Robotic-assisted total knee arthroplasty is associated with the use of thinner polyethylene liners compared to navigation-guided and manual techniques.

PURPOSE: The purpose of this study was to examine the effects of intraoperative technology use on the rate of using polyethylene liners 15 mm or greater during primary total knee arthroplasty (TKA). METHODS: There were 103,295 implants from 16,386 primary unilateral TKAs performed on 14,253 patients at a single institution between 1 January 2018, and 30 June 2022, included in the current study. Robotic assistance and navigation guidance were used in 1274 (8%) and 8345 (51%) procedures, respectively. The remaining 6767 TKAs (41%) were performed manually. Polyethylene liners were manually identified and further subcategorised by implant thickness. Patients who underwent robotic-assisted TKA were younger (p < 0.001) and more likely to be male (p < 0.001) compared to patients who underwent navigation-guided or manual TKAs. RESULTS: Average polyethylene liner thickness was similar between groups (10.5 ± 1.5 mm for robotic-assisted TKAs, 10.9 ± 1.8 mm for navigation-guided TKAs and 10.8 ± 1.8 mm for manual TKAs). The proportions of polyethylene liners 15 mm or greater used were 4.9%, 3.8% and 1.9% for navigation-guided, manual and robotic-assisted procedures, respectively (p < 0.001). Multivariate regression analyses demonstrated that navigation-guided (odds ratio [OR]: 2.6, 95% confidence Interval [CI]: [1.75-4.07], p < 0.001) and manual (OR: 2.0, 95% CI: [1.34-3.20], p = 0.001) procedures were associated with an increased use of polyethylene liners 15 mm or greater. CONCLUSION: Robotic-assisted TKA was associated with a lower proportion of polyethylene liners 15 mm or greater used compared to navigation-guided and manual TKA. These findings suggest that robotic assistance can reduce human error via a more precise cutting system, limit over-resection of the tibia and flexion-extension gap mismatch and ultimately allow for more appropriately sized implants. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Total knee arthroplasty survivorship and outcomes in young patients: a review of the literature and 40-year update to a longitudinal study.

INTRODUCTION: Growing numbers of younger patients are electing to undergo total knee arthroplasty (TKA) for end-stage osteoarthritis. The purpose of this study was to compare established literature regarding TKA outcomes in patients under age 55, to data from an ongoing longitudinal young patient cohort curated by our study group. Further, we aimed to provide a novel update on survivorship at 40 years post-TKA from our longitudinal cohort. METHODS: A literature search was conducted using the electronic databases PubMed, Embase, and Cochrane Library, using terms related to TKA, patients under age 55, and osteoarthritis. Demographic and outcome data were extracted from all studies that met the inclusion criteria. Data were divided into the "longitudinal study (LS) group," and the "literature review (LR) group" based on the patient population of the study from which it came. RESULTS: After screening, 10 studies met the inclusion criteria; 6 studies comprised the LR group, and 4 studies comprised the LS group. 2613 TKAs were performed among the LR group, and 114 TKAs were longitudinally followed in the LS group. The mean patient ages of the LR and LS groups were 46.1 and 51, respectively. Mean follow-up was 10.1 years for the LR group. Mean postoperative range of motion was 113.6° and 114.5° for the LR and LS groups, respectively. All-cause survivorship reported at 10 years or less ranged from 90.6% to 99.0%. The LS cohort studies reported survivorship ranges of 70.1-70.6% and 52.1-65.3% at 30 and 40 years, respectively. CONCLUSIONS: Young TKA patients demonstrated improved functionality at each follow-up time point assessed. Survivorship decreased with increasing lengths of follow-up, ultimately ranging from 52.1-65.3% at 40 years post-TKA. The paucity of literature on long-term TKA outcomes in this patient population reinforces the necessity of further research on this topic.

An Artificial Intelligence Chatbot is an Accurate and Useful Online Patient Resource Prior to Total Knee Arthroplasty.

BACKGROUND: Online information is a useful resource for patients seeking advice on their orthopaedic care. While traditional websites provide responses to specific frequently asked questions (FAQs), sophisticated artificial intelligence tools may be able to provide the same information to patients in a more accessible manner. Chat Generative Pretrained Transformer (ChatGPT) is a powerful artificial intelligence chatbot that has been shown to effectively draw on its large reserves of information in a conversational context with a user. The purpose of this study was to assess the accuracy and reliability of ChatGPT-generated responses to FAQs regarding total knee arthroplasty. METHODS: We distributed a survey that challenged arthroplasty surgeons to identify which of the 2 responses to FAQs on our institution's website was human-written and which was generated by ChatGPT. All questions were total knee arthroplasty-related. The second portion of the survey investigated the potential to further leverage ChatGPT to assist with translation and accessibility as a means to better meet the needs of our diverse patient population. RESULTS: Surgeons correctly identified the ChatGPT-generated responses 4 out of 10 times on average (range: 0 to 7). No consensus was reached on any of the responses to the FAQs. Additionally, over 90% of our surgeons strongly encouraged the use of ChatGPT to more effectively accommodate the diverse patient populations that seek information from our hospital's online resources. CONCLUSIONS: ChatGPT provided accurate, reliable answers to our website's FAQs. Surgeons also agreed that ChatGPT's ability to provide targeted, language-specific responses to FAQs would be of benefit to our diverse patient population.

The Financial Burden of Aspirin versus Oral Factor Xa Inhibitors for Thromboprophylaxis Following Total Knee Arthroplasty.

BACKGROUND: Aspirin and oral factor Xa inhibitor thromboprophylaxis regimens are associated with similarly low rates of venous thromboembolism following total knee arthroplasty (TKA). However, the rate of prosthetic joint infection (PJI) is lower with aspirin use. This study aimed to compare the cost differential between aspirin and factor Xa inhibitor thromboprophylaxis with respect to PJI management. METHODS: We used previously published rates of PJI following aspirin and factor Xa inhibitor thromboprophylaxis in primary TKA patients at a single, large institution. Prices for individual drugs were obtained from our hospital's pharmacy service. The cost of PJI included that of 2-stage septic revision, with or without the cost of 1-year follow-up. National data were obtained to determine annual projected TKA volume. RESULTS: The per-patient costs associated with a 28-day course of aspirin versus factor Xa inhibitor thromboprophylaxis were $17.36 and $3,784.20, respectively. Including cost of follow-up, per-patient costs for a 28-day course of aspirin versus factor Xa inhibitors increased to $73,358.76 and $77,125.60, respectively. The weighted average per-patient costs for a 28-day course were $237.38 and $4,370.93, respectively. The annual cost difference could amount to over $14.1 billion in the United States by 2040. CONCLUSIONS: The per-patient cost associated with factor Xa inhibitor thromboprophylaxis is as much as 1,980.6% higher than that of an aspirin regimen due to increased costs of primary treatment, differential PJI rates, and high costs of management. In an era of value-based care, the use of aspirin is associated with major cost advantages.

Changes in Body Composition and Athletic Performance in National Collegiate Athletic Association Division I Female Field Hockey Athletes Throughout a Competitive Season.

ABSTRACT: Summer, LC, Cheng, R, Moran, JT, Lee, M, Belanger, AJ, TaylorIV, WL, and Gardner, EC. Changes in body composition and athletic performance in National Collegiate Athletic Association Division I female field hockey athletes throughout a competitive season. J Strength Cond Res 38(1): 146-152, 2024-The purposes of this study were (a) to analyze the changes in total and regional body composition measurements in a National Collegiate Athletic Association (NCAA) Division I female field hockey team throughout a 17-game competitive season using dual X-ray absorptiometry (DXA); (b) to examine improvements, if any, in athletic performance measures after a season; and (c) to report on the relationship between these body composition changes and changes in athletic performance. Preseason and postseason dual-energy DXA and performance data from the 2019-2020 season were retrospectively identified for 20 field players (forwards, midfielders, and defenders). Body composition data included total and regional fat mass, lean mass, and body fat percentage, whereas athletic performance measures included the vertical jump, 10-yard dash, and pro-agility (5-10-5) shuttle run. All variables were quantitative and analyzed using paired t -tests or its nonparametric equivalent and an alpha level of p < 0.05 was used to determine significance. After a competitive season, athletes had significant decreases in fat mass and increases in lean mass in their arms, legs, trunks, gynoids, and total body measurements. Android fat mass and body fat percentage also decreased. Athletes performed significantly better on the pro-agility shuttle run at the end of the season, but no significant differences were observed in other performance metrics. Moderate correlations were observed between changes in body composition (total fat mass and total lean mass) and changes in athletic performance. Our study provides a novel, longitudinal assessment of body composition and athletic performance for elite female field hockey athletes that will help trainers and coaches better understand how these variables change throughout a season and allow them to better prepare their players for competitive success.

JUN promotes hypertrophic skin scarring via CD36 in preclinical in vitro and in vivo models.

Pathologic skin scarring presents a vast economic and medical burden. Unfortunately, the molecular mechanisms underlying scar formation remain to be elucidated. We used a hypertrophic scarring (HTS) mouse model in which Jun is overexpressed globally or specifically in α-smooth muscle or collagen type I­expressing cells to cause excessive extracellular matrix deposition by skin fibroblasts in the skin after wounding. Jun overexpression triggered dermal fibrosis by modulating distinct fibroblast subpopulations within the wound, enhancing reticular fibroblast numbers, and decreasing lipofibroblasts. Analysis of human scars further revealed that JUN is highly expressed across the wide spectrum of scars, including HTS and keloids. CRISPR-Cas9­mediated JUN deletion in human HTS fibroblasts combined with epigenomic and transcriptomic analysis of both human and mouse HTS fibroblasts revealed that JUN initiates fibrosis by regulating CD36. Blocking CD36 with salvianolic acid B or CD36 knockout model counteracted JUN-mediated fibrosis efficacy in both human fibroblasts and mouse wounds. In summary, JUN is a critical regulator of pathological skin scarring, and targeting its downstream effector CD36 may represent a therapeutic strategy against scarring.

Prophylactic treatment with transdermal deferoxamine mitigates radiation-induced skin fibrosis.

Radiation therapy can result in pathological fibrosis of healthy soft tissue. The iron chelator deferoxamine (DFO) has been shown to improve skin vascularization when injected into radiated tissue prior to fat grafting. Here, we evaluated whether topical DFO administration using a transdermal drug delivery system prior to and immediately following irradiation (IR) can mitigate the chronic effects of radiation damage to the skin. CD-1 nude immunodeficient mice were split into four experimental groups: (1) IR alone (IR only), (2) DFO treatment for two weeks after recovery from IR (DFO post-IR), (3) DFO prophylaxis with treatment through and post-IR (DFO ppx), or (4) no irradiation or DFO (No IR). Immediately following IR, reactive oxygen species and apoptotic markers were significantly decreased and laser doppler analysis revealed significantly improved skin perfusion in mice receiving prophylactic DFO. Six weeks following IR, mice in the DFO post-IR and DFO ppx groups had improved skin perfusion and increased vascularization. DFO-treated groups also had evidence of reduced dermal thickness and collagen fiber network organization akin to non-irradiated skin. Thus, transdermal delivery of DFO improves tissue perfusion and mitigates chronic radiation-induced skin fibrosis, highlighting a potential role for DFO in the treatment of oncological patients.