Short-to Mid-Term Survivorship of a Patient-specific Unicompartmental Knee Arthroplasty Implant Cast from a Three-Dimensional Printed Mold.

The purpose of this study was to determine early survivorship and complication rates associated with the implantation of a new patient-specific unicompartmental knee implant cast from a three-dimensional (3D) printed mold, introduced in 2012. We retrospectively reviewed 92 consecutive patients who underwent unicompartmental knee arthroplasty (UKA) with a patient-specific implant cast from a 3D printed mold between September 2012 and October 2015. The early results of a patient-specific UKA implant were favorable in our cohort, with survivorship free from reoperation of 97% at an average 4.5 years follow-up. Future studies are necessary to investigate the long-term performance of this implant. Survivorship of a patient-specific unicompartmental knee arthroplasty implant cast from a 3D printed mold.

A Multicenter Prospective Investigation on Patient Physical and Mental Health After Girdlestone Resection Arthroplasty.

BACKGROUND: Girdlestone resection arthroplasty is a salvage procedure for hip periprosthetic joint infection (PJI) that controls infection and reduces chronic pain, but may result in limited postoperative joint function. The aim of this study was to assess physical function and mental health after Girdlestone. METHODS: This was a multicenter, prospective study evaluating patients with Girdlestone. The Prosthesis Evaluation Questionnaire (PEQ) and patient-reported outcomes measurement information system (PROMIS) global physical health and mental health surveys were administered postoperatively via telephone. The PEQ consists of four scales (ie, ambulation, frustration, perceived response, and social burden) with scores ranging from 0 to 10. The PROMIS measures generated T-scores (mean: 50, standard deviation: 10) that enable comparison to the general population. RESULTS: Thirty-five patients completed all surveys. The average time from procedure to survey completion was 6 years (range, 1 to 20). The median scores for the ambulation, frustration, perceived response, and social burden scales of the PEQ were 0.0 [interquartile range: 0-4.1], 6.0 [3.0-9.3], 9.0 [7.2-10.0], and 7.5 [4.3-9.5]. The median raw scores of the PROMIS global physical health and mental health were 11.91 [interquartile range: 9-14] and 14.0 [10.0-16.0]. These corresponded to average T scores of 39.7 (standard error : 4.3) for physical health and 46.1 (standard error: 3.8) for mental health, which were 10.3 points and 3.9 points below the average score in the United States general population, respectively. CONCLUSION: Girdlestone can have a substantial negative impact on physical functions; however, mental health and social interaction may be only moderately affected. These outcomes can be used to guide patient expectations, as this procedure may be necessary in certain salvage scenarios.

Similar 20-year survivorship for single and bilateral total knee arthroplasty.

BACKGROUND: Long-term follow-up after total knee arthroplasty (TKA) is crucial to providing survivorship updates on available TKA implants to guide patient expectations when undergoing TKA. The purpose of this study was to compare implant survivorship between patients undergoing primary single, simultaneous bilateral, and staged bilateral TKA with 15-year minimum follow-up. METHODS: This retrospective study included 826 patients (n = 1089) who underwent primary single (n = 454), simultaneous bilateral (n = 266), or staged bilateral (n = 369) TKA using a single TKA system by a single surgeon from 1991-2005 with 15-year minimum follow-up. Demographics, clinical variables, and surgical outcomes were collected and compared using Student's t-test, chi-squared tests, or Kaplan-Meier analyses. Reoperation was defined as all surgeries performed on the knee after the index procedure; revision TKA was defined as complete implant exchange. p < 0.05 significant. RESULTS: Patients in the staged TKA cohort were younger (65.4 years = staged, 67.8 = simultaneous, 67.1 = single, p < 0.019). Women were less likely to receive simultaneous TKAs (22 %vs.29%, p < 0.001). Postoperative range of motion was similar (116.8° = simultaneous, 114.9° = staged, 114.8° = single, p = 0.11). Overall 15-year implant survival based on revision TKA was similar (97.7% = simultaneous, 97.2% = staged, 96.7% = single, p = 0.45). The estimated 15-year reoperation rate was 7.0% (95% CI, 5.5-8.7%). Reoperations were secondary to infection (35.5%), implant wear (26.3%), arthrofibrosis (18.4%), traumatic injuries (10.5%), pain (6.6%), pathologic lesion (1.3%), and avascular necrosis (1.3%). CONCLUSION: This study demonstrated a high implant survival rate of 95-97% at 20-years after primary single, staged bilateral and simultaneous bilateral TKA. Furthermore, simultaneous bilateral TKAs exhibited similar range of motion, implant survival, and rates of reoperation to staged bilateral and single TKA.

Comparing the Efficacy of Articulating Spacer Constructs for Knee Periprosthetic Joint Infection Eradication: All-Cement vs Real-Component Spacers.

BACKGROUND: The most common treatment for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a 2-stage revision. Few studies have compared different articulating spacer constructs. This study compares the outcomes of real-component and all-cement articulating spacers for TKA PJI treatment. METHODS: This retrospective observational study examined the arthroplasty database at 3 academic hospitals for articulating spacers placed for TKA PJIs between April 2011 and August 2020. Patients were categorized as receiving a real-component or an all-cement articulating spacer. Data on demographics, surgical information, and outcomes were collected. RESULTS: One-hundred sixty-four spacers were identified: 72 all-cement and 92 real-component spacers. Patients who received real-component spacers were older (67 ± 10 vs 63 ± 12 years; P = .04) and more likely to be former smokers (50.0% vs 28.6%; P = .02). Real-component spacers had greater range of motion (ROM) after Stage 1 (84° ± 28° vs 58° ± 28°; P < .01) and shorter hospital stays after Stage 1 (5.8 ± 4.3 vs 8.4 ± 6.8 days; P < .01). There was no difference in time to reimplantation, change in ROM from pre-Stage 1 to most recent follow-up, or reinfection. Real-component spacers had shorter hospital stays (3.3 ± 1.7 vs 5.4 ± 4.9 days; P < .01) and operative times during Stage 2 (162.2 ± 47.5 vs 188.0 ± 66.0 minutes; P = .01). CONCLUSION: Real-component spacers had improved ROM after Stage 1 and lower blood loss, shorter operative time, and shorter hospital stays after Stage 2 compared to all-cement articulating spacers. The 2 spacer constructs had the same ultimate change in ROM and no difference in reinfection rates, indicating that both articulating spacer types may be safe and effective options for 2-stage revision TKA. LEVEL OF EVIDENCE: III, retrospective observational analysis.

Weight loss before total joint arthroplasty using a remote dietitian and mobile app: study protocol for a multicenter randomized, controlled trial.

BACKGROUND: The months prior to elective surgery may present an opportunity for patients to initiate behavior changes that will simultaneously ready them for surgery and improve their overall health status. An upcoming elective total joint arthroplasty (TJA) may serve as motivation for patients with severe obesity (body mass index [BMI]> 40 kg/m2) to lose weight, as it may optimize clinical outcomes following TJA and help them become eligible for TJA since some surgeons use a BMI of 40 kg/m2 as a cut-off for offering surgery in an effort to optimize outcomes. METHODS: The purpose of this multicenter randomized, controlled trial is to assess the feasibility and efficacy of a 12-week remote dietitian (RD) supervised dietary and physical activity weight loss intervention and mobile app for 60 patients with severe obesity prior to undergoing TJA. Intervention participants will receive access to a smartphone app and connect with an RD who will contact these participants weekly or bi-weekly via video calls for up to nine video calls. Together, participants and RDs will set goals for lifestyle modifications, and RDs will check on progress towards achieving these goals using in-app tools such as food logs and text messages between video calls. All patients will be encouraged to lose at least 20 pounds with a goal BMI < 40 kg/m2 after 12 weeks. Individuals randomized to the control group will receive clinical standard of care, such as nutritionist and/or physical therapy referrals. Outcome and demographic data will be collected from blood serology, chart review, mobile app user data, pre- and postintervention surveys, and phone interviews. The primary outcome measure will be weight change from baseline. Secondary outcome measures will include percentage of patients eligible to undergo TJA, number of sessions completed with dietitians, self-reported global health status (PROMIS Global Health scale), self-reported joint-specific pain and function (Knee injury and Osteoarthritis Outcome Score (KOOS) or Hip disability and Osteoarthritis Outcome Score (HOOS)), and serologies such as hemoglobin A1c, total lymphocyte count, albumin, and transferrin. Qualitative responses transcribed from phone interviews about the intervention will also be analyzed. DISCUSSION: This will be the first study to assess pre-operative weight loss in patients with severe obesity anticipating orthopaedic surgery using an RD and mobile app intervention aimed at helping patients become eligible for TJA. TRIAL REGISTRATION: Registered on 1 April 2020 at Clincialtrials.gov. Trial number is NCT04330391 .

Reducing the risk of infection after total joint arthroplasty: preoperative optimization.

Total joint arthroplasty (TJA) is one of the most commonly performed procedures in orthopedic surgery, and as the demand for TJA increases over time, the number of concurrent complications such as surgical infection will also increase. There are multiple risk factors that independently increase the risk of surgical site infection (SSI) and periprosthetic joint infection (PJI) after surgery. These modifiable risk factors can be identified in preoperative clinic screening visits that gives physicians the opportunity to provide specific intervention that can decrease patient infection risk. The risk factors that are known to significantly increase the risk of PJI and/or SSI include MSSA/MRSA colonization, rheumatoid arthritis, cardiovascular and renal disease, obesity, diabetes mellitus, hyperglycemia, anemia, malnutrition, tobacco use, alcohol consumption, depression, and anxiety. Patients who present with one or more of these risk factors require intervention with a multidisciplinary approach including patient education, counseling, and follow-up. Preoperative patient optimization for high risk TJA patients can significantly decrease PJI and SSI risk while improving surgical outcomes and patient care.