The Use of Technology to Achieve the Functional Acetabular Safe Zone in Total Hip Arthroplasty.

¼: Functional acetabular safe zones based on patient-specific factors during total hip arthroplasty are theorized to result in more optimal component stability than the use of traditional safe zones based on static targets. ¼: Preoperative planning that takes into account functional pelvic positions and spinopelvic mobility is increasingly recommended. ¼: Computer navigation and robotics can be utilized to help accurately achieve the targeted cup position within the functional safe zone. ¼: Each technology platform (imageless and image-based computer navigation and robotics) utilizes a specific referencing method for the pelvis, which influences anteversion and inclination values. ¼: The purpose of this article is to summarize how these different systems reconcile differences in pelvic referencing to ensure that the surgeon achieves the targeted functional cup position.

Spinopelvic Hypermobility Corrects After Staged Bilateral Total Hip Arthroplasty.

Background: Spinopelvic hypermobility may be secondary to a stiff osteoarthritic hip with a compliant spine. Purpose: We sought to determine if spinopelvic hypermobility resolves after total hip arthroplasty (THA) and when it resolves in patients with bilateral hip osteoarthritis (OA) undergoing staged bilateral THA. We also sought to analyze the change in spinopelvic parameters before and after the second THA. Methods: We conducted a retrospective review of 2047 THAs that were performed by 2 fellowship-trained arthroplasty surgeons from 2014 to 2018. Patients with preoperative spinopelvic hypermobility undergoing staged bilateral THA were identified. Radiographic spinopelvic parameters, including sacral slope (SS), pelvic incidence (PI), lumbar lordosis (LL), PI-LL mismatch, anterior pelvic plane tilt (APPt), and spinopelvic tilt (SPT), were measured on preoperative, 6-week postoperative, and 1-year postoperative lateral standing and sitting radiographs. Bilateral hip OA was graded using Kellgren-Lawrence criteria. Results: We identified 42 patients with preoperative spinopelvic hypermobility who underwent staged bilateral THA. Mean time (standard deviation) between surgeries was 9.4 months (±10.0). After the first THA, spinopelvic hypermobility resolved in 29% of the patients. After the second THA, it resolved in 67% at 6 weeks, increasing to 98% at 1 year postoperatively. Conclusion: Spinopelvic hypermobility resolves after staged bilateral THA in 98% of the patients, occurring most often only after the second THA. Less than one-third of the patients had resolution after the first THA, suggesting that contralateral hip OA continues to drive hip-driven spinopelvic motion. Acetabular component position targets based on functional pelvic position should incorporate these changes in spinopelvic motion with the understanding that resolution of hypermobility usually occurs after the second THA.

Assessing Pelvic Tilt in Patients Undergoing Total Hip Arthroplasty Using Sensor Technology.

BACKGROUND: The purpose of our study was to assess the accuracy of a commercially available wearable sensor in replicating pelvic tilt movement in both the sitting and standing position in patients before total hip arthroplasty. METHODS: This prospective study evaluated patients undergoing a primary unilateral total hip arthroplasty by a single surgeon. Patients were excluded if they had a body mass index (BMI) greater than 40 kg/m2. Two sensors were adhered directly to patients' skin at S2 and T12. The S2 angle was recorded on the sensor at maximum flexion and extension angles and compared with pelvic tilt measurements on both sitting and standing radiographs. The primary outcomes recorded were patients' pelvic tilts measured using radiographs (PT-RAD) and sensors (PT-SEN), with Pearson correlation coefficients and intraclass correlation coefficients (ICCs) calculated. RESULTS: Sixty-one patients (35 males and 26 females) with an average age of 61.5 ± 8.5 years and BMI of 26.9 ± 4.1 kg/m2 were analyzed. The mean prestanding PT-RAD and PT-SEN were 1.5 ± 8.3 and 1.0 ± 8.1, respectively, with an ICC of 0.98 (95% confidence interval, 0.96-0.99). The mean presitting PT-RAD and PT-SEN were -21.9 ± 12.5 and -20.9 ± 11.7, respectively, with an ICC of 0.97 (95% confidence interval, 0.95-0.98). The multiple R2 was 0.95 for the prestanding and presitting comparisons. The R2 for all comparisons between PT-RAD and PT-SEN was >0.85, regardless of BMI or sex. CONCLUSIONS: Although the use of wearable technology may have limitations, based on our results, a wearable sensor is accurate in replicating pelvic tilt movement.

Total knee arthroplasty in dialysis patients: Is it safe? A systematic review of the literature.

PURPOSE: This systematic review characterizes the safety and efficacy of total knee arthroplasty (TKA) in end stage renal disease (ESRD) patients due to the unique challenges they face. RESULTS: The cumulative complication rate for 3684 patients on dialysis for ESRD after primary TKA was 25%(N = 925/3702), with incidence rates of 2.5%(N = 92/3702) for periprosthetic joint infection, 3.7%(N = 71/1895) for reoperations, and 2.5%(N = 90/3578) for mortality. CONCLUSION: Patients on dialysis for ESRD face significant mortality rates after primary TKA, in addition to other major complications. Careful counseling regarding risks and benefits should be provided prior to TKA in this population.

Relatively Low Rate of Heterotopic Ossification Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-analysis.

BACKGROUND: Heterotopic ossification (HO) is abnormal growth of ectopic bone and negatively affects the outcomes after total knee arthroplasty (TKA). This systematic review and meta-analysis were performed to characterize the prevalence and severity of HO after primary TKA. METHODS: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Patient demographics, publication year, and HO prevalence after a primary TKA were recorded. A meta-analysis was performed to determine the overall prevalence of HO formation, and a subanalysis compared the studies published in different timeframes to determine whether a temporal effect exists for HO prevalence. RESULTS: Two thousand nine hundred eighty-eight patients underwent primary TKA across the included studies. Fourteen percent of patients (9% to 20%; I2: 93.68%) developed HO postoperatively during a mean follow-up of 40.1 months (11 to 108 months). HO rates seemed to decrease in studies published in more recent years, with a pooled HO prevalence of 5% (0% to 13%; I2: 92.26%) among studies published in the past 15 years compared with 18% (12% to 25%; I2: 92.49%) among studies published before then. CONCLUSION: Although studies reported a relatively low overall rate of HO after a primary TKA, the absence of a single, standardized classification system precludes the comparisons of HO severity between studies. Overall, HO prevalence seems to have decreased over time, likely reflecting the changes in perioperative medication protocols.

An Overview of Telehealth in Total Joint Arthroplasty.

With the increase in technological advances over the years, telehealth services in orthopedic surgery have gained in popularity, yet adoption among surgeons has been slow. With the onset of the COVID-19 pandemic, however, orthopedic surgery practices nationwide have accelerated adaptation to telemedicine. Telehealth can be effectively applied to total joint arthroplasty, with the ability to perform preoperative consultations, postoperative follow-up, and telerehabilitation in a virtual, remote manner with similar outcomes to in-person visits. New technologies that have emerged, such as virtual goniometers, wearable sensors, and app-based patient questionnaires, have improved clinicians' ability to conduct telehealth visits. Benefits of using telehealth include high patient satisfaction, cost-savings, increased access to care, and more efficiency. Notably, some challenges still exist, including widespread accessibility and adaptation of new technologies, inability to conduct an in-person orthopedic physical examination, and regulatory barriers, such as insurance reimbursement, increased medicolegal risk, and privacy and confidentiality concerns. Despite these hurdles, telehealth is here to stay and can be successfully incorporated in any total joint arthroplasty practice with the appropriate adjustments.

Preoperative spinopelvic hypermobility resolves following total hip arthroplasty.

AIMS: Spinopelvic mobility plays an important role in functional acetabular component position following total hip arthroplasty (THA). The primary aim of this study was to determine if spinopelvic hypermobility persists or resolves following THA. Our second aim was to identify patient demographic or radiological factors associated with hypermobility and resolution of hypermobility after THA. METHODS: This study investigated patients with preoperative posterior hypermobility, defined as a change in sacral slope (SS) from standing to sitting (ΔSSstand-sit) ≥ 30°. Radiological spinopelvic parameters, including SS, pelvic incidence (PI), lumbar lordosis (LL), PI-LL mismatch, anterior pelvic plane tilt (APPt), and spinopelvic tilt (SPT), were measured on preoperative imaging, and at six weeks and a minimum of one year postoperatively. The severity of bilateral hip osteoarthritis (OA) was graded using Kellgren-Lawrence criteria. RESULTS: A total of 136 patients were identified as having preoperative spinopelvic hypermobility. At one year after THA, 95% (129/136) of patients were no longer categorized as hypermobile on standing and sitting radiographs (ΔSSstand-sit < 30°). Mean ΔSSstand-sit decreased from 36.4° (SD 5.1°) at baseline to 21.4° (SD 6.6°) at one year (p < 0.001). Mean SSseated increased from baseline (11.4° (SD 8.8°)) to one year after THA by 11.5° (SD 7.4°) (p < 0.001), which correlates to an 8.5° (SD 5.5°) mean decrease in seated functional cup anteversion. Contralateral hip OA was the only radiological predictor of hypermobility persisting at one year after surgery. The overall reoperation rate was 1.5%. CONCLUSION: Spinopelvic hypermobility was found to resolve in the majority (95%) of patients one year after THA. The increase in SSseated was clinically significant, suggesting that current target recommendations for the hypermobile patient (decreased anteversion and inclination) should be revisited. Cite this article: Bone Joint J 2021;103-B(12):1766-1773.

Outcomes and Patient Safety in Overlapping vs. Nonoverlapping Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.

INTRODUCTION: Overlapping surgery is defined as two cases occurring in separate operating rooms (ORs), where the same attending surgeon conducts the critical surgical portions of each case at different times. Although it has been suggested that this established practice may improve the utilization of resources, allow for more opportunities to teach surgical trainees, and facilitate timely access to care, there is still no consensus on its use in elective orthopaedic surgery, such as total joint arthroplasty (TJA). METHODS: A systematic review and meta-analysis of the literature was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify articles investigating the use of overlapping and single operating room TJA. Relevant data, including surgical time, intraoperative complications, postoperative complications, mortality rate, revision rate, and readmission rate, were extracted and recorded. RESULTS: Six articles were included (35,938 patients: 17,677 overlapping and 18,261 nonoverlapping). Overall revision rates were 1.2% and 1.1% for the overlapping and nonoverlapping cohorts, respectively (odds ratio [OR] = 1.19; 95% confidence interval [CI]: 0.93 to 1.53). The overall intraoperative complication rate was 1.6% for both cohorts (OR = 0.98; 95% CI: 0.79 to 1.23), and the overall postoperative orthopaedic complication rates were 2.0% and 1.95% within the overlapping and nonoverlapping OR cohorts, respectively (OR = 1.07; 95% CI: 0.89 to 1.29). The readmission rate was 4.6% in the overlapping group and 4.2% in the nonoverlapping group (OR = 0.88; 95% CI: 0.70 to 1.11). Two studies with comparable groups reported markedly increased surgical time in the overlapping group compared with the nonoverlapping group. DISCUSSION: Overlapping surgery was found to be as safe as nonoverlapping surgery in patients undergoing TJA. Although overlapping TJA surgery is associated with satisfactory short-term revision rates, prolonged follow-up is required to further assess the medium-term and long-term outcomes of overlapping surgery compared with nonoverlapping surgery. Finally, although overlapping TJA surgery might be associated with increased OR time, this difference is not clinically relevant.