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Total Joint Arthroplasty: Management and Future Opportunities
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Total Joint Arthroplasty: Management and Future Opportunities

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 20 January 2025 | Viewed by 9018

Special Issue Editors

Dr. Riccardo Giorgino

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Guest Editor
1. Residency Program in Orthopaedics and Traumatology, University of Milan, 20141 Milan, Italy
2. IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
Interests: orthopedics; traumatology; osteoarthritis; regenerative medicine; basic science; osteoporosis; artificial intelligence
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Laura Mangiavini

E-Mail Website
Guest Editor
1. Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
2. IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, Italy
Interests: knee arthroplasty; knee osteoarthritis; sarcopenia; bone and cartilage development; tissue engineering strategies for musculoskeletal tissues
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue represents a deep dive into the field of Total Joint Arthroplasty, offering a detailed exploration of complex management strategies and opening new perspectives for the future. This collection covers a wide range of topics, from the analysis of hip and knee replacements to the latest innovations, such as robot-assisted surgery. These articles shed a clear light on the ongoing evolution in the joint arthroplasty landscape, revealing challenges faced in areas like implant materials, infection prevention, and long-term outcomes for patients undergoing these procedures.

We intend to delve into current practices and open new horizons for revolutionary discoveries, hoping to lay the groundwork for possible advancements in the field. Despite the numerous recent strides in this field, many challenges still need to be undertaken. To name a few: customization and adaptation of prosthetics, utilization of innovative and durable materials, advanced motor control, and infection prevention.

In summary, this Special Issue presents an unmissable opportunity to explore the vast and continuously evolving world of Total Joint Arthroplasty. By offering insights into current best practices, anticipating future developments, and addressing emerging challenges, this Special Issue stands as a reference point for anyone involved in the field, making a significant contribution to the advancement of science and patient care.

Dr. Riccardo Giorgino
Prof. Dr. Laura Mangiavini
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • total joint arthroplasty
  • joint replacement
  • surgical techniques
  • robotic-assisted surgery
  • implant materials
  • post-operative care
  • patient outcomes
  • future opportunities
  • orthopedic surgery
  • innovation in arthroplasty

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Published Papers (8 papers)

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Research

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9 pages, 1655 KiB  
Article
Quantified Deltoid Muscle Stiffness Can Predict Improved Muscle Strength for Elevation Following Reverse Shoulder Arthroplasty
by Taku Hatta and Ryosuke Mashiko
J. Clin. Med. 2024, 13(20), 6038; https://doi.org/10.3390/jcm13206038 - 10 Oct 2024
Viewed by 531
Abstract
Objective: Although the indications for reverse shoulder arthroplasty (RSA) are expanding, an improvement in muscle strength in each patient following RSA remains unclear. The objective was to investigate whether or not improvement in muscle strength for shoulder elevation in patients who underwent [...] Read more.
Objective: Although the indications for reverse shoulder arthroplasty (RSA) are expanding, an improvement in muscle strength in each patient following RSA remains unclear. The objective was to investigate whether or not improvement in muscle strength for shoulder elevation in patients who underwent RSA was influenced by pre- or postoperative deltoid muscle stiffness measured using shear wave elastography (SWE). Methods: Sixty-five patients who underwent RSA over a 12-month follow-up period were included. Patient characteristics and clinical and radiologic measurements were recorded. Preoperatively and at 3, 6, 9, and 12 months after surgery, deltoid muscle stiffness and muscle strength for scapular-plane abduction were sequentially measured using SWE and a portable dynamometer. In each quarterly period (3–6, 6–9, and 9–12 months), patients were assessed for an improvement in muscle strength and separated into two groups: improved and non-improved. To assess the risk of lack of improvement in each quarterly period, the variables were compared between the groups. Results: Improvement in muscle strength was observed in 52 patients (80%) at 3–6 months, 46 patients (71%) at 6–9 months, and 39 patients (60%) at 9–12 months. Notably, SWE measurements at the beginning of each period showed significantly greater values in the non-improved group than in the improved group during the subsequent quarterly period. A receiver operating characteristic (ROC) curve analysis suggested that SWE values >45.1–50.0 kPa might be associated with a lack of muscle strength improvement over 3 months with 73–87% specificity and 73–85% sensitivity. Conclusions: Our study demonstrated that increased deltoid muscle stiffness negatively correlated with an improvement in muscle strength following RSA. According to our results, a postoperative assessment with SWE may be useful for not only improving muscle strength after RSA but also facilitating postoperative improvement by preventing excessive stiffness in the deltoid muscle. Full article
(This article belongs to the Special Issue Total Joint Arthroplasty: Management and Future Opportunities)
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10 pages, 933 KiB  
Article
Etiology, Outcomes, and Complications of Total Hip Arthroplasty in Younger Patients: A Nationwide Big Data Analysis
by David Maman, Linor Fournier, Yaniv Steinfeld and Yaron Berkovich
J. Clin. Med. 2024, 13(15), 4535; https://doi.org/10.3390/jcm13154535 - 2 Aug 2024
Viewed by 1267
Abstract
Background: This study investigates the rising trend of total hip arthroplasty (THA) in patients under 55 years old, commonly referred to as “younger” THA patients. Traditionally a procedure for older adults with osteoarthritis, THA is increasingly performed on younger patients. Methods: Using data [...] Read more.
Background: This study investigates the rising trend of total hip arthroplasty (THA) in patients under 55 years old, commonly referred to as “younger” THA patients. Traditionally a procedure for older adults with osteoarthritis, THA is increasingly performed on younger patients. Methods: Using data from the Nationwide Inpatient Sample (NIS) from 2016 to 2019, we analyze the factors driving this trend, including the causes of hip issues, patient characteristics, and coexisting medical conditions. The study examines in-hospital mortality, length of stay, post-surgical complications, and hospitalization costs for 231,630 THA patients aged 18–54.9, identified using ICD-10 codes. Results: Statistical analysis revealed that younger patients (aged 18–34.9) had higher rates of chronic anemia, inflammatory bowel disease, sickle cell disorders, connective tissue disorders, and coagulation defects compared to patients aged 35–44.9 and 45–54.9. They also experienced the longest hospital stays (2.08 days) and highest costs ($70,540). Significant odds ratios were found for sickle cell disorders (36.078), coagulation defects (1.566), inflammatory bowel disease (2.582), connective tissue disorders (11.727), hip dislocation (3.447), and blood transfusion (1.488) in younger patients compared to other THA patients. Conclusions: Comprehensive analysis of these unique needs is crucial for optimizing care, tailoring treatment, managing co-existing conditions, and personalizing recovery strategies to improve outcomes and quality of life for younger THA patients. Full article
(This article belongs to the Special Issue Total Joint Arthroplasty: Management and Future Opportunities)
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14 pages, 12498 KiB  
Article
The Efficacy of Antibiotic-Loaded Calcium Sulfate Beads (Stimulan) in Patients with Hip Arthroplasty Infections
by Florentin Dimofte, Cristina Dimofte, Sorin Ungurianu, Cristina Serban, George Țocu, Nicoleta Cârneciu, Iulia Filip, Laura Bezman, Bogdan Mihnea Ciuntu, Irina Mihaela Abdulan, Raul Mihailov, Radu Dan Necula, Florin Lucian Sabou and Dorel Firescu
J. Clin. Med. 2024, 13(14), 4004; https://doi.org/10.3390/jcm13144004 - 9 Jul 2024
Cited by 1 | Viewed by 1426
Abstract
Background: Given the increasing rate of infections following hip arthroplasty, one of the current options is the application of a biocomposite at the site of the infection. One of the products used is Stimulan, a completely resorbable calcium sulfate, designed to treat acute [...] Read more.
Background: Given the increasing rate of infections following hip arthroplasty, one of the current options is the application of a biocomposite at the site of the infection. One of the products used is Stimulan, a completely resorbable calcium sulfate, designed to treat acute and chronic infections. This biocomposite has a controlled purity, is easy to mix with liquid, powder, and antibiotics, and can be applied directly to the site of infection, or it can be injected. Methods: We analyzed data from 76 patients, who were admitted to the County Clinical Hospital of Emergency “St. Apostol Andrei” in Galati during January 2017–September 2023, with a diagnosis of infection associated with hip arthroplasty. Results: In 69.73% of cases (52 patients), we decided to keep the implant in place. In this subgroup, Stimulan was applied in 26 cases (57.78%). Of these, 100% were cured—compared to the subgroup in which Stimulan was not applied, where this percentage was lower. All patients underwent chemical and mechanical toileting, and for 24 patients (20.27%), it was necessary to ablate the implant with or without the application of Stimulan, then reimplantation of the prosthesis. Conclusions: The patients with Stimulan had a longer average length of hospitalization, almost half of them required intervention in two periods, and a quarter required the implantation of spacers. However, the cure rate was higher, only in three people could we not control the infection, and there was no death. This study confirms the effectiveness of the treatment when using a biocomposite in addition to the classical treatment for both acute and chronic cases. Full article
(This article belongs to the Special Issue Total Joint Arthroplasty: Management and Future Opportunities)
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10 pages, 901 KiB  
Article
Kinematic Alignment Achieves a More Balanced Total Knee Arthroplasty Than Mechanical Alignment among CPAK Type I Patients: A Simulation Study
by Noriaki Arai, Seikai Toyooka, Hironari Masuda, Hirotaka Kawano and Takumi Nakagawa
J. Clin. Med. 2024, 13(12), 3596; https://doi.org/10.3390/jcm13123596 - 19 Jun 2024
Cited by 1 | Viewed by 1034
Abstract
Background: There is no consensus on whether mechanical alignment (MA) or kinematic alignment (KA) should be chosen for total knee arthroplasty (TKA) for coronal plane alignment of the knee (CPAK) Type I with a varus arithmetic HKA (aHKA) and apex distal joint [...] Read more.
Background: There is no consensus on whether mechanical alignment (MA) or kinematic alignment (KA) should be chosen for total knee arthroplasty (TKA) for coronal plane alignment of the knee (CPAK) Type I with a varus arithmetic HKA (aHKA) and apex distal joint line obliquity (JLO). The aim of this study was to investigate whether MA or KA is preferable for soft tissue balancing in TKA for this phenotype. Method: This prospective cohort study included 64 knees with CPAK Type I osteoarthritis that had undergone cruciate-retaining TKA. Using optical tracking software, we simulated implant placement in the Mako system before making the actual bone cut and compared the results between MA and KA. Extension balance (the difference between medial and lateral gaps in extension) and medial balance (the difference in medial gaps in flexion and extension) were examined. These gap differences within 2 mm were defined as good balance. Achievement of overall balance was defined as an attainment of good extension and medial balance. The incidence of balance in each patient was compared with an independent sample ratio test. Results: Compared with the MA group, the KA group achieved better soft tissue balance in extension balance (p < 0.001). A total of 75% of the patients in the KA group achieved overall balance, which was greater than the 38% achieved in the MA group (p < 0.001). Conclusions: In robot-assisted TKA for CPAK Type I osteoarthritis, KA achieved knee balance during extension without soft tissue release in a greater percentage of patients than MA. Full article
(This article belongs to the Special Issue Total Joint Arthroplasty: Management and Future Opportunities)
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10 pages, 764 KiB  
Article
Maintaining the Physiological Lateral Flexion Gap in the Kinematically Aligned TKA Does Not Compromise Clinical Outcomes at One-Year Follow-Up
by Cristina Jimenez-Soto, Joaquín Moya-Angeler, Vicente J. León-Muñoz, Carlo Theus-Steinmann, Bernhardt Christen and Tilman Calliess
J. Clin. Med. 2024, 13(12), 3423; https://doi.org/10.3390/jcm13123423 - 11 Jun 2024
Viewed by 663
Abstract
Background: Instability is a common cause of (total knee arthroplasty) TKA failure, which can be prevented by achieving proper gap balance during surgery. There is no consensus on the ideal gap balance in TKA, and different alignment philosophies result in varying soft-tissue tightness. [...] Read more.
Background: Instability is a common cause of (total knee arthroplasty) TKA failure, which can be prevented by achieving proper gap balance during surgery. There is no consensus on the ideal gap balance in TKA, and different alignment philosophies result in varying soft-tissue tightness. Traditional TKA aims for symmetric compartment balance, while kinematic alignment (KA) restores anatomy and accepts asymmetric flexion gaps. This study evaluated the impact of these philosophies on the flexion gap balance and clinical outcomes. Methods: A retrospective review of 167 patients who received true or restricted KA robotic-assisted TKA with at least one year of follow-up was conducted. The groups were based on intraoperative flexion gap differences: symmetric (0–1 mm) (n = 94) and asymmetric (2–5 mm) (n = 73). Results: Preoperative demographics and postoperative clinical and functional scores were compared. Both groups were similar in demographics and preoperative scores. True KA alignment was more likely to result in an asymmetric flexion gap, while restricted KA produced symmetric gaps. Conclusions: The study found no adverse effects from the physiological asymmetric flexion gap, with clinical and functional outcomes comparable to symmetric gaps. A 5 mm difference between the medial and lateral gap width did not negatively impact the outcomes. True KA more frequently results in a physiological asymmetric flexion gap. Full article
(This article belongs to the Special Issue Total Joint Arthroplasty: Management and Future Opportunities)
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9 pages, 5338 KiB  
Article
Revision of Failed Short Stems in Total Hip Arthroplasty
by Filippo Migliorini, Francesco Coppola, Alessio D’Addona, Marco Rosolani and Federico Della Rocca
J. Clin. Med. 2024, 13(9), 2459; https://doi.org/10.3390/jcm13092459 - 23 Apr 2024
Cited by 1 | Viewed by 956
Abstract
Background: The current literature lacks studies which evaluate the failure of short stems in total hip arthroplasty (THA). Therefore, the present clinical investigation reported our experience with the failure of short stems in THA, evaluating the causes of failure, survivorship, and the [...] Read more.
Background: The current literature lacks studies which evaluate the failure of short stems in total hip arthroplasty (THA). Therefore, the present clinical investigation reported our experience with the failure of short stems in THA, evaluating the causes of failure, survivorship, and the clinical outcomes of revision arthroplasty. Methods: The present study was performed according to the STROBE guidelines. This study was conducted at the Department of Orthopaedic Surgery of the Humanitas Clinical Institute, Milan, Italy, between 2017 and 2022. All patients who underwent revision surgery of a previously implanted THA using a short stem were prospectively included in the present study. Surgeries were performed with patients in lateral position, using a minimally invasive posterolateral approach. The outcomes of interest were to report information on the type and survivorship of implants used for the revision surgery and evaluate the clinical outcomes and the rate of complications. The following patient-reported outcome measures (PROMs) used for the clinical assessment were the Western Ontario McMaster Osteo-Arthritis Index (WOMAC) and related subscales of pain, stiffness, and function, and the visual analogue scale (VAS). Results: Data from 45 patients were retrieved. Of them, 31% (14 of 45 patients) were women. The mean age was 63.7 ± 13.9 years. The mean length of the implant survivorship was 6.2 ± 5.7 years. In total, 58% (26 of 45 patients) underwent revision of all components, 36% (16 of 45 patients) revised only the stem, and 1% (3 of 45 patients) received a two-stage revision. The mean length of the follow-up was 4.4 ± 1.5 years. The cup was revised in 58% (26 of 45) of patients. At 4.4 ± 1.5 years of follow-up, the WOMAC score was 3.5 ± 1.3 and the VAS was 1.2 ± 1.3. In total, 9% (4 of 45) of patients experienced minor complications. One patient used a walking aid because of reduced function. One patient evidenced muscular hypotrophy. Two patients experienced hip dislocations. All two dislocations were managed conservatively with repositioning in the emergency room under fluoroscopy. No patient needed additional revision surgery or experienced further dislocations. Conclusions: Revision surgery is effective and safe when a short stem THA fails. At approximately four years of follow-up, all patients were highly satisfied with their clinical outcomes. Despite the relatively high number (9%), complications were of a minor entity and were successfully managed conservatively. Full article
(This article belongs to the Special Issue Total Joint Arthroplasty: Management and Future Opportunities)
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Review

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13 pages, 5158 KiB  
Review
US-Guided Interventional Procedures for Total Hip Arthroplasty
by Domenico Albano, Roberto Cintioli, Carmelo Messina, Francesca Serpi, Salvatore Gitto, Laura Mascitti, Giacomo Vignati, Pierluigi Glielmo, Paolo Vitali, Luigi Zagra, Žiga Snoj and Luca Maria Sconfienza
J. Clin. Med. 2024, 13(13), 3976; https://doi.org/10.3390/jcm13133976 - 8 Jul 2024
Viewed by 1409
Abstract
In patients with total hip arthroplasty (THA) with recurrent pain, symptoms may be caused by several conditions involving not just the joint, but also the surrounding soft tissues including tendons, muscles, bursae, and peripheral nerves. US and US-guided interventional procedures are important tools [...] Read more.
In patients with total hip arthroplasty (THA) with recurrent pain, symptoms may be caused by several conditions involving not just the joint, but also the surrounding soft tissues including tendons, muscles, bursae, and peripheral nerves. US and US-guided interventional procedures are important tools in the diagnostic work-up of patients with painful THA given that it is possible to reach a prompt diagnosis both directly identifying the pathological changes of periprosthetic structures and indirectly evaluating the response and pain relief to local injection of anesthetics under US monitoring. Then, US guidance can be used for the aspiration of fluid from the joint or periarticular collections, or alternatively to follow the biopsy needle to collect samples for culture analysis in the suspicion of prosthetic joint infection. Furthermore, US-guided percutaneous interventions may be used to treat several conditions with well-established minimally invasive procedures that involve injections of corticosteroid, local anesthetics, and platelet-rich plasma or other autologous products. In this review, we will discuss the clinical and technical applications of US-guided percutaneous interventional procedures in painful THA that can be used in routine daily practice for diagnostic and therapeutic purposes. Full article
(This article belongs to the Special Issue Total Joint Arthroplasty: Management and Future Opportunities)
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Other

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13 pages, 3315 KiB  
Systematic Review
Cutting Periprosthetic Infection Rate: Staphylococcus aureus Decolonization as a Mandatory Procedure in Preoperative Knee and Hip Replacement Care—Insights from a Systematic Review and Meta-Analysis of More Than 50,000 Patients
by Luca Bianco Prevot, Luca Tansini, Accetta Riccardo, Vittorio Bolcato, Livio Pietro Tronconi and Giuseppe Basile
J. Clin. Med. 2024, 13(14), 4197; https://doi.org/10.3390/jcm13144197 - 18 Jul 2024
Cited by 2 | Viewed by 1064
Abstract
Background: No consensus in the literature has been found about the necessity of implementing a decolonization screening protocol for Staphylococcus aureus in patients who undergo prosthesis implantation of the knee (TKA) or of the hip (THA), with the aim of reducing periprosthetic [...] Read more.
Background: No consensus in the literature has been found about the necessity of implementing a decolonization screening protocol for Staphylococcus aureus in patients who undergo prosthesis implantation of the knee (TKA) or of the hip (THA), with the aim of reducing periprosthetic infections (PJIs). Methods: A systematic literature search was conducted using PubMed, Web of Science, and Embase in April 2024. Studies conducted on patients who underwent a TKA or THA and who followed a screening and decolonization protocol from S. aureus were included. The benefits of implementing this protocol were evaluated through the number of infections overall caused by S. aureus and other pathogens. The risk of bias and quality of evidence were assessed using Cochrane guidelines. Results: A total of 922 articles were evaluated, and of these, 12 were included in the study for a total of 56,930 patients. The results of the meta-analysis showed a reduced risk of overall PJI (p = 0.002), PJI caused by S. aureus (p < 0.0001), and PJI caused by MRSA (p < 0.0001) and highlighted no differences between the two groups in the onset of a PJI caused by other bacteria (p = 0.50). Conclusions: This study showed that the screening and decolonization of S. aureus in patients undergoing THA or THA procedures reduced the risk of a PJI. The screening and decolonization protocol for this kind of patient represents an important procedure for the safety of the patient and in social-economic and medico-legal terms. Full article
(This article belongs to the Special Issue Total Joint Arthroplasty: Management and Future Opportunities)
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