eight first-time aseptic rTKAs were analyzed. The 3 most common diagnoses were aseptic loosening (n = 156), instability (n = 109), and stiffness (n = 37). RESULTS The mean KOOS Jr 1-year postoperative MCID for rTKA was 10.3. Overall, 75.4% achieved MCID and 56.9% achieved PASS. The percentage of patients per diagnosis achieving MCID and PASS, respectively, were periprosthetic fracture (100, 44), aseptic loosening (94, 60), implant fracture (88, 63), stiffness (60, 38), instability (59, 61), polyethylene wear/osteolysis (57, 57), and metal allergy (44, 33). CONCLUSION Aseptic rTKA MCID is 10.3 for KOOS Jr at 1 year postoperatively. rTKA outcomes vary depending on preoperative diagnosis. Even in diagnoses with a high proportion of MCID achieved, less than 2/3 of patients achieved PASS, suggesting rTKA provides noticeable improvement but may not return patients to a satisfactory state.
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Affiliation(s)
- Ilya Bendich
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
| | - Thomas D Tarity
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
| | - Kyle Alpaugh
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
| | - Stephen Lyman
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
| | - Alioune Diane
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
| | - Peter K Sculco
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
| | - Alexander S McLawhorn
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
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