Arthroplasty关节置换术
Arthroplasty(英文缩写 ARTHROPLASTY),ISSN 2524-7948,eISSN 2524-7948,中文译名:关节置换术 是一本学术期刊。本页汇总该期刊的最新影响因子、分区信息以及最新收录于 PubMed 的文献,帮助您快速了解期刊全貌。
发文量统计区间：2025-10-01 至 2026-09-30，按本站收录文献的发表日期统计。
期刊介绍
Arthroplasty 最新收录文献
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1. Unicompartmental knee arthroplasty after failed high tibial osteotomy in appropriately selected patients: a systematic review and meta-analysis.
PMID:日期:2026-10-05High tibial osteotomy (HTO) is an established treatment for medial knee osteoarthritis in younger, more active patients than typical arthroplasty candidates, but some may require conversion over time. Total knee arthroplasty (TKA) has traditionally been the preferred procedure after failed HTO. With advances in implant design and surgical techniques, the role of medial unicompartmental knee arthroplasty (UKA) in this setting warrants re-evaluation. This systematic review and meta-analysis aims to summarize and descriptively compare the outcomes of UKA and TKA following HTO. A systematic review and meta-analysis was conducted on MEDLINE, Embase, Scopus, and Web of Science until 14th August 2025 (date last searched). Randomized and observational studies (cohort, case-control, and case series) reporting outcomes of UKA or TKA following HTO were included, while case reports, technical notes, reviews, and studies without sufficient data were excluded. Forty-one studies (6 UKA-only, 33 TKA-only, and 2 comparative studies contributing to both groups) met inclusion criteria. Due to the limited number of comparative studies, comparisons between procedures are indirect/descriptive and should not be interpreted as evidence of relative treatment performance. After HTO, UKA demonstrated pooled revision and reoperation rates of 10.2% (95% CI = 4.5-21.6%, I = 61.6%) (in 226 knees) and 14.4% (95% CI = 9.1-21.9%, I = 37.0%) (in 226 knees), respectively, with PJI rates of 0-3.3% (in 71 knees). Mean improvement in the Knee Society Score (KSS) ranged from 34.09 to 38.80 points. For TKA, the pooled revision, reoperation, and PJI rates were 5.0% (95% CI = 3.5-7.2%, I = 79.5%) (in 6208 knees), 11.1% (95% CI = 7.3-16.3%, I = 92.8%) (in 6236 knees), and 2.9% (95% CI = 2.0-4.0%, I = 33.5%) (in 2107 knees), with a KSS improvement range of 25.0 to 57.0 points. Direct comparative studies found no significant differences in survivorship or function. In an exploratory analysis of studies published after 2020, the revision rate for UKA and TKA was 6.3% and 3.9%, respectively. The most common cause of UKA revision was lateral progression of osteoarthritis. The meta-analysis showed a pooled infection rate of 2.9% (in 2107 knees) following TKA. This study suggests that UKA after HTO should not be considered an absolute contraindication and may have a role in a carefully selected subset of patients with isolated medial osteoarthritis, sufficient MCL, and acceptable residual alignment. However, these findings should be interpreted cautiously, as the current evidence base consists predominantly of retrospective observational studies. Accordingly, the present findings should be viewed as hypothesis-generating rather than as evidence establishing equivalence or comparative effectiveness between UKA and TKA after failed HTO. Prospective comparative studies are needed to better define its effectiveness relative to TKA, refine patient selection algorithms, and clarify the influence of residual deformity on outcomes. Level III, systematic review and meta-analysis.
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2. Outcomes after total first metatarsophalangeal joint arthroplasty for hallux rigidus: a systematic review and meta-analysis.
PMID:日期:2026-10-02The role of first metatarsophalangeal (MTP) joint arthroplasty in hallux rigidus remains controversial. Although used as a motion-preserving alternative to arthrodesis, outcomes vary between studies and implant designs. This systematic review and meta-analysis evaluated clinical outcomes, range of motion (ROM), and implant survivorship following total first MTP arthroplasty. A systematic review identified studies reporting pre- and postoperative outcomes following total first MTP arthroplasty for hallux rigidus. Pooled outcomes were the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI) score, visual analogue scale (VAS) pain score, and ROM. One postoperative timepoint per study was selected using a prespecified rule, prioritising the timepoint closest to 24 months, or follow-up between 12 and 36 months where discrete timepoints were not reported. Random-effects pre-post meta-analysis used an assumed pre-post correlation of 0.5. Heterogeneity, prediction intervals, leave-one-out analysis, and sensitivity analyses were performed. Twelve studies were included in the AOFAS-HMI meta-analysis, seven in the VAS meta-analysis, and thirteen in the ROM meta-analysis. Arthroplasty was associated with a pooled improvement in AOFAS-HMI of 42.76 points (95% CI 38.44-47.09; p < 0.001), a pooled reduction in VAS pain of 5.24 points (95% CI 3.82-6.67; p < 0.0001), and a pooled improvement in ROM of 27.02° (95% CI 17.19-36.86; p < 0.001). Heterogeneity was high. Prediction intervals remained wholly positive for AOFAS-HMI and VAS, but crossed zero for ROM, indicating less consistent motion gain. Secondary complication outcomes were reported as crude observational frequencies across studies with variable follow-up durations. Radiographic failure occurred in 14.5% of reported feet and revision in 10.0%; these figures are not annualised incidence rates or formal meta-analytic survivorship estimates. Longer follow-up cohorts suggested reduced implant durability over time. Total first MTP arthroplasty is associated with improvement in pain and function, but these benefits should be interpreted alongside appreciable revision and radiographic failure rates. ROM improves on average, although restoration of motion remains inconsistent and non-physiological. Current evidence therefore supports total arthroplasty as an option in select patients rather than a uniformly reliable alternative to arthrodesis and highlights the need for further implant development and longer-term evaluation of newer designs.
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3. Anatomic versus reverse total shoulder replacement with an intact rotator cuff: a comparative musculoskeletal simulation study of glenohumeral joint biomechanics.
PMID:日期:2026-10-01Reverse total shoulder replacement (rTSR) is increasingly being conducted, including in selected elderly patients with intact-cuff osteoarthritis, due to concerns about subsequent cuff failure or glenoid component loosening after anatomic total shoulder replacement (aTSR). However, the biomechanical differences between rTSR and aTSR remain insufficiently understood. This computational study aimed to compare the biomechanics of aTSR and rTSR with an intact rotator cuff under identical conditions, representing selected intact-cuff osteoarthritis cases in which either implant design may be considered. A validated musculoskeletal multibody simulation framework of the upper extremity was used to compare the glenohumeral (GH) biomechanics during arm elevation in the scapular plane. The GH joint was modeled in detail with six degrees of freedom and explicit contact between the articulating implant components. This enabled the evaluation of muscle forces, deltoid-to-cuff force ratio, GH joint contact forces, shear-to-compression joint force balance, contact area, contact pressure, center of pressure, and GH translations. Compared with aTSR, rTSR reduced the mean middle deltoid muscle force by 16% and decreased overall rotator cuff force requirements, while increasing deltoid-to-cuff dominance throughout most of the motion. Furthermore, rTSR showed 26.5% and 33.4% lower compressive and resultant GH contact forces, but earlier and 98.7% higher peak superior shear force and a higher shear-to-compression joint force ratio. Contact pressure was 3.5 times lower in rTSR, whereas the contact area was nearly three times larger. Center-of-pressure trajectories differed substantially between designs, in both magnitude and direction. GH translations were more constrained in rTSR, with negligible posterior-anterior displacements and smaller overall translations. Under an intact-cuff condition, aTSR and rTSR produced altered mechanical strategies for arm elevation. rTSR was characterized by more deltoid-dominant loading, lower joint compression, altered shear force patterns, and more constrained joint translations. This study provides a biomechanical insight for interpreting clinically relevant differences between the two mechanically distinct TSR designs. These findings may help surgeons better understand design-specific trade-offs in joint loading, shear-to-compression joint force balance, and muscle function, and may support clinical decision-making, particularly in intact-cuff conditions.
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4. Clinical outcomes and perioperative safety of primary total knee arthroplasty for hemophilic arthropathy versus osteoarthritis: a retrospective cohort study.
PMID:日期:2026-09-18Hemophilic arthropathy (HAr) frequently progresses to end-stage joint disease requiring total knee arthroplasty (TKA), but coagulation dysfunction raises concerns about perioperative bleeding and complications. We aim to analyze the clinical outcomes and safety associated with primary TKA in patients with HAr. This single-center retrospective cohort included 22 TKAs in 20 men with HAr and 66 TKAs in 66 male osteoarthritis (OA) controls selected by surgeon and proximity of surgery date. The procedure was the analysis unit, and standard errors were clustered by patient. Continuous outcomes were compared with Welch tests and adjusted using baseline-outcome analysis of covariance including group, age, and body mass index. Sparse binary outcomes were exploratory and analyzed with Fisher exact tests and Firth logistic regression. Calculated blood loss was evaluated using the Nadler-Gross method. Patients with HAr were younger (41.86 ± 11.29 versus 68.33 ± 6.70 years). Mean improvement in the Knee Society clinical score was 49.64 ± 18.43 versus 53.24 ± 5.77 points (unadjusted between-group change-score difference, - 3.61; 95% CI - 11.88 to 4.67; p = 0.376). Adjusted 12-month group effects were 0.54 points (95% CI - 4.19 to 5.28; p = 0.820) for Knee Society clinical score and 3.02 points (95% CI - 9.73 to 15.77; p = 0.639) for Knee Society function while adjusted flexion remained lower (mean difference, - 19.64°; 95% CI - 38.29° to - 0.99°; p = 0.039). Calculated blood loss did not differ significantly (532.53 ± 355.18 versus 628.00 ± 328.38 mL; p = 0.275), while transfusion occurred in 4/22 versus 0/66 procedures (p = 0.003). Wound problems (6/22 versus 3/66) and 90-day readmissions (9/22 versus 1/66) were more frequent in crude comparisons, but adjusted estimates were highly imprecise. Under comprehensive blood management, TKA produced substantial within-group functional improvement in HAr. Adjusted 12-month Knee Society clinical and function scores were not detectably different, although flexion remained lower. Calculated blood loss was not increased, but transfusion and unadjusted wound or readmission signals warrant multidisciplinary care and confirmation in larger, prospectively defined cohorts.
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5. Advancing preoperative planning technology in total joint arthroplasty with a real-time machine learning calculator: 1-year mortality risk in a value-based care era.
PMID:日期:2026-09-09Technological innovation in total joint arthroplasty (TJA) has largely focused on intraoperative precision through robotics, navigation, and implant design, while preoperative decision-making remains comparatively underdeveloped. Accurate estimation of patient-specific risk is central to surgical indications, yet existing tools provide limited resolution for consequential outcomes such as 1-year mortality. A machine learning model was developed using the TriNetX Research Network. Patients undergoing total knee (TKA) or hip (THA) arthroplasty with verifiable 1-year follow-up were included in the analysis. An XGBoost model incorporating 43 preoperative variables was trained using nested cross-validation with isotonic calibration. Model performance was assessed using discrimination, calibration, and decision curve analysis, and the results were used to derive thresholds for a web calculator based on machine-learning-derived inputs. Feature contributions were assessed using SHapley Additive exPlanations (SHAP). The observed 1-year mortality rate was 0.574% (n = 1,344). On internal validation, the model demonstrated an Area Under the Receiver Operating Characteristic (AUROC) of 0.761 (fold-level range: 0.744-0.787, standard deviation [SD]: 0.016), a Brier score of 0.006, and an average precision of 0.037. Calibration remained stable across risk deciles, with mean absolute error below 0.15% for D1-D9 and modest overprediction confined to D10 (+ 0.16%). Mortality increased monotonically across stratified risk groups: the highest quintile had a 1.488% mortality rate (2.6-fold above baseline), the highest decile had 2.50% (4.4-fold), and the top 5% had 3.57% (6.2-fold). Feature importance analysis identified age as the dominant predictor (mean |SHAP| = 0.407), followed by male sex (0.218), serum creatinine (0.162), hemoglobin (0.153), and BMI (0.145). Threshold-based risk stratification yielded two clinically relevant operating points: a sensitivity-anchored threshold of 0.235% captured 90.1% of all deaths, while a Youden-optimal threshold of 0.767% achieved 83.9% specificity. One-year mortality following primary THA and TKA can be estimated with discriminative accuracy using routinely available preoperative variables, with predictive importance attributable primarily to age and markers of physiologic reserve. Supported by these findings and future external validations, machine learning-derived mortality models are amenable to prospective clinical deployment via web-based interfaces, enabling individualized preoperative risk quantification at the point of care.
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6. DVIA technique for acute periprosthetic joint infection: a surgical technique and case series.
PMID:日期:2026-09-08Periprosthetic joint infection (PJI) remains a major challenge in orthopaedic surgery. While debridement, antibiotics, and implant retention (DAIR) are a common treatment for acute PJI, its success rate is variable. Intra-articular antibiotic administration and wound healing techniques may enhance infection control and improve clinical outcomes. This study aimed to describe a modified technique combining DAIR with vacuum sealing drainage (VSD) and intra-articular antibiotic infusion (DVIA) for treating acute PJI, and evaluate its clinical feasibility and preliminary outcomes. This retrospective, single-center case series included 31 patients who underwent DVIA (hip: 19; knee: 12) between September 2019 and December 2023. Following DAIR, a technique integrating vacuum-sealed drainage for wound management with intra-articular antibiotic infusion was applied. Inflammatory markers (CRP, ESR) and intra-articular antibiotic concentrations were monitored at multiple time points. Treatment outcomes, CRP and ESR levels, Knee Society Score (KSS), KSS functional score, Harris Hip Score (HHS), and the 36-item Short-Form (SF-36) physical function scale were evaluated over a 12-month follow-up. Infection control was achieved in 90.32% (28/31) of patients. CRP and ESR levels decreased after treatment. Joint function and patient-reported physical function improved during follow-up. Intra-articular vancomycin concentrations measured in a subset of patients exceeded previously reported minimum biofilm eradication concentration (MBEC) thresholds. No catheter-related complications, retrograde infections, or systemic antibiotic-related adverse events were observed. The DVIA technique appears to be a feasible adjunctive strategy for the management of acute PJI, enabling effective local antibiotic delivery and favorable clinical outcomes. These findings are preliminary and warrant further validation in prospective controlled studies.
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7. Quadriceps muscle status after medial-pivot versus ultracongruent total knee arthroplasty using localized bioimpedance analysis: a randomized exploratory study.
PMID:日期:2026-09-07Implant design in total knee arthroplasty (TKA) may influence postoperative biomechanics and muscle recovery. Ultracongruent (UC) and medial pivot (MP) designs aim to enhance anteroposterior stability and reproduce physiological knee kinematics, yet comparative data remain scarce, and muscle recovery has rarely been directly evaluated. Localized bioelectrical impedance analysis (L-BIA) provides an objective method to assess skeletal muscle status, but its application to compare muscle recovery between different TKA implant designs has not been previously investigated. A prospective, randomized, patient-blinded study was conducted between 2022 and 2024, including 40 patients undergoing primary TKA for advanced knee osteoarthritis. Patients were randomly assigned to receive either a medial-pivot (MP) or an ultracongruent (UC) prosthesis. The final analysis included 30 patients (15 per group). The primary outcome was postoperative quadriceps muscle recovery between implant groups, assessed longitudinally by reactance (Xc) of the rectus femoris, vastus medialis, and vastus lateralis using localized bioelectrical impedance analysis (L-BIA). Assessments were performed preoperatively and at 6 and 12 months postoperatively. Secondary outcomes included resistance (R), WOMAC, Knee Society Score, range of motion, and radiographic parameters. Temporal changes and between-group differences were analysed using repeated-measures and covariance-based statistical models. Demographic and preoperative characteristics were comparable between groups. Resistance values remained stable across all time points with no differences between implant designs. Reactance showed a transient decrease at 6 months followed by recovery at 12 months in both groups, with no significant differences between groups. ANCOVA demonstrated that baseline reactance was associated with 12-month reactance values (all p < 0.001), whereas implant design had no significant effect. The clinical relevance of this finding remains uncertain. Radiographic parameters, postoperative range of motion, and clinical outcomes improved significantly after surgery in both groups without significant differences between MP and UC designs. No significant differences in quadriceps recovery were observed between MP and UC implants during the first postoperative year. Baseline muscle status was associated with postoperative L-BIA outcomes, whereas no significant differences were observed between implant designs.
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8. Calprotectin identified as a key differentially expressed plasma biomarker in periprosthetic joint infection against aseptic failure: a precision health proteomics study.
PMID:日期:2026-09-04Periprosthetic joint infection (PJI) is a debilitating and dangerous complication following joint arthroplasty procedures. With the increasing incidence of arthroplasty procedures, the burden of PJI is expected to continually grow. A correct and early diagnosis of PJI proves difficult, with the lack of a single standardized molecular test. The utilization of serology-based biomarkers would provide a non-invasive sampling method; however, these methods have not proven sufficient to satisfy the diagnostic criteria. The present study aimed to employ liquid chromatography/mass spectrometry-based (LC-MS) techniques to explore the proteomic profile of plasma samples derived from a prospective Danish PJI cohort, PRIS, to identify relevant proteins that are significantly differentially expressed in acute PJI compared to those with aseptic failure or chronic pain related to the prosthesis. Serum from patients included in the LC-MS analysis was measured for a biomarker of neutrophil activity, CPa9-HNE, measuring a neo-epitope of neutrophil elastase-cleaved calprotectin. A total of 656 plasma proteins were quantified by the discovery proteomic approach, and differential abundance analysis showed increased abundance of calprotectin heterodimers, S100A8, and S100A9 in acute PJI samples compared to both aseptic failure and chronic pain. Functional enrichment of the significantly regulated proteins in acute PJI, compared to aseptic failure and chronic pain, showed an upregulation of acute immune-related pathways. Serum levels of a biomarker of neutrophil activity, an elastase-derived calprotectin neo-epitope, CPa9-HNE, showed statistically significant differences between infection and both aseptic failure and chronic pain in the same cohort, supporting the findings in LC-MS analysis. Plasma LC-MS proteomics and targeted measurement of CPa9-HNE neutrophil activity biomarker in matched serum samples of patients with PJI, aseptic failure, and chronic pain show significant upregulation of calprotectin heterodimers, S100A8 and S100A9, as well as CPa9-HNE in patients with PJI.
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9. A novel classification system for anterior femoral notching in total knee arthroplasty.
PMID:日期:2026-09-03Femoral notching in Total Knee Arthroplasty (TKA) is traditionally associated with an increased risk of periprosthetic fracture in cases of excessive anterior resection. Beyond fracture risk, notching can influence implant fit, patellofemoral and tibiofemoral balance, joint stability, and overall biomechanics. Despite its clinical importance, a standardized system for describing femoral notching is lacking. We propose a novel Femoral Notch Classification, based on resection depths and trochlear geometry, intended as a common language applicable both intraoperatively and on lateral radiographs, independent of alignment philosophy. The classification was developed through clinical observation and biomechanical rationale, focusing on preserving anterior cortical integrity while permitting a controlled notch when required. Definitions relate resection depths to implant thickness, distal femoral anatomy, and trochlear geometry, with attention to balancing anterior and posterior gaps. Perpendicularity of the anterior cut relative to the cortex can be evaluated and adapted according to implant design and alignment technique. Four descriptive categories were established, providing a structured framework for assessment. (1) Type 0-No Notch: Complete preservation of the anterior cortex with no visible step-off or indentation. Anterior resection may match implant thickness precisely; if not, anterior overstuffing or posterior over-resection should be controlled. (2) Type 1-On the Line: Anterior resection is flush with the femoral cortex, creating a subtle notch that remains biomechanically stable without compromising the cortex. (3) Type 2-Controlled Notch: A deeper anterior resection (ideally, < 3 mm) beyond the cortical line in the presence of specific trochlear geometry or distal femoral anatomy. This configuration is acceptable when the radiographic pattern is consistent with trochlear accommodation. Posterior gaps must still be carefully controlled to avoid overstuffing. (4) Type 3-Critical Notch: Excessive anterior resection (> 3 mm) characterized by significant cortical interruption and the absence of a radiographically identifiable anatomical correlate. This configuration may compromise distal femoral strength and is associated with increased risk of periprosthetic fracture when not justified by trochlear geometry. Surgeons should exercise caution and verify proper implant alignment. Inter-observer reliability was substantial (Fleiss' κ = 0.80; quadratic weighted κ = 0.87) and intra-observer reliability was almost perfect (mean Cohen's κ = 0.91). The majority of cases were classified as Type 0 and Type 1. The Femoral Notch Classification provides a practical, reproducible framework for assessing femoral notching in TKA, suitable for intraoperative guidance and radiographic analysis. It may help surgeons avoid over- or under-resection while allowing a controlled notch when required. Further clinical validation is needed to assess its impact on long-term patient outcomes.
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10. Custom-made acetabular implants for severe acetabular bone defects: implant evolution, mid-term clinical and radiographic outcomes, and complications in 154 consecutive patients over 18 years.
PMID:日期:2026-09-02Custom-made acetabular components (CMAC) represent an important treatment option for complex acetabular defects where standard implants are not sufficient. Over the years, substantial advances in implant design and materials have improved stability, function, and longevity of implants. However, evidence on implant survivorship and design evolution in custom-made acetabular reconstruction remains limited. In this retrospective single-center study, 154 consecutive patients treated with a CMAC between October 2007 and June 2025 were analysed. All reconstructions were performed for severe acetabular defects classified as Paprosky type 3A (n = 85) or 3B (n = 69), corresponding to the Acetabular Defect Classification (ADC) type 3C (n = 85) and ADC type 4 (n = 69) with pelvic discontinuity (4A n = 14, 4B n = 28, 4C n = 27). Demographic data, implant design characteristics, and surgical technique were recorded. Clinical outcomes were assessed using the Oxford Hip Score (OHS), all complications were recorded, and radiographic evaluation was performed. The mean follow-up was 34.82 months (± 26.2 range, 6.2-168 months). Paired preoperative and postoperative OHS improved from 21.69 ± 5.59 to 30.93 ± 5.26, corresponding to a mean improvement of 9.23 points (p < 0.0001). Kaplan-Meier estimated survivorship at 3 and 5 years was 0.85 (SE = 0.04) and 0.78 (SE = 0.05) for explantation and 0.64 (SE = 0.04) and 0.58 (SE = 0.05) for reoperation for any reason. Postoperative periprosthetic infection (11.0%) and dislocation (10.4%) were the most frequent complications. In an exploratory multivariable Cox model, flange design was the only covariate associated with explantation (HR 17.70, 95% CI 4.78-65.52; p < 0.001). This 18-year single-centre experience with 154 CMAC demonstrates the mid-term clinical reliability of an individualized approach to complex acetabular reconstruction. Postoperative periprosthetic infection (11.0%) and dislocation (10.4%) remained relevant complications. The design transition from multiflange to monoflange constructs represents the principal evolution of this experience and warrants dedicated comparative evaluation.