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BACKGROUND: Venous thromboembolism (VTE) following revision total joint arthroplasty (TJA) poses significant risks despite prophylactic measures. The optimal VTE prophylaxis agent for revision TJA remains unclear. This study aimed to compare aspirin against various anticoagulant agents regarding efficacy and safety in preventing symptomatic VTE events after revision TJA. METHODS: A retrospective analysis included 4,575 patients undergoing revision TJA between 2008 and 2020. Of these, 2,091 received aspirin, while 2,484 received other anticoagulants. Demographic, procedural, and outcome data were collected. Logistic regression models were used to identify predictors of symptomatic VTE. RESULTS: The aspirin group showed a significantly lower incidence of symptomatic VTE compared to the other anticoagulant group (0.53 versus 2.54%, P < .001). Logistic regression confirmed a higher risk of VTE with other anticoagulants (odds ratio: 0.2 to 0.26, P < .001), while blood transfusion (odds ratio: 2.72, P = .001) were identified as risk factors. CONCLUSIONS: This study demonstrated that aspirin is a viable and potentially safer option than other anticoagulants, exhibiting comparable efficacy in preventing VTE events in revision TJA. Balancing effectiveness and safety is crucial, considering patient-specific risk factors and bleeding tendencies. This large cohort study demonstrated that aspirin was associated with a more effective and safer VTE prophylaxis agent, compared to other anticoagulants, in patients undergoing revision TJA.
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BACKGROUND: The medial patellofemoral ligament (MPFL), along with the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament, aid in the stabilization of the patellofemoral joint. Although the MPFL is the primary stabilizer and the MPTL is a secondary limiter, this ligament is critical in maintaining joint stability. There have been few studies on the combined MPFL and MPTL reconstruction and its benefits. AIM: To look into the outcomes of combined MPFL and MPTL reconstruction in frequent patellar instability. METHODS: By May 8, 2022, four electronic databases were searched: Medline (PubMed), Scopus, Web of Science, and Google Scholar. General keywords such as "patellar instability," "patellar dislocation," "MPFL," "medial patellofemoral ligament," "MPTL," and "medial patellotibial ligament" were co-searched to increase the sensitivity of the search. RESULTS: The pooled effects of combined MPFL and MPTL reconstruction for Kujala score (12-mo follow-up) and Kujala score (24-mo follow-up) were positive and incremental, according to the findings of this meta-analysis. The mean difference between the Cincinnati scores was also positive, but not statistically significant. The combination of the two surgeries reduces pain. According to cumulative meta-analysis, the trend of pain reduction in various studies is declining over time. CONCLUSION: The combined MPFL and MPTL reconstruction has good clinical results in knee function and, in addition to providing good control to maintain patellofemoral joint balance, the patient's pain level decreases over time, making it a valid surgical method for patella stabilization.
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Periprosthetic joint infection (PJI) is a rare yet devastating complication following total joint arthroplasty (TJA). Early and accurate diagnosis of PJI is paramount in order to maximize the chances of successful treatment. However, we are yet to identify a single "gold standard" test for the diagnosis of PJI. As a result, the diagnosis of PJI is often challenging. Currently, the 2018 ICM definition of PJI is the only validated diagnostic criteria available. This article will review the importance of serum and synovial biomarkers in the diagnosis of PJI. In addition, it will provide a brief overview of the emerging modalities for the identification of infections in this setting.