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Subsequent total joint arthroplasty: Are we learning from the first stage?

World Journal of Orthopedics 2024年第3期15卷 230-237页

作者： Christine Jiang Wu Colin Penrose Sean Patrick Ryan Michael Paul Bolognesi Thorsten Markus Seyler Samuel Secord Wellman Department of Orthopaedic Surgery Duke University HospitalDurhamNC 27710United States Department of Orthopaedic Surgery Midwest Center for Joint ReplacementIndianapolisIN 46241United States

BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource *** degenerative conditions progress in multiple joints,many patients undergo multiple *** To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second *** The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were *** demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second *** metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)*** A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were *** was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 *** THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(P<0.001).THA patients had significantly decreased operative time only when the same sized implant was utilized(P=0.025).The vast majority(93.3%)of patients were discharged to the same type of location following their second ***,when a change in disposition was present from the first surgery,patients were significantly more likely to be discharged to home after the second procedure(P=0.033).There was no difference between procedures for post-operative readmissions(P=0.438)or ED visits(P=0.915).CONCLUSION After gaining valuable experience recovering from the initial surgery,a patient’s perioperative outcomes are improved for their second *** may

关键词： Staged total joint arthroplasty Asynchronous total joint arthroplasty Subsequent total joint arthroplasty Contralateral total joint arthroplasty Perioperative outcomes

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Predicting Pain in Total and Partial Knee Arthroplasty

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Open Journal of Orthopedics 2015年第6期5卷 151-156页

作者： Tatsuya Sueyoshi Wesley G. Lackey Robert A. Malinzak John B. Meding Alex Farris Kenneth E. Davis Merrill A. Ritter Indiana Research Foundation (JRSI) Center for Hip and Knee Surgery Mooresville USA midwest center for joint replacement Indianapolis USA

Object: Although pain relief is a primary goal of a total knee arthroplasty (TKA) and partial knee arthroplasty (PKA), a significant number of arthroplasty patients experience unexplained pain. This study attempts to determine preoperative or intraoperative factors that may predict pain after knee arthroplasty. Methods: 2585 primary TKAs and 423 PKAs were performed between 1993 and 2013. Infections, loosening, and revision arthroplasty were excluded. Knee Society scores, demographics, component sizes, pre- and postoperative alignment, treatment of the posterior cruciate ligament, range of motion, and diagnosis were analyzed. Statistical analysis utilized repeated measures ANOVA. Results: Significant predictors of increased pain after TKA were pre-operative varus alignment >5° (p = 0.0042), postoperative flexion range of motion 5° (p = 0.0006), small tibial component sizes (p = 0.0080), excision of the posterior cruciate ligament (p = 0.0259), and diagnosis as osteonecrosis (p = 0.0077). Factors not associated with pain included age, body mass index, gender, postoperative alignment and bone quality. For PKA, age was the only factor associated with pain. Conclusions: Six factors were found to be relevant to postoperative pain in TKA. For PKA, reported pain is not associated with any of the same factors, but is associated with age. Surgeons should be aware of these risk factors as we continue to understand pain after total and partial knee arthroplasty.

关键词： Postoperative Pain Total Knee Arthroplasty Partial Knee Arthroplasty Alignment Tibial Size

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Meeting Increased Demand for THA and Follow-Up: An Actuarial Method to Determine Optimal Follow-Up Schedules

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Open Journal of Orthopedics 2015年第8期5卷 245-252页

作者： John B. Meding Merrill A. Ritter Kenneth E. Davis Alex Farris Tatsuya Sueyoshi Indiana Research Foundation (JRSI) Center for Hip and Knee Surgery Mooresville IN USA midwest center for joint replacement Indianapolis IN USA

If a surgeon performs 200 procedures per year, he/she will have to see 800 patients for follow-up by year 5 and 1300 patients per year by year 10. Normal time constraints make this implausible. When do total hip arthroplasty (THA) patients have the greatest need for follow-up? We reviewed 8331 primary THAs to determine the greatest risk of failure across time. Patients failed with the greatest ratio at 1 year or earlier, followed by 10 and 12 years postoperatively. The median time to failure for all hips was 8.8 years, the average time to failure was 9.2 years, and 75% of failures occurred by 13.0 years. The most common failure mechanisms were due to the cup (5.0%), dislocation (3.2%), cup and stem (1.7%), infection (0.4%), and the stem (0.4%). Based on the most common failure mechanisms, it is recommended to evaluate patients at the 6 months, 1 year, 3 years, 7 years, 10 years, 12 years, 18 years, and 25 years postoperatively.

关键词： Component Total Hip Arthorplasty Postoperative Optimal Follow-Up Fail Risk

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A Concise Review of Surgical exposures for Revision Knee Arthroplasty

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Surgical Science 2012年第5期3卷 256-260页

作者： Ashish Anand Raviraj Adala Manish Kumar J. Vijay Kumar Srinivas Gautam Kodikal Consultant Orthopedic Surgeon Center for Joint Replacement Fortis Hospitals Bangalore India Junior Resident Center for Joint Replacement Fortis Hospitals Bangalore India Senior Resident Center for Joint Replacement Fortis Hospitals Bangalore India

Revision knee arthroplasty is fraught with complications such as delayed wound healing, arthrofibrosis, increased chances of infection, instability and extensor mechanism disruption. The key to avoiding these complications is to handle the soft tissue with care and to have an adequate surgical exposure at the same time. As the number of revisions has gone up, there has been a renewed interest in getting the basics right to have an adequate surgical exposure. Numerous surgical approaches have been proposed and subsequently modified. We present a concise review of the various surgical approaches for a revision knee replacement.

关键词： Knee Arthroplasty Revision Exposures

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A systematic review of progenitor survival and maturation in Parkinsonian models

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Neural Regeneration Research 2025年第11期20卷 3172-3178页

作者： Giulia Comini Eilís Dowd Pharmacology&Therapeutics and Galway Neuroscience center University of GalwayGalwayIreland

Stem cell-based brain repair is a promising emergent therapy for Parkinson's disease based on years of foundational research using human fetal donors as a cell *** current therapeutic options for patients,this approach has the potential to provide longterm stem cell–derived reconstruction and restoration of the dopaminergic input to denervated regions of the brain allowing for restoration of certain functions to *** ultimate clinical success of stem cell–derived brain repair will depend on both the safety and efficacy of the approach and the latter is dependent on the ability of the transplanted cells to survive and differentiate into functional dopaminergic neurons in the Parkinsonian *** the pre-clinical literature suggests that there is considerable variability in survival and differentiation between studies,the aim of this systematic review was to assess these parameters in human stem cell-derived dopaminergic progenitor transplant studies in animal models of Parkinson's disease.A defined systematic search of the PubMed database was completed to identify relevant studies published up to March *** screening,76 articles were included in the analysis from which 178 separate transplant studies were *** these,graft survival could be assessed in 52 studies and differentiation in 129 ***,we found that graft survival ranged from<1% to 500% of cells transplanted,with a median of 51%of transplanted cells surviving in the brain;while dopaminergic differentiation of the cells ranged from 0% to 46% of cells transplanted with a median of 3%.This systematic review suggests that there is considerable scope for improvement in the differentiation of stem cell-derived dopaminergic progenitors to maximize the therapeutic potential of this approach for patients.

关键词： cell replacement therapy differentiation embryonic stem cells graft induced pluripotent stem cells Parkinson's disease survival transplant

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How are those “lost to follow-up” patients really doing? A compliance comparison in arthroplasty patients

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World Journal of Orthopedics 2015年第1期6卷 150-155页

作者： Jung Keun Choi Jeffrey A Geller David A Patrick Jr Wenbao Wang William Macaulay center for Hip and Knee replacement Department of Orthopaedic SurgeryNew York-Presbyterian Hospital at Columbia University Medical Center

AIM: To determine whether there is a functional difference between patients who actively follow-up in the office(OFU) and those who are non-compliant with office follow-up visits(NFU). METHODS: We reviewed a consecutive group of 588patients, who had undergone total joint arthroplasty(TJA), for compliance and functional outcomes at one to two years post-operatively. All patients were given verbal instructions by the primary surgeon to return at one year for routine follow-up visits. Patients that were compliant with the instructions at one year were placed in the OFU cohort, while those who were non-compliant were placed in the NFU cohort. Survey mailings and telephone interviews were utilized to obtain complete follow-up for the cohort. A χ2 test and an unpaired t test were used for comparison of baseline characteristics. Analysis of covariance was used to compare the mean clinical outcomes after controlling for confounding ***: Complete follow-up data was collected on 554 of the 588 total patients(93%), with 75.5% of patients assigned to the OFU cohort and 24.5% assigned to the NFU cohort. We found significant differences between the cohorts with the OFU group having a higher mean age(P = 0.026) and a greater proportion of females(P = 0.041). No significant differences were found in either the SF12 or WOMAC scores at baseline or at 12 mo ***: Patients who are compliant to routine follow-up visits at one to two years post-operation do not experience better patient reported outcomes than those that are non-compliant. Additionally, after TJA, older women are more likely to be compliant in following surgeon instructions with regard to follow-up office care.

关键词： Total joint arthroplasty Revision joint arthroplasty Functional outcomes Patient compliance Patient follow-up

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Short Leg Film Is Sufficient for Postoperative Follow-Up in Total Knee Arthroplasty

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Open Journal of Orthopedics 2015年第7期5卷 175-178页

作者： David M. Fang Tatsuya Sueyoshi Kenneth E. Davis Merrill A. Ritter center for Hip and Knee Surgery Joint Replacement Surgeons of Indiana Research Foundation (JRSI) Mooresville USA

The gold standard for evaluating postoperative alignment after total knee arthroplasty (TKA) has been standing AP hip to ankle radiograph. The objective of this study was to determine if the angle between the anatomic axis of the tibia and femur measured on short standard radiographs accurately reflected overall coronal and mechanical alignment from full length knee films. Both full length and short length knee films were retrospectively compared measurements made on from 188 knees in 129 consecutive patients after primary TKA between July 1990 and January 1991. The tibiofemoral angle, distal femur and proximal tibia resection angles, and mechanical alignment were evaluated on the long leg by a blinded observer. The difference in the tibiofemoral angle measured on short and long leg films, 4.4 (+/﹣2.9) vs 5.2 (+/﹣3.0) degrees of valgus, respectively, was statistically significant (p < 0.01). The correlation coefficient between the tibiofemoral angle and mechanical axis was 0.9 (p < 0.01). There was no difference in the distal femur or proximal tibia resection angle measured on short length knee vs long leg films. In conclusion, the tibiofemoral angle measured on short length knee radiographs accurately reflects postoperative alignment. The differences between tibiofemoral angle and the mechanical alignment are highly correlated and equivalent measures of overall alignment.

关键词： Total Knee Rthroplasty Tibiofemoral Angle Standing AP Radiograph Accuracy

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Early Clinical Outcomes with a 3-D Porous Titanium Acetabular Cup

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Open Journal of Orthopedics 2016年第6期6卷 121-125页

作者： Tatsuya Sueyoshi E. Michael Keating Merrill A. Ritter John B. Meding Matthew J. Brunsman center for Hip and Knee Surgery Joint Replacement Surgeons of Indiana Research Foundation (JRSI) Mooresville IN USA

Cementless acetabular components are associated with a significant incidence of polyethylene wear and secondary osteolysis. 3-dimentional (3-D) porous coating and enhanced shell to a liner fixation are expected to reduce the polyethylene wear and to increase the longevity of an acetabular cup. The authors report the early clinical outcome with a cementless acetabular cup, Regenerex Ringloc+ (Zimmer Biomet, Warsaw, IN) for total hip arthroplasty. Between 2007 and 2013, the registry with 476 hip joints was reviewed retrospectively. There were 210 (48.4%) female and 224 (51.6%) male patients. The average age of the patients at the surgery was 63.9 (± 12.0) years and the average follow-up period was 2.6 years [0.5, 6.5]. At the final follow-up, there was no loosening or cup failure. There were 2 infections, 1 dislocation and 1 liner fracture, resulting in revision hip surgery. Average Harris hip score improved from 53.9 preoperatively to 91.4 postoperatively. The survivorship of Regenerex Ring Loc+ cup and the low complication rate is comparable with previous studies using other 3-D porous metal prostheses. Although this short-term outcome from the institute is very encouraging, a longer follow-up study is required.

关键词： Total Hip Arthroplasty (THA) 3-D Porous Regenerex Ringloc+ Clinical Outcome Complication

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Changes in Femoral Stem Geometry Reduce Intraoperative Femoral Fracture Rates in Total Hip replacement

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Open Journal of Orthopedics 2015年第5期5卷 115-119页

作者： Tatsuya Sueyoshi Michael E. Berend John B. Meding Robert A. Malinzak Wesley G. Lackey Merrill A. Ritter center for Hip and Knee Surgery Joint Replacement Surgeons of Indiana Research Foundation (JRSI) Mooresville IN USA

Intraoperative fracture rates in total hip arthroplasty (THA) have been associated with uncemented stems, anterolateral surgical approach, diagnoses other than osteoarthritis, and female gender. The purpose of this study was to investigate if changes in stem design would influence intraoperative fracture rates. 1497 THA with Bi-Metric stems were compared to 1277 THA with Echo Bi-Metric Full Proximal Profile stems and 366 THA with Echo Bi-Metric Reduced Proximal Profile stems. The intraoperative fractures rates were 5.48%, 1.41% and 1.37% for Bi-Metric and Echo Bi-Metric with standard and reduced proximal geometry stems, respectively. Stem survivorship with aseptic loosening as an endpoint was 100% in all cohorts at the final follow-up. We conclude that changes in femoral stem geometry in uncemented THA reduce intraoperative fracture rates while preserving fixation.

关键词： Total Hip Arthroplasty Stem Design Intraoperative Fractures Survivorship

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Longitudinal evaluation of time related femoral neck narrowing after metal-on-metal hip resurfacing

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World Journal of Orthopedics 2013年第2期4卷 75-79页

作者： Wenbao Wang Jeffrey A Geller Rohit Hasija Jung Keun Choi David A Patrick Jr. William Macaulay center for Hip and Knee replacement Department of Orthopaedic SurgeryNew York-Presbyterian Hospital at Columbia University Medical Center New York NY 10032 United States

AIM: To track the short-term neck narrowing changes in Birmingham metal-on-metal hip resurfacing(MOMHR) patients. METHODS: Since 2001, the center for Hip and Knee replacement started a registry to prospectively collect data on hip and knee replacement patients. From June 2006 to October 2008, 139 MOMHR were performed at our center by two participate surgeons using Birmingham MOMHR prosthesis(Smith Nephew, United States). It is standard of care for patients to obtain low, anteriorposterior(LAP) pelvis radiographs immediately after MOMHR procedure and then at 3 mo, 1 year and 2 year follow up office visits. Inclusion criteria for the present study included patients who came back for follow up office visit at above mentioned time points and got LAP radiographs. Exclusion criteria include patients who missed more than two follow up time points and those with poor-quality X-rays. Two orthopaedic residency trained research fellows reviewed the X-rays independently at 4 time points, i.e., immediate after surgery, 3 mo, 1 year and 2 year. Neck-to-prosthesis ratio(NPR) was used as main outcome measure. Twenty cases were used as subjects to identify the reliability between two observers. An intraclass correlation coefficient at 0.8 was considered as satisfied. A paired t-test was used to evaluate the significant difference between different time points with P < 0.05 considered to be statistically ***: The mean NPRs were 0.852 ± 0.056, 0.839 ± 0.052, 0.835 ± 0.051, 0.83 ± 0.04 immediately, 3 mo, 1 year and 2 years post-operatively respectively. At 3 mo, NPR was significantly different from immediate postoperative X-ray(P < 0.001). There was no difference between 3 mo and 1 year(P = 0.14) and 2 years(P = 0.53). Femoral neck narrowing(FNN) exceeding 10% of the diameter of the neck was observed in only 4 patients(5.6%) at two years follow up. None of these patients developed a femoral neck fracture(FNF). CONCLUSION: Femoral neck narrowing after MOMHR occurred as e

关键词： Hip joint Arthroplasty Complications Hip resurfacing Femoral neck narrowing

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