BACKGROUND AND PURPOSE:Few clinical studies have assessed migration of trapeziometacarpal implants, and long-term outcomes are warranted. We aimed to evaluate 10-year migration, clinical outcomes, and revisions of cementless and cemented Motec cups. Additionally, early migration of revised and non-revised cups, and the association between clinical outcomes and cup revision were investigated. METHODS:Radiostereometric analysis (RSA) was performed after cast removal (baseline = 3 weeks), at 3 months, 1, 2, 5, and 10 years. Clinical outcomes and revisions were evaluated prospectively. RESULTS:22 cementless Motec titanium-screw cups were inserted from 2009 to 2010, followed by 47 cemented Motec all-polyethylene cups inserted with Palacos bone cement from 2011 to 2012. At the 10-year follow-up, mean cup total translation (TT) was 0.79 mm (standard error [SE] 0.55) for cementless cups (n = 3) and 1.33 mm (SE 0.30) for cemented cups (n = 10), with cemented cups demonstrating 0.54 mm (CI -0.68 to 1.77) higher translation. 10 of 22 cementless cups and 15 of 47 cemented cups were revised, primarily due to aseptic loosening. There was a difference in TT between revised and non-revised cups of 1.75 mm (CI 0.45-3.05) for cementless cups at 1-year follow-up, and of 1.11 mm (CI 0.30-1.93) for cemented cups at 2-year follow-up. Increased pain in activity and Disabilities of the Arm, Shoulder, and Hand (QDASH) score was associated with revision. At 10 years, patients with retained cups reported high satisfaction and grip strength, pain, and QDASH improvement above the minimal clinically important difference compared with preoperatively. CONCLUSION:10-year cup migration was similar between Motec cup groups. Revised cups migrated more than non-revised cups in both groups, and pain in activity and QDASH score were associated with revision. As such, decline in clinical outcomes, as well as progression in cup TT, seem to be useful predictors of cup revision.
Background and purpose: We aimed to clarify whether preoperative flexion contracture (FC) and limited knee flexion in patients with anteromedial osteoarthritis (OA) were associated with postoperative outcomes in mobile-bearing medial unicompartmental knee arthroplasty (UKA). Methods: We retrospectively evaluated all patients who underwent mobile-bearing medial UKA. Preoperative extension and flexion angles, and the Oxford Knee Score (OKS) and Forgotten Joint Score-12 (FJS) recorded preoperatively and at 3, 12, and 24 months, were assessed. Patients were categorized by preoperative extension (no FC, < 10°, ≥ 10°) and flexion angles (< 120°, ≥ 120°). Changes in OKS and FJS were compared using general linear models with adjustment for age, sex, body mass index, and preoperative scores. Results: 1,199 patients were included. Preoperatively, 85% of patients had full extension, 12% had < 10° FC, and 3.1% had ≥ 10° FC. Regarding flexion, 40% had < 120°, while 60% had ≥ 120°. At 12 months, the < 10° FC group showed greater improvements than the ≥ 10° FC group in OKS (adjusted mean difference, 5.5 points; 95% confidence interval [CI] 0.9–10.2; P = 0.01) and FJS (17.0 points; CI 1.0–33.0; P = 0.03). The < 120° flexion group showed greater FJS improvement than the ≥ 120° flexion group (adjusted mean difference, 4.8 points; CI 0.1–9.6; P = 0.045). At 24 months, the CIs for all between-group differences included no difference. Conclusion: Mild preoperative FC and mild-to-moderately limited knee flexion were not associated with inferior outcomes. Patients with more pronounced FC showed slower recovery but still achieved the same increase in patient-reported outcome measures (PROMs) as those with mild FC.
BACKGROUND AND PURPOSE:Ankle fractures are common, and open reduction and internal fixation (ORIF) is standard treatment for unstable injuries. Surgical site infections (SSI) remain a significant clinical challenge. We aimed to estimate incidence and to identify patient- and treatment-related factors associated with SSI after ankle ORIF. METHODS:In this retrospective cohort, we included all adults (≥ 18 years) who underwent ankle ORIF at 2 trauma centers in northern Sweden from 2015 to 2024. Data from medical records covered demographics, comorbidities, injury characteristics, surgical details, and peri/postoperative care. The primary outcome was incidence of SSI and the secondary outcome was independent factors associated with SSI. SSI was defined as an infection occurring at or near the surgical incision within 30 days after surgery or up to 1 year later in the presence of an implant. RESULTS:We included 781 patients (mean age 54 years; 61% women). SSI occurred in 11%; 27% of infections underwent revision surgery, and 39 infections (43%) were categorized as fracture-related infection (FRI). Other complications included urinary tract infections (2.2%), pneumonia (0.8%), deep vein thrombosis (0.5%), and pulmonary embolism (0.4%). In adjusted analyses, higher odds of SSI were observed with smoking (aOR 2.3, 95% confidence interval [CI] 1.1-4.8, P = 0.02), initial external fixation (aOR 5.6, CI 1.7-17.6, P = 0.004), and longer operative time (OR per minute 1.0, CI 1.0-1.0, P = 0.004). The American Society of Anesthesiologists (ASA) class estimate suggested increased risk but was imprecise (aOR 9.7, CI 1.0-93.6, P = 0.049). Age, sex, and open fracture were not associated with SSI in the adjusted model. CONCLUSION:After ankle ORIF, SSI occurred in 11%. Smoking, initial external fixation, and longer operative time were associated with higher risk of infection, while ASA estimate was imprecise. These findings support perioperative risk mitigation (e.g., smoking cessation and operative efficiency) and motivate study of physiological risk (ASA).
BACKGROUND AND PURPOSE:Robotic-assisted total knee arthroplasty (rTKA) has been proposed to improve component positioning but evidence on its effect on implant survival is limited. We aimed to compare implant survival between rTKA and conventional total knee arthroplasty (cTKA) overall and due to peri-prosthetic joint infection (PJI). METHODS:We included all rTKAs performed in Finland from April 2021 until May 2023, all implanted with Triathlon TKA using MAKO robotic-arm assist. Propensity score matching was used to form a control group with similar characteristics for the same time period. Primary survival endpoint was first revision due to any cause within 12 months after the index surgery. PJI and non-PJI revisions were considered secondary outcomes. Kaplan-Meier (KM) analysis and Cox proportional hazards regression were used to assess implant survival and between-group contrasts hazard ratios (HR) with 95% confidence intervals (CIs), respectively. RESULTS:1,318 fixed bearing rTKAs were compared with a control group of 1,318 cTKAs. Revision-free survival at 12 months after index surgery did not differ between groups. KM estimates were 99.1% (CI 98.5-99.7) for rTKA and 98.6% (CI 98.0-99.3) for cTKA with HR 0.61 (CI 0.28-1.34). The rTKA group demonstrated better PJI-free survival at 12 months (HR 0.29, CI 0.10-0.90). Overall, PJI was the most common reason for revision. At the end of available follow-up, the estimated overall survival was 97.7% (CI 94.9-100.0) for rTKA and 97.9% (CI 96.6-99.2) for cTKA. CONCLUSION:No difference in all-cause revision risk was observed between rTKA and cTKA groups. However, within the first 12 months, fewer revisions due to PJI occurred in the rTKA group.
